Lifesaving liver transplant performed on premature infant

www.grub4life.com today reports that a 5-month-old New York infant received a lifesaving liver transplant for advanced liver failure diagnosed following her birth 10 weeks premature. She only weighed 4 pounds, making her the smallest to ever receive this kind of transplant.02-07-2010

The surgery was led by Dr. Tomoaki Kato, surgical director of liver and intestine transplant programs at NewYork-Presbyterian Hospital/Columbia University Medical Center, and chief of abdominal organ transplantation and professor of surgery at Columbia University College of Physicians and Surgeons.
   
"Performing a transplant in a premature infant this size is a major challenge where any technical issue would have been fatal, but it was the only option," says Dr. Kato. "Most babies born with her condition would not have the chance to grow up. This surgery shows that transplantation is possible -- although only at an academic medical centre with appropriate resources and only with focused teamwork and dedication."
   
A few weeks after being born, she was diagnosed with an irreversible liver injury of unknown origin. Cared for in the neonatal intensive care unit, she was on a ventilator and had dangerous fluid buildup in her abdomen and difficulty taking down food. After being on the organ waitlist for two weeks, a replacement liver became available in Florida.
   
"The donor organ wasn't a matching blood type and it was substantially larger than her diseased organ, but it was critical that we proceed. To accommodate its size we created an artificial abdominal wall using a Gore-Tex mesh," explains Dr. Kato. "Unlike other organs, the liver has the unique ability to adapt itself to the patient's body. In this case the organ is making itself smaller. As she grows, her new liver will grow with her."
   
In the weeks following the surgery, the patient started recognizing her mother and responding to her by smiling. The child has also gained the ability to get nutrition through a feeding tube rather than intravenously. Her liver function normalized, and soon after the Gore-Tex mesh was removed and her abdomen closed.

Her medical care has been overseen by Dr. Steven Lobritto, medical director of pediatric liver transplantation at NewYork-Presbyterian/Morgan Stanley Children's Hospital and associate clinical professor of paediatrics and medicine at Columbia University College of Physicians and Surgeons.

"While she is on immunosuppressant medication and received a blood-type mismatched organ, rejection is usually not a major issue in babies, whose bodies can more easily accept an organ than someone who is full grown," says Dr. Lobritto.