10-month-old Delek's liver was failing due to congenital biliary atresia. His family traveled 2900 km from Tibet to Hangzhou, for the liver transplantation that his life depended solely on. Luckily, with successful surgery, Delek could have a new life with a new liver.

Shortly after Delek was born, he presented symptoms of jaundice and was diagnosed with neonatal hyperbilirubinemia. Sunlight treatment was used. However, no matter how much sunlight Delek was exposed to, Delek’s jaundice became even severe, progressing to the yellowing of the whole-body skin and the eyes. His development was also more delayed than the other same age babies.

In December 2023, Delek was thoroughly examined at a hospital near the city of Qamdo, where Delek was finally diagnosed with biliary atresia. Liver transplantation was advised by the doctor. All of these terms were never heard of before for Delek’s family, like a bolt from the blue. The family was in dire straits.  

"Fortunately, I am so blessed. I met a mother online. Her child had a liver transplant at the HPB Department of SAHZU. The surgery was done by Prof. WANG Weilin. The child recovered very well!"

"This mother also invited me to a patient support group. Many parents of children in need of liver transplant are in that group, also SAHZU doctors."

On Jan. 18, Delek’s mother Drolma held Delek in her arms and arrived at Hangzhou, after flying for about 10+ hours with Delek’s mandarin speaking uncle from Qamdo of Tibet, a city 2900 km away from Hangzhou.   

At the same time, SAHZU HPB Surgeon Dr. ZHOU Xiaohu and SHAZU Pediatrician Dr. JIN Yuting have been waiting at the airport in the ambulance for this special family.

"I have never traveled so far away from home before. I know no one in Hangzhou and felt very worried at first. But as soon as I saw SAHZU doctors waiting for us at the arrival gate, I immediately felt at ease and was particularly touched by this kind gesture. Hangzhou cares about us."

Delek was admitted to SAHZU Pediatrics that same night.

After admission, Delek underwent multiple examinations to evaluate the function of his liver, kidney, heart, lung and other major organs. Results shew that he was not in good condition. Congenital biliary atresia and liver failure could take his life at any minute.

Adequate and necessary preparations for liver transplantation were then conducted to maintain a stable internal environment for Delek and to correct his anemia and low protein level. 

On Jan 22, Delek ushered in a turning point in his fate. The liver transplant team, with academic chair of SAHZU HPB Surgery and SAHZU president Prof. WANG Weilin and executive vice chair of SAHZU HPB Surgery Prof. YAN Sheng together to be chief surgeons, began the operation.

13:45 Surgery started.

15:32 The failing liver was removed.

16:30 The new liver was placed. The portal vein, hepatic vein, artery, bile duct, etc. were all meticulously anastomosed one by one.

19:45 The transplant was completed after 6 hours. Intraoperative ultrasound shew that the surgery was perfectly done.

Due to the severity of Delek's liver failure, he underwent a split liver transplant. The left lateral lobe of the donor liver were transplanted to Delek. But Delek’s organs are much smaller and blood vessels thinner because of his age and delayed development. His portal vein is only as thin as chopsticks, hepatic artery as thin as a matchstick, and the liver is already as hard as a dry rock. The surgeons even had to reduce the left lateral lobe of the donor liver in order to fit it in Delek. All these added up to make the surgery super difficult.

Fortunately, the transplant went very well. On Feb 5, Delek met all requirements and was discharged after 16 days of hospitalization.

Recalling the surgery process, Prof. WANG was overwhelmed with emotion: "Liver transplantation involves reconstruction of blood vessels and bile duct. But Delek is just a baby and weighs only 5 kilograms. His vessels and bile ducts are very thin, so the surgery is very difficult. But we have a comprehensive team comprising of HPB surgeons, pediatricians, ICU doctors, anesthesiologists, ultrasound doctors, and nurses. With the team collaboration, the baby survived all difficulties from the transplantation surgery to rejection and infection in post-operative periods, while the team also focused on early rehabilitation for the baby's better recovery."

According to Chair of SAHZU Pediatrics Prof. FENG Jianhua, the whole pediatrics team was very concerned about Delek even before the family came to Hangzhou. They recruited Tibetan language volunteers to assist communication with Delek family and arranged ambulance pick-up in the airport to directly transfer Delek to the hospital. Upon the baby’s arrival, a comprehensive pre-operative evaluation was immediately carried out by the team. After the surgery, the team carefully managed antibiotic medication administration and the level of fluids of the patient. They instructed Delek's mother on how to take care of her child postoperatively. “In addition, because Delek is severely malnourished and only weighs 5kg, we paid close attention to his nutritional status and will continue to provide guidance on his growth and development after discharge." Said Prof. FENG.

After the transplantation, Delek was admitted to the ICU. The department made full preparations for this special pediatric patient. They adjusted the postoperative noninvasive mechanical ventilation machine, and planned for rehabilitation, nutrition, fluid volume management, anti-rejection and anti-infection, etc. “But we were very happy to see that Delek was able to sit up the second day after the surgery and he looks quite good.” Said chair of SAHZU Comprehensive ICU Prof. HUANG Man. “The nurses used toys to comfort the baby, just hoping that he could stay strong and get through the perioperative period smoothly."

The postoperative recovery of liver function depends largely on the condition of anastomosed blood vessels and bile ducts. The SAHZU ultrasound team thus is fully committed to the Delek’s case. Chair of SAHZU Ultrasound Medicine Prof. HUANG Pingtong explained that, before the operation, the team participated in the perioperative evaluation; During the operation, they stood by to provide real-time evaluation of the ducts, such as the extent of clearance, or the status of stenosis and thrombus, etc.; After the operation, ultrasound examination was performed every day to assess the liver, blood vessels, bile ducts, and the abdominal cavity etc.

Prof. YAN Min, chair of SAHZU Anesthesiology, and her team also made individualized plan for Delek, ranging from preoperative preparations to intraoperative monitoring, including types and dosages of medications, fluid management, postoperative recovery, postoperative analgesia and other aspects.

It was a great relief to all the teams involved that with seamless cooperation across the specialties, the surgery was successfully completed and Delek gradually recovered. In next months, Delek will need to be closely followed up for early detection and timely management of post-transplantation complications in order to achieve a favorable long-term prognosis.

We would like also to thank the donor and the family for their great contribution.