When 6-year-old Angela Bushi’s organs started to fail, her family feared they would lose her – just as they had lost her 18-month-old sister Alicia to liver failure a few months earlier.

“When you see your children in this situation, and there’s nothing you can do, it is so hard,” said Angela’s mom, Valbona Bushi.  “We went through a lot.”

But today, Angela’s organs are functioning better than ever.  thanks to a team of geneticists and surgeons at Holtz Children’s Hospital and the University of Miami Miller School of Medicine/Jackson Memorial Hospital, her life was saved after she underwent a combined liver, pancreas, and kidney transplant – the first ever quadruple transplant of its kind performed on a child.

Initially born healthy, Angela developed type 1 diabetes when she was just a year old.  Four years later, she became even sicker, developing flu-like symptoms, which  eventually turned into fatal liver failure.

“This was kind of an unusual combination of acute liver failure and diabetes,” said Dr. Olaf Bodamer, director of the pediatric genetics program at Holtz Children’s Hospital, who eventually diagnosed Angela.  “We knew that her sister had died under similar circumstances, so we assumed that her condition was genetic.  When you go to the medical literature, the list of syndromes that came up to explain her condition was very small.”

Bodamer finally discovered the culprit – Wilcott-Rallison Syndrome (WRS), an extremely rare disease with only 60 known cases in medical literature worldwide.  Those with WRS have a multitude of health problems, including diabetes, liver and/or kidney failure, bone and growth problems, repeated infections and intellectual impairment.

And for the majority of children with WRS, the condition is typically fatal.

After finally diagnosing Angela with WRS, surgeons knew that if they were going to save her life, transplanting just one organ wasn’t going to cut it.

“The risk to her life was from three (different) organs – the liver, pancreas, and kidneys,” said Dr. Andreas Tzakis, chief of the liver/GI transplant program at UM’s Miller School of Medicine and Jackson Memorial Hospital, and one of the transplant surgeons who operated on Angela.  “If there was to be a solution, we knew we’d have to combine these (three different types of) organs into one transplant.  We had several consultations within the team, outside the team, and the parents; and collectively, we decided the transplant was the way to go.”

Angela was placed on a transplant list, and on December 29, 2011, she received the ground-breaking quadruple transplant.  Because of Angela’s small size and the combination of the organs needed, Angela’s new liver, pancreas, and kidneys all came from a single donor.  the organs were left in a “block,” almost as if they were all one organ.  

The surgery was the first to ever be performed on a child – and the first to be used to treat WRS.  Liver transplants had previously been considered to treat the disease, but surgeons never followed through with them for fear of complications with other organs.  but because the surgeons transplanted all the organs at once, the complications were minimized as much as possible.

Initially, Angela started to reject the organs – but the doctors were prepared and treated the issue with anti-rejection meds, and she has since fully recovered. she was discharged from Holtz at the end of February.

Angela no longer needs insulin treatment, and the only evidence of her innovative surgery is a slightly protruding belly, which houses two pancreases, a new liver and four kidneys.

The surgeons hope Angela’s story will not be the only one of its kind and that more transplants like hers can be done in the future.

“The surgery itself might benefit other children who might need this combination,” Tzakis said.  “It might give hope to children with this syndrome – that there might be at least one solution that can prolong their life.  For the first time, we have a sense of enjoyment about this whole process.   Seeing the child looking well and the family being relieved, this is the first time I feel joy for having done this procedure.”

The Bushi family, who live in Jacksonville, Fla., are also joyous to have Angela back home and feeling better.  they said they look forward to seeing Angela live a long and healthy life.

“She’s a normal child again, and we can do everything like normal parents,” Valbona said.  “She even wants to be a doctor when she grows up.”

Hepatitis is a type of viral infections that causes inflammation of the liver because of the presence of inflammatory cells in the tissue of liver. Hepatitis may heal of it own or it can lead to Fibrosis and Cirrhosis. A group of viruses together known to be Hepatitis Virus along with other infections cause the disease. however due to other various toxins like alcohol and other medications, hepatitis disease can affect a person.

Hepatitis can be acute and chronic. Acute Hepatitis last for 2-6 weeks and generally affects to younger people. The symptoms that would likely to be felt are malaise, muscle and joint aches with high fever, nausea and diarrhoea. if the disease continues then other symptoms like loss of appetite, dark urine, yellow eyes and even jaundice can happen. Hepatitis also can lead to acute liver failure which leads to hepatic encephalopathy and the only cure is a liver transplant.

However, chronic hepatitis leads to symptoms like tiredness and weakness. this can be understood from the blood test report. Extensive damage of liver leads to several dysfunction of the body like weight loss, swelling of the legs and accumulation of fluid in the abdominal cavity.

The common symptoms are:

• Mild fever with joint aches
• Acute nausea and vomiting with eventually loss of appetite
• Diarrhoea
• Jaundice
• Dark urine
• Headache and
• Enlarged spleen accompanied by itching.

The most common type of Hepatitis diseases are:

1.      Hepatitis A: Affects to children and one of the most common disease. The virus spreads through direct face to face directly and contamination from foods, cooking utensils, raw shellfish and from drinking water.

2.      Hepatitis B: it is the most serious form of hepatitis. it spread through sexual contact, blood transfusion or through the blood of infected person blood via cuts and needle sharing. it is considered to be a Sexual Transmitted Disease.

3.      Hepatitis C: It is considered to be a chronic disease and is transmitted by blood contact (contaminated needles and blood transfusion).

4.      Hepatitis D: It can both be acute and chronic. it is found in those people who are carriers of the Hepatitis B virus.

5.      Hepatitis E: is commonly found in the Indian Ocean area. There are two types of non-viral hepatitis called alcoholic hepatitis and toxic/drug induced hepatitis.

The doctor goes through a through medical history and his daily habits like medications and consumptions of alcohol, surgeries and sexual activities. Several tests are done like blood tests and liver panel tests. There are certain other tests like ELISA II, RIBA Ii and RNA test are done. if needed, doctors do a liver biopsy for further testing.

Medicines are available in the markets however self consciousness is needed to solve the problem of hepatitis.

The following can be done to protect oneself from the disease:

1.      Indulge in safe sex

2.      Sharing of needles, razors, toothbrush to be stopped

3.      Limiting of alcohol intake

4.      Wash hands well after using any washroom

5.      Eating of fresh cooked foods

Drink only commercially bottled water or boiled water

Summary: Does Tylenol cause liver problems? the Food & Drug Administration (FDA) says the answer is yes! according to the FDA, it has forced Tylenol to warn consumers of Tylenol’s risk of liver injury. the FDA says Tylenol is generally safe when used according to the directions on its labeling. However, taking more than the recommended amount can cause liver damage, acute liver failure, and even death.

Why is Tylenol dangerous? Acetaminophen is the generic name of a drug found in many common brand name such as Tylenol, as well as prescription products such as Vicodin and Percocet. the FDA says Acetaminophen is an important drug because it is very effective; however, taking too much can be extremely dangerous! below is some important from the FDA. Remember, if you have taken Tylenol & experienced liver problems— call my office today at 702-240-0000.   

FAQ from the FDA:

Q: Are there risks from taking too much acetaminophen?

A: Yes, acetaminophen can cause serious liver damage if you take too much. it is very important to follow your doctor’s directions and the directions on the medicine label.

You may not notice the signs and symptoms of liver damage right away because they take time to appear. Or, you may mistake early symptoms of liver damage (for example, loss of appetite, nausea, and vomiting) for something else, like the flu. Liver damage can develop into liver failure or death over several days.

Acetaminophen is generally safe when taken as directed. To lower your risk of liver damage make sure you do the following:

• Follow dosing directions and never take more than directed; even a small amount more than directed can cause liver damage.
• Don’t take acetaminophen for more days than directed.
• Don’t take more than one medicine that contains acetaminophen at a time. For example, your risk of liver damage goes up if you take a medicine that contains acetaminophen to treat a headache, and while that medicine is still working in your body, you take another medicine that contains acetaminophen to treat a cold.

Q: How can I safely take acetaminophen?

A: Follow this advice to take acetaminophen safely:

• Read all the information given to you by your doctor and follow directions.
• Read the information on the OTC “Drug Facts” label or on the prescription label and follow directions.
• Be sure you understand the following:- the dose, which is how much acetaminophen you can take at one time- how many hours you must wait before taking another dose of acetaminophen- how many doses of acetaminophen you can take safely each day- when to stop taking acetaminophen and ask a doctor for help
• Never take more than directed, even if your pain or fever isn’t any better. taking more acetaminophen than directed can put you at risk for liver damage.
• Never take more than one medicine that contains acetaminophen. Check the active ingredients of all your medicines to make sure you are taking no more than one medicine containing acetaminophen at a time.

Q: What should I do if the pain or fever doesn’t get better after taking acetaminophen as directed?

A: take the medicine only as directed. Don’t take more. if the medicine doesn’t help you feel better, talk to your doctor, nurse, or pharmacist.

Find more at: fda.gov/forconsumers/consumerupdates/ucm168830.htm