Children’s, UCHSC Docs Performed Groundbreaking Split-Liver Transplant
from The Children's Hospital (TCH) News, December 2004
9-month-old Aaliya Rugeric-Tena (center, with mother Jennifer Tena)
received half of a liver in October in a split-liver transplant peformed
by TCH doctors Frederick Karrer, left, and Richard Hendrickson, right.
Children’s Hospital and University of Colorado Health Sciences (UCHSC) doctors in November became the first in the region to perform a split-liver transplant on a child and an adult with the same rare disease, said Michael Narkewicz, MD.
Dr. Narkewicz, medical director of Children’s Pediatric Liver Center and Hewit Andrews Chair in Pediatric Liver Disease, said Children’s doctors Frederick Karrer, MD, Richard Hendrickson, MD, and UCHSC doctors Igal Kam, MD, and Michael Wachs, MD, split a cadaveric liver and transplanted the halves into a 9-month-old girl and a 25-year-old woman Oct. 25. Both patients have biliary atresia, which is the disappearance of tubes and tiny ducts that drain bile from the liver to the small intestine, where it aids in the digestive process.
Of 50 liver transplants performed at Children’s since 1998, seven were split-liver transplants, Dr. Narkewicz said, but this is the first case in which both patients had the same disease.
Biliary atresia is the most common cause for liver transplants in children, Dr. Narkewicz said; roughly 50 percent of the patients who receive liver transplants at Children’s each year have the disease.
Patients from the region and all over the world come to The Children’s Hospital – the lead center in a nine-center biliary atresia research consortium – for treatment of the disease, Dr. Narkewicz said. The Pediatric Liver Center has treated more than 200 patients with the disease since 1973.
“This kind of transplant can only happen in a place like this, with a long history of treating large numbers of children with biliary atresia,” he said. “We’re known for very good outcomes. We are working to learn the causes of biliary atresia and to develop therapies to decrease the need for transplants.”
If doctors diagnose biliary atresia early enough, he said, they can fashion an artificial bile duct – a procedure called the Kasai . Ten to 15 percent of the patients who receive the Kasai won’t need a liver transplant in the future, Dr. Narkewicz said. But the rest – 85 to 90 percent – eventually will.
The adult who received half the liver – a former Children’s patient – had a Kasai done the year she was born and lived 25 years before she needed a new liver, Dr. Narkewicz said. In the split-liver transplant, a liver from a cadaver is split in half. Doctors can transplant part of an adult liver into a child, Dr. Narkewicz said, but an adult can’t receive a pediatric liver because it would be too small. The pediatric patient generally gets the smaller left lobe, while the adult gets the larger right lobe. The liver must be a blood-type match for both patients, Dr. Narkewicz said, and must be the right size. Once the liver is transplanted, he said, each half will regenerate – a characteristic unique to the liver.
“The liver will enlarge to meet demand,” Dr. Narkewicz said. The 9-month-old girl and adult are both doing fine after the transplant, he said. The procedure already is making a major impact, he said. “This allows a single donor liver to be used for two recipients,” he said. “It’s a good thing, too, with 18,000 people waiting for a liver. There aren’t enough donors to meet the current demand; split-liver transplants allow more transplants to be done and will help reduce the waiting time in pediatrics.”
