Rare liver transplant offers hope

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Rare

liver transplant offers hope

Posted

on Sun, Dec. 02, 2007 By RASHA MADKOUR Associated Press Writer

MIAMI --

Lindsey marvels that her 3-year-old son

Merrick doesn't need to take 10 different medicines anymore. He

can safely frolic on the playground among the germs that lurk there. Two years ago, Merrick's liver suddenly shut down. Standard treatment would have meant a full liver

transplant and a lifetime on drugs to keep his body from rejecting the new

organ. The medication suppressing his immune system

would have raised his risk for infection and possibly damaged his kidneys. Instead, Merrick underwent a rare and once virtually

abandoned operation in which a partial donor liver was attached temporarily to

his failing liver. His own liver

regenerated, and the transplanted liver is shrinking and may eventually waste

away. He has been taken off the anti-rejection

medication.

Seven children have had the operation at the

University of Miami/ Memorial Hospital - the only U.S. facility believed to be regularly

performing the surgery. Four of them are now off

anti-rejection drugs and a fifth is close.

The procedure was first tried in the mid-1990s, but U.S. doctors thought the chance of death or

complications was too high. One patient who had the

surgery at the Miami hospital in 1998 remained hospitalized

for three months because of complications. Ultimately,

his liver recovered and he too was taken off the anti-rejection drugs.

Surgeons in England, France and Japan continued to do the procedure, and in

several cases had favorable results. 's Dr. Tomoaki

Kato was encouraged by reports out of Europe. Since 2005, he has performed six partial transplants;

all have survived.

It's " time to revisit the procedure, " said

Kato, the hospital's director of pediatric liver and gastrointestinal

transplant program. " There's a great benefit for

the children and the technology has developed so much. "

Still, some surgeons say they will stick with the

traditional transplant until they see more proof that the partial transplant is

safe. The operation can take more than 10 hours, twice

as long as the standard transplant surgery, and is more complicated, increasing

risks to the patient. After surgery, a patient must

have multiple biopsies to see if his own liver is regenerating.

Dr. , director of liver transplantation

at the Cleveland Clinic, said that what concerns surgeons

" is that you're taking a very sick patient and, in most cases, you

would rather do the simplest operation. " The liver, which cleans toxins from the

blood, is unique among the body's organs in its ability to regenerate, making

the procedure possible. In some cases, the liver can

recover from acute, or sudden, failure on its own. But

if the organ doesn't recover fast enough, patients can

suffer brain damage from the toxins if they don't get a transplant. For Lindsey, choosing the potentially

riskier partial transplant for Merrick was easy. Either road was

going to be difficult, she said, and at least with the partial transplant, the

little boy had a chance to regain the use of his own liver. Little more than a year after the

operation, Merrick's liver had regenerated enough that Kato

took him off his anti-rejection drugs. His

transplanted liver is shrinking and may eventually disappear.

(In some patients, it is surgically removed.)

" I can sit here and say my son is off. He's off everything, " Lindsey said. " What they did was a true miracle. "

Because the operation is so rare, organizations like

the United Network for Organ Sharing and the American Liver Foundation do not

track the number of partial transplants performed or have specific guidelines

for it. Kato has created his own

rough guidelines. He says children fare better with

the operation because their livers have better rejuvenating abilities than

adults, and he's only used it for cases of acute liver failure. Chronic liver problems, like hepatitis or cancer, would

not be cured with this procedure.

Using this criteria, the number of people who could

benefit from this procedure is limited. Fewer than 400

people got transplants for acute liver failure in 2006, about a fifth of them

children, according to data from the Organ Procurement and Transplantation

Network. The procedure is covered

by insurance companies. Kato said the cost is roughly

the same as traditional transplants. He also noted the

long-term health care savings: After patients get off anti-rejection drugs,

they save thousands of dollars a year.

And while the Miami patients received livers from deceased

donors, the surgery could be performed using a live donor, such as a parent if

tests showed compatibility.

The University of Chicago's Dr. Jensen said that although

the procedure is promising, if his own child were

involved, he would still choose a standard liver transplant. Jensen, director of the university's

Center for Liver Disease, said some of the partial transplant's safety and

other issues, still need to be worked out.

Some of Kato's patients have needed a second surgery

to remove the transplanted partial liver because it became inflamed after

anti-rejection drugs were halted. And a few have yet

to get off those drugs. Yailin Nunez's 2-year-old son was the sixth

patient to have the partial liver transplant at Miami. Of all the patients, his liver has shown

the least recovery more than 20 months later, even compared to a boy who had

the operation this summer.

" I still have faith my son's liver's going to

regenerate.... It's just taking a little longer, "

Nunez said through tears. " And if it doesn't,

it's OK.... We're given the chance and I've met other

moms who weren't given the chance. "

Brenner Logan's parents are praying the toss-up goes

in their favor. In August, the 2-year-old became the

most recent to have the surgery. His

liver is already showing signs of recovery. Brenner's mother, Logan, is

cautiously optimistic. After her son's surgery, she

met one of the patients whose transplant was a success.

" You think, 'Wow. This

could be my son,' " Logan said. " You

begin to have so much more hope for the future. "

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (33) UC 91 - PSC 99 - Tx 6/21 & 6/30/07 @ Baylor in Dallas