'Two
for One' Liver Transplants Save More Lives
New
York Times Syndicate
SUZANNE
LEIGH
July 15, 1999
With the availability of such life-sustaining donated
organs as the liver in short supply, efforts have been underway
to improve a technique for using one donated liver to save two peoples'
lives.
Splitting a single donor liver between two recipients until recently
involved a heart-wrenching dilemma. In using one organ to save
two lives, were doctors compromising both patients' prognoses?
It's a question that Dr. Ajai Khanna of the University of California
at San Diego (UCSD) had struggled with in preparation for the
city's first ever split-liver transplantation that took place
last week.
When a healthy 29-year-old woman died suddenly, Khanna knew there
were two patients whose survival hung in the balance pending the
availability of a donor liver. One patient was 18-month-old Cesar
Sepulveda who had been diagnosed with an incurable genetic disorder
that meant his body was unable to properly metabolize protein
and fat. The second patient was 62-year-old Harold Turner who
suffered from a debilitating complication of the liver disease
hepatitis C.
Split-liver transplantation seemed the obvious solution and one
that no longer places patients' lives in peril.
``Surgical techniques have improved and with the right training
we can expect the same results as those cases using whole livers,''
said Khanna, UCSD Healthcare's director of pediatric abdominal
transplantation and transplantation research.
Young Cesar is now out of the intensive care unit and could be
discharged from the hospital as early as Thursday, said Khanna
who was the lead surgeon in the child's intricate 13-hour operation.
As for Turner, a patient who was bedridden and required oxygen,
he is now walking around the ward with his wife.
According to the United Network for Organ Sharing in Richmond,
Va., there are more than 10,000 people on the waiting list for
a liver transplant in the United States. Approximately 30 percent
of patients die because no donor liver is available.
``Split-liver transplantation is the way to go; it is the way
to circumvent the organ shortfall,'' said Khanna. In liver transplants,
unlike with other organs, it is not necessary to match donor and
recipient by race.
According to the University of California at Los Angeles (UCLA),
which has been performing split-liver transplantations since 1992,
a baby in need of a liver transplant spends about 270 to 290 days
on the waiting list. Under the split-liver program ,most babies
wait less than one month.
Split-liver transplantation, which typically involves one child
and one adult, entails dividing the organ into two transplantable
segments. The child receives the left lateral lobe, the smallest
of the liver's three lobes, which makes up about 10 to 15 percent
of the liver. The larger segment is transplanted into the adult
patient. The liver is the only human organ that can regenerate
itself, and over time, the patient's new organ will grow to a
normal size. When the surgery is successful, transplanted livers
are expected to function normally within a few months.
At the annual meeting in May of the American Society of Transplantation
in Chicago, Dr. Jorge Reyes, director of the pediatric transplant
program at Children's Hospital in Pittsburgh presented data on
the success of split-liver surgeries. Of 58 split-liver recipients
who underwent transplantation at the University of Pittsburgh
between 1989 and 1998, patient survival was 100 percent and graft
survival was 90 percent. This figure is comparable to whole-organ
transplantation, according to Reyes.
However for pediatric patients using the liver of a child donor
increases the chance of graft survival, according to data presented
at the same meeting by Dr. Sue McDiarmid, director of pediatric
liver transplantation at UCLA. When children get transplants from
adult donors, the probability of graft failure is 16.3 at one
year. Using the liver of pediatric donors the failure rate falls
to just 8.8 per cent.
(The Medical Tribune Web site is at http://www.medtrib.com)
c.1999 Medical Tribune News Service
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