Rare liver surgery offers hope

MIAMI — Kimberly Lindsey marvels that her 3-year-old son, Merrick, doesn't need to take 10 different medicines anymore. He can safely frolic on the playground among the germs that lurk there.

Two years ago, Merrick's liver suddenly shut down. Standard treatment would have meant a full liver transplant and a lifetime on drugs to keep his body from rejecting the new organ. The medication suppressing his immune system would have raised his risk for infection and possibly damaged his kidneys.

Instead, Merrick underwent a rare and once virtually abandoned operation in which a partial donor liver was attached temporarily to his failing liver.

His own liver regenerated, and the transplanted liver is shrinking and may eventually waste away. He has been taken off the anti-rejection medication.

Seven children have had the operation at the University of Miami/Jackson Memorial Hospital — the only U.S. facility believed to be regularly performing the surgery. Four of them are now off anti-rejection drugs and a fifth is close.

The procedure was first tried in the mid-1990s, but U.S. doctors thought the chance of death or complications was too high. One patient who had the surgery at the Miami hospital in 1998 remained hospitalized for three months because of complications. Ultimately, his liver recovered, and he, too, was taken off the anti-rejection drugs.

Surgeons in England, France and Japan continued to do the procedure and in several cases had favorable results. Jackson's Dr. Tomoaki Kato was encouraged by reports out of Europe. Since 2005, he has performed six partial transplants; all have survived.

It's "time to revisit the procedure," said Kato, the hospital's director of pediatric liver and gastrointestinal transplant program. "There's a great benefit for the children and the technology has developed so much."

Still, some surgeons say they will stick with the traditional transplant until they see more proof that the partial transplant is safe. The operation can take more than 10 hours, twice as long as the standard transplant surgery, and is more complicated, increasing risks to the patient. After surgery, a patient must have multiple biopsies to see if his own liver is regenerating.

The liver, which cleans toxins from the blood, is unique among the body's organs in its ability to regenerate, making the procedure possible. For Lindsey, choosing the potentially riskier partial transplant for Merrick was easy. Either road was going to be difficult, she said, and at least with the partial transplant, the little boy had a chance to regain the use of his own liver.