Jefferson and Nemours/Alfred I. duPont Hospital for Children Perform Split-Liver Transplant
Assiah Phinisee is a little girl with a big story.
In July 2008, shortly after she was born, Assiah began experiencing the debilitating effects of biliary atresia — a blockage of the ducts that carry bile from the liver to the gallbladder and intestines. When trapped in the liver, bile creates scar tissue that causes cirrhosis and eventually leads to liver failure.
When she came to Nemours/Alfred I. duPont Hospital for Children in 2010, Assiah had already endured multiple surgeries — including a failing liver transplant performed in July 2009 — and spent hundreds of days in the hospital. Her mother, Rasheena, who had been studying public relations at Temple University, put her job and schooling on hold to focus on Assiah and her care.
On July 9, 2012, Stephen P. Dunn, MD, chair of the Department of Surgery at Nemours/Alfred I. duPont Hospital for Children and Professor of Surgery at Sidney Kimmel Medical College, and Warren Maley, MD, Professor of Surgery at Jefferson, performed Assiah's second transplant: a partial liver whose other lobe was transplanted to 1960s teen idol and fellow Philadelphian Robert Ridarelli — better known as Bobby Rydell. Nearly three months later, Assiah is thriving.
Assiah's First Transplant
By the time Rasheena took Assiah to meet Dr. Dunn, she was both highly knowledgeable about her daughter's condition — and a bit frustrated with the care she had received to date.
At two-and-a-half months old, Assiah had undergone a Kasai procedure to bypass the abnormal ducts by connecting the liver directly to the small intestine. When the Kasai procedure failed to facilitate the flow of bile from her liver, Assiah was listed for a liver transplant. Rasheena recalls the long 14-month wait and the relief when an 18-month-old donor was identified in the Midwest.
"Assiah received the new liver in July 2009, and at first, everything looked great," Rasheena says. "For about five months, she gained weight and her hair grew. But, clinically, her liver numbers never stabilized or came down."
By Thanksgiving 2009, Assiah was again experiencing telltale signs of biliary obstruction. She was hospitalized and given emergency fluids and antibiotics. Days later, Assiah underwent another surgical procedure to insert external drains to stretch the narrowed common bile duct in her transplant. According to Rasheena, those drains led to persistent, recurring infections, heavy use of last-resort antibiotics and a suspicion that the right lobe of the donor liver may have been irreversibly damaged.
Seeking a Second Opinion
Nearly a year after Assiah's transplant, Rasheena was advised that she needed another surgery to remove the damaged lobe. She decided to seek a second opinion from Dr. Dunn — a decision she doesn't regret.
"When we went to DuPont, my relationship with the doctors and the team was so natural. It puts you at ease when you feel like you have a team that is really listening to you," Rasheena says. "As a mother, you spend so much time with your child that you can identify signs and symptoms almost immediately. Whenever I describe my observations to Dr. Dunn, he listens to what I have to say."
Dr. Dunn and the duPont team — with whom Jefferson partners to provide pediatric transplants — agreed with the original recommendation to sever the right lobe of Assiah's transplanted liver, a procedure that Dr. Dunn performed in June 2010. Again, the initial results appeared positive, but ultimately the rest of the donor liver began to fail. By January 2011, Rasheena and the care team at DuPont were talking about another transplant, and in March of that year, Assiah was officially listed.
"We waited almost a year and a half for the second organ. Dr. Dunn said he had received a few offers but didn't accept them because of donor size and laboratory findings," Rasheena recalls. "We even received an offer from one of my cousins in Mississippi. He was 14 and had died in a car accident. Dr. Dunn turned it down, but three days later we got the offer for the split organ that was transplanted into Assiah in July."
These days, Rasheena says she's never seen her daughter so healthy. Since the transplant, Assiah's skin is glowing, she's eating and growing, and she has tons of energy. She's also doing first-grade work at home with Rasheena, who's searching for the "perfect" preschool for this precocious little girl.
Rasheena values and appreciates the care and respect that she and her daughter received from Dr. Dunn and the multidisciplinary team at duPont.
"They were very knowledgeable about everything that was going on with Assiah. I think the steps we chose to take were very effective. Even before the transplant, the care that Dr. Dunn provided allowed her condition to be stable for the first time ever."
After four years of nonstop hands-on experience caring for Assiah, Rasheena is also considering a career in the medical field. "Dr. Dunn has often introduced me as 'a doctor who doesn't have her degree,'" laughs Rasheena, who says she plans to finish her PR degree before pursuing a career as a clinician.