Surgeons at the Johns Hopkins Children's Center have transplanted sections of a single liver into a teen-ager and a toddler whose lives were threatened by dangerously long waits for organs to replace their own diseased livers.
The technique, first tried in France five years ago, is one of several ways surgeons are coping with the lack of sufficient donor organs to meet the burgeoning number of patients awaiting transplants.
The operations, performed almost a month ago, marked the first time in Maryland that a transplant center had used the split-liver method for two patients in need.
The liver is the only solid organ that regenerates itself when it is reduced in size, giving doctors the ability to fit children with shaved-down adult livers, which then grow as the recipients move into adulthood.
Yesterday doctors reported that the patients were doing well despite bouts of rejection and other complications. The transplants were performed in adjoining operating rooms in a 24-hour stretch beginning the morning of May 25.
The liver, from a brain-dead adult whose identity is being kept confidential, was split about 60-40. The smaller section was given to 20-month-old Irungu Karangu of Baltimore, who had been waiting for 15 months, then the larger section went to Jackie Moreland, 16, who had been waiting for eight months.
The boy is the son of Anna Karangu, a homemaker, and Mwangi Karangu, an economics professor at Morgan State University.
The girl, who has returned to her home in Odenton, is the daughter of Judith Moreland, a preschool aide, and Philip Moreland, a cook at a seafood restaurant.
"I have all my energy back," said Jackie, who will be a senior at Arundel High School next September. "I'm a little sore, that's it. I can do basically anything except hard sports." Before her operation, the slender teen-ager had been so weak that she was able to attend school only three days a week. She suffered from biliary cirrhosis, a congenital abnormality in which the bile ducts become obstructed and infected.
The Karangu boy suffered from biliary atresia, a condition in which the bile ducts fail to develop. Bile, a digestive juice manufactured in the liver, normally drains through tubes into the small intestines.
Yesterday, the boy looked chubby and alert in the pediatric intensive care unit, where he has been recovering since his transplant.
He had a new operation to repair a leaking bile duct Friday but was reportedly making a good recovery.
"Rejection, infection and bile leaks are standard complications we see in any case," said Dr. Paul Colombani, director of Hopkins' pediatric transplant program. He led a team of six surgeons, four anesthesiologists and eight nurses.
Over the past decade or so, the demand for suitable organs has grown much faster than the supply as doctors have become more experienced and confident with transplant procedures. Hopkins, for example, performed about 70 liver transplants last year but has a waiting list of about 100 patients.
The liver, the largest solid organ, manufactures and regulates many chemicals essential for human life while filtering toxins from the bloodstream.
In recent years, surgeons began to give children lobes from VTC living parents and from brain-dead adults when pediatric livers weren't available. Then, they started using the split-liver procedure. The technique is being done at about a half-dozen hospitals in the United States, Dr. Colombani said.
Survival odds for the two children should not vary greatly from the odds given patients in more conventional liver transplants, Dr. Colombani said. Generally, patients are given a 75 percent to 85 percent chance of living five years -- the threshold at which
patients have cleared most hurdles.