Dual Organ Transplant – Double the Bliss - NUH

cover story
02
On 3 November 2010 at 4am,
which was about the same
time the alarm went off to wake
Weihao for his kidney dialysis, he received
a call that would change the course of his
life. His long wait was over - a suitable liver
and kidney had been found.
Weihao suffered from primary
hyperoxaluria – a rare genetic disorder
which led him to form kidney stones at the
tender age of five.
Sometime in 2009, Weihao’s father noticed
that something was not right with his only
son as he was losing weight. Weihao
also got tired very easily. His kidney was
starting to fail.
Weihao started dialysis - which took him
around 10 hours everyday - when his
kidney failure became more acute.
‘His weight dropped drastically from
68kg to 58kg in a matter of weeks. He
was about 50kg when he went in for the
operation,’ said his mother.
On that fateful night, Professor K
Prabhakaran, Director, Paediatric Organ
Transplant Programme at NUH was
awoken from his sleep by a call at 2am,
informing him that there was a suitable
liver for Weihao. At the same time,
Weihao’s primary physician Prof Yap
Hui Kim contacted him to discuss the
possibility of a simultaneous liver and
kidney transplant.
When both organs were found to be
suitable, they called to inform the family
at 4am. Weihao was admitted at 7am to
prepare for the surgery.
The multi-disciplinary team led by
Professor Prabhakaran started with the
liver transplant operation which took
eight hours. Professor Prabhakaran
and Dr Tiong Ho Yee, Consultant,
Department of Urology, NUH then
moved on to the kidney transplant
which took another three hours.
Weihao received a new kidney and
liver in slightly over 24 hours.
The surgery scored a first in the
medical history in Singapore, making
it to a selected list of success stories in the
world. A 2006 American report stated that
to date, only 1,032 combined liver-kidney
transplants (inclusive of adults) had been
performed worldwide.
Now Weihao is able to do
the one thing he has always
dreamed of - to travel
the world.
Mdm Lim Kim Hiok,
Weihao’s mother.
What Weihao had - Primary Hyperoxaluria
A person suffering from this condition will have too much
of a substance called oxalate, or salt crystals present in
the urine. It is a natural by-product of metabolism but too
much of it causes kidney stones. The stones can cause
urinary obstruction, secondary infection of urinary tract and
eventually kidney damage. It becomes progressively more
severe, and can lead to death.
In Type 1 primary hyperoxaluria, which is the genetic
disease that Weihao is suffered from, the liver creates
too little of an enzyme called alanine/glyoxylate
aminotransferase (AGT).
Very large amounts of oxalate are produced when there is
not enough of this enzyme in the liver.
Among patients with primary hyperoxaluria, half will have
kidney failure by age 15, and about 80 per cent will have
kidney failure by age 30. For that reason, it is critical to
have primary hyperoxaluria diagnosed and treated as early
as possible.
Patients most often develop the first symptoms, typically
kidney stones, anywhere from birth to the mid-20s.
However, the condition may go undiagnosed until age 30
to 40. In some patients the first symptom is kidney failure.
Patients with Type 1 primary hyperoxaluria who do not
sufficiently respond to Vitamin B6 will need a liver and
kidney transplant to cure their disease.