Friday, July 27, 2012

Living donor gives sister liver transplant

Judith Lattin
STANFORD, Calif.--A liver failure patient is enjoying a new lease on life after Stanford surgeons transplanted a portion of her sister’s liver, which later regenerated into the full-size organ.

At 48, Judith Lattin was diagnosed with liver failure. Over the next nine years, Lattin fought that condition and its complications, enduring procedures and an unpleasant regimen of medications to control a bleeding esophagus, an enlarged spleen and major vein blockages. She was unable to walk at times, but she was not sick enough to be high on the list for a transplant.
She nearly lost all hope when doctors told her that the complications stemming from her liver disease made them uncomfortable with trying a transplant.

But then she met with the liver transplant team at Stanford Hospital & Clinics, led by surgeons who trained with Thomas Starzl, the American physician who pioneered successful liver transplantation. For Lattin, that changed everything. At her first meeting with Stanford’s chief of clinical transplantation, Waldo Concepcion, MD, “He said, ‘Yes,’ they could do it, and there was hope. I saw light at the end of the tunnel again,” Lattin said. “When you’ve been told that surgery is not an option for you, that’s basically a death sentence. It can be a very uncomfortable death. I had seen that as inevitable for me.”
But, Lattin still faced another obstacle — where and how to find a kidney donor. According to the United Network for Organ Sharing (UNOS), while the waiting list for liver donors is continually growing and currently averages between 16,000 and 18,000, the number of available deceased-donor livers has been stable at about 6,000 each year for the last decade. One in seven patients dies before receiving a new liver. There is no equivalent of kidney dialysis or cardiac-assist devices for the liver.
Luckily, Stanford was willing to do something else that many other hospitals would or could not: use a piece of Lattin’s sister’s liver as a transplant. Instead of having to wait on the list for a deceased-donor liver, Lattin could get that life-saving transplant as soon as Stanford’s team approved the donation from Lattin’s sister, Christine Webb. She was nine years younger and in good health, a strong candidate for the procedure.

At about 3 ½ pounds, the liver is the body’s largest solid organ by weight. Its functions are crucial. It detoxifies the blood, stores vitamins, breaks down fats and sugars, generates hormones and, most vital when surgery is involved, it produces the substance that clots blood. It is also the one organ in the body whose tissues respond to loss by regrowing to restore the organ’s original volume. That remarkable quality is what enables someone to give away as much as 60 percent of a liver without repercussions, assuming the surgery is done well. For that to happen, surgeons must control bleeding in an organ that’s rich with blood vessels and pumping through 1 ½ quarts of blood each minute.

“It’s a challenging, difficult surgery,” said Stanford Transplant Division Chief Carlos Esquivel, MD, PhD. “The risk of life-threatening hemorrhage is ever present, but we do this because there aren’t enough organs to go around.”

Despite this, Lattin and Webb were confident. “I had faith in the Stanford medical team that took care of me,” Webb said. “I knew that they were some of the best in the world, and that they don’t go into these surgeries lightly at all. I knew they would leave nothing unchecked, so I really trusted them.”
Only the most senior surgeons are allowed to do this type of operation, Esquivel said. The surgery to remove the diseased liver and the surgery to remove the donor liver portion take place simultaneously, followed by the surgery to connect the transplant, so Esquivel, Concepcion and their colleague, C. Andrew Bonham, MD, all worked the sisters’ surgery day.

The living donor procedure emerged in the late 1990s. Stanford performs three to five living donor transplants each year and 50 to 60 deceased donor liver transplants each year; its government-reported results place it in the top ranks for safety and survival. In addition to the wisdom gained from doing many procedures, advances in imaging used by Stanford surgeons also have improved safety, said Walid Ayoub, MD, who has been Lattin’s pre- and post-transplant hepatologist. With that imaging, “surgeons can see all the vessels ahead of time. They have a road map of the liver that allows them to stay clear of large veins and partition the liver safely.”

The team also uses instrumentation and tools to reduce blood loss, and it carefully calculates just how much liver to take. Every step has been developed to protect the donor and recipient.
Lattin’s and Webb’s operations took place on Dec. 20, 2010. Lattin was in the hospital for a month. Webb was released after four days. Lattin lives carefully, following the rules for her medication, diet and exercise. “I have energy to do things,” she said. “I have just so much more of a joy for life. I waited nine years for a transplant, and I didn’t realize just how much I had declined until after transplant when I started to feel so much better, and then I just started to do things.”
Webb, too, felt rewarded following the surgery. “There’s not a feeling in the world that is better than when doctors come to you and say, ‘You saved two people.’ I saved my sister, but I also saved the person who will now get the deceased donor liver my sister won’t need. It really brings it home when you think about it that way.”
To watch the video of this story, go here.

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