Comprehensive Multistage Care Plan and Complex Surgeries Return Critically Ill Patient To Normal Life

To fly from Doha, Qatar, to New York and from New York to Cleveland, Ohio, one must travel 6,951 miles. For Hamza AlDosari, who lives in Doha, and his family, no distance was too far to travel to obtain the lifesaving surgery provided to him by Kareem Abu-Elmagd, MD, PhD, director of the center for gut rehabilitation and transplant at Cleveland Clinic.

For months, Hamza’s health had been deteriorating due to complications from bariatric surgery to combat severe morbid obesity when he was 33. Despite ongoing care and additional surgical intervention in Qatar, then a hospital in New York, things kept getting worse.

Thanks to internet research, Hamza’s brother had found Dr. Abu-Elmagd. “He called me, begging me to help his brother,” says Dr. Abu-Elmagd. “I vividly remember the date. I spoke with the surgeon in New York who was operating on him and provided some advice, but things kept going wrong. His brother called me again, asking me to help because Hamza was dying.”

Once his brother reached out to the Qatar embassy health office in Washington D.C., the process to transfer Hamza from the hospital in New York to Cleveland Clinic began immediately.

When Hamza arrived at Cleveland Clinic, he was severely malnourished, with an open abdomen and secretions leaking into his abdominal cavity. He also had a diverting stoma (a surgically created opening) of the esophagus in his neck to divert all saliva secretions away from his abdominal cavity.

“I’m so fortunate to have been able to come to Cleveland Clinic and receive exceptional care from Dr. Abu-Elmagd and his team. The doctors I had elsewhere told me they had no hope of saving me.”

An initial assessment by Dr. Abu-Elmagd found a leak from Hamza’s distal esophagus with his disruptive biliary duct, and duodenum were freely draining into his abdominal cavity.

“To see if Hamza would qualify for a transplant, I explored his abdomen and found a major problem that had confused other surgeons. Hamza has an abnormal vascular anatomy of his kidneys and the major blood vessels that supply the abdominal organs. Every time the other surgeons went in to try to fix things, they injured some of the vessels and cut off the blood supply and caused more ischemia (reduced blood flow) to his gut,” says Abu-Elmagd.

Dr. Abu-Elmagd developed a three-stage plan to restore Hamza’s gut continuity and save his life.

First, he surgically reconstructed the resident part of Hamza’s gastrointestinal tract to make him eligible for a transplant by clearing the intrabdominal infection and closing the abdomen that was opened. Another aim of the first stage procedure is to minimize the number of organs that would need to be replaced/transplanted. To do that, Dr. Abu-Elmagd did something very innovative. He connected Hamza’s colon to his abdominal esophagus and duodenum, which controlled the leak from the esophagus and biliary system.

“The outcome of that first surgery gave me hope that things could get better,” says Hamza.

One month later, the second stage of treatment began. Developed via collaboration between Dr. Abu-Elmagd and his multidisciplinary colleagues at Cleveland Clinic, surgery was performed to restore the continuity of Hamza’s esophagus.

“With that surgery completed, followed by a few weeks of recovery, I was finally able to have a sip of water,” says Hamza, who at that time had not been able to normally drink (or eat) for nine months. “I never imagined something we do on a daily basis could be such a blessing. I felt like I became a human being again.”

After approval by the transplant committee, Hamza was listed for a modified multivisceral organ transplant that would include stomach, duodenum, pancreas and intestine to replace his lost organs and restore continuity to a normal gastric tract – the third stage of Dr. Abu-Elmagd’s treatment plan. Hamza was able to leave the hospital but needed to remain within 100 miles of Cleveland Clinic. His family members travelled to Cleveland to spend time with him while waiting for the gift of life. He received home nursing and wound care and learned how to administer Total Parenteral Nutrition (TPN), a method of providing complete intravenous nutrition. He also needed to have blood work done twice a week.

A couple months later, a call came that organs were available from a suitable donor based on UNOS (United Network for Organ Sharing) guidelines, followed by a call from Dr. Abu-Elmagd to Hamza confirming the suitability of the organs. Hamza arrived to Cleveland Clinic at 9 p.m., and following testing and bloodwork that was promptly done, at 5 a.m., Hamza’s transplant surgery began.

Following a 16-hour surgery and four days in intensive care, Hamza was transferred to a regular hospital room, where he was closely monitored through daily clinical exams, and full blood work completed two to three times a week to ensure all the transplanted organs were working well. The transplanted intestine was monitored by surveillance endoscopy and biopsy once a week through the created temporary stoma through the transplanted bowel.

“One of the most innovative part of the procedure is the transplanted stomach was connected to the esophagus via a segment of the native colon that was left intact with the esophagus to avoid any major surgical complications in the chest,” says Dr. Abu-Elmagd.

With the continual progress of Hamza’s clinical condition and functioning organs, he underwent twice-weekly lab work and endoscopies to make sure everything was ok. This intense care was reduced to weekly, then once every two weeks.

Several months passed until the chimney ostomy that had been formed at the time of surgery could be safely closed. After a few months of monitoring his overall condition in outpatient settings, Dr. Abu-Elmagd gave Hamza the chance of a safe return home with fully functioning transplanted organs.

Back home in Doha, Qatar, Hamza has continued his education, earning both a master’s and a doctorate degree. He also became a certified life coach, dedicated to helping others on their own journeys.

“After 15 months of a long journey with hope and despair I finally returned home safe where I was welcomed by my family with a huge celebration,” says Hamza.

For Hamza to fully recover and be a productive citizen in his home country, he went through physical rehabilitation for a gradual return to his normal daily activities.

Thanks to the telemedicine innovations, Dr. Abu-Elmagd was able to closely follow his progress over the Atlantic through virtual visits. In addition to the virtual visits, Hamza was asked to return to Cleveland Clinic every three months for the first year, then every six months for the next year. Now, he returns once a year for follow-up care.

“I’m so fortunate to have been able to come to Cleveland Clinic and receive exceptional care from Dr. Abu-Elmagd and his team. The doctors I had elsewhere told me they had no hope of saving me,” says Hamza, who was severely malnourished weighing less than 100 pounds during his medical journey from losing his gut to receiving his new transplanted organs. “My journey affected me physically and mentally, but when I recovered fully, I decided to pursue further education, obtaining my master’s and doctorate degrees, and becoming a certified life coach so I can help others.”

Dr. Abu-Elmagd reinforces Hamza’s thoughts, explaining that multivisceral transplantation is a life-changing surgery when properly indicated and done by the skilled hands at centers of excellence like Cleveland Clinic.

“Hamza is a life example of the innovations that continue to develop at the Cleveland Clinic. Despite the complexity of Hamza’s medical and surgical condition, the technical innovations in Hamza included autologous reconstructive surgery and transplantation to achieve the optimal outcome and restore nutritional autonomy utilizing the residual native and transplanted organs. Hamza is now able to enjoy a normal life with unrestricted oral intake for more than 11 years after his surgery. We are able to provide a successful transplant and allow the patient to return home – whether home is in Europe, the U.S., the Middle East or elsewhere – to enjoy a normal life,” says Dr. Abu-Elmagd.