MEDICINE

Lifesaving surgery

Doctors perform a pioneering liver transplant

HOLGER JENSEN December 11 1989
MEDICINE

Lifesaving surgery

Doctors perform a pioneering liver transplant

HOLGER JENSEN December 11 1989

Lifesaving surgery

MEDICINE

Doctors perform a pioneering liver transplant

For the first seven hours, the mood was tense in the green-tiled operating theatre at the University of Chicago Medical Center as a team of four surgeons worked on one of the human body’s most delicate organs. As it began to appear that the operation would be a success, the atmosphere noticeably lightened. “This is really the fun part,” said Dr. Christoph Broelsch, the leader of the surgical team, as he proceeded to implant a fist-sized piece of tissue taken from the liver of Teresa Smith, a 29-year-old Texas schoolteacher, into the liver of her 21-month-old daughter, Alyssa. As it turned out, the operation was marred by a series of mishaps that made Broelsch’s optimism appear premature. Still, the pioneering procedure could hold out hope for hundreds of children born in the United States and Canada each year with faulty livers.

The operation, which took 13 hours to complete, was the first in North America involving a liver transplant from a living donor. The operation was carried out because Alyssa was born with biliary atresia, a blockage of the bile ducts that usually proves fatal by the age of 2.

The procedure was technically difficult, and two complications arose.

Hospital officials said that, while the surgeons were Smith: fraught cutting off one-third of the mother’s liver, they damaged her spleen, necessitating its removal. Broelsch said that the loss of her spleen could leave Smith more susceptible to future bacterial infections.

As they were about to implant the segment of Smith’s liver into her daughter, the surgeons also noticed that it had a hematoma, a small pool of blood under the thin layer of skin covering the liver. Dr. Peter Whitington, a member of the transplant team, said that he and his colleagues did not think the hematoma was significant. But it began to bleed after the

operation, and Alyssa had to undergo five more hours of surgery to stop the internal bleeding.

Broelsch emerged from the second operation looking drawn. Said the surgeon: “We really, sincerely hope that we are sailing in smooth waters now.” At week’s end, a hospital spokesman said that Alyssa’s condition was “serious,” but that the child was awake, alert and drinking liquids.

Many doctors have expressed interest in the Chicago Medical Center’s work, but some said that they have reservations about using live donors. Said Dr. Calvin Stiller, head of the transplant unit at the University Hospital in London, Ont.: “By cutting into the donor we offend the primary rule of medicine—above all, do not harm.”

Until now, there was little hope for babies bom with biliary atresia. Some infants suffering from the disease have been given livers transplanted from dead donors. Still, of the hundreds of Canadian and American children awaiting transplants each year, about half die before suitable organs can be found. There have only been four previous liver transplants involving Uve donors—in Australia, Brazil and Jail pan—and those were per| formed on children who g were already critically ill. y Hospital officials said that the Chicago operation reduced the risk of with problems rejection because the parent’s tissue provided a

closer match than that of an unrelated donor. As well, doctors said that because the operation was performed while Alyssa Smith was still reasonably healthy, she will have a better chance of recovery. Despite the difficulties encountered in their first living-donor liver transplant, the doctors said that they would probably perform the operation on another baby this week, in an effort to perfect a procedure that could save thousands of lives.

HOLGER JENSEN with correspondents’ reports