November 18, 2000
Even though 20-month-old Myiesha Hardy suffered with a liver disease that caused her skin to itch unbearably and made it difficult to digest food, the high demand for donated livers for transplants put her low on the list for receiving an organ anytime soon.
Coming to the rescue was Myiesha's father, Micah, who donated part of his liver to be transplanted into his daughter in Tulane's first living-donor liver transplant, performed June 1 at the medical center's Multi-Organ Transplant Center. At a press conference the day after the surgery, Douglas Slakey, assistant professor of surgery and the lead surgeon on the case, said living-donor liver transplants are a successful alternative to transplant-ing livers from a deceased person.
"The waiting time for a cadaveric liver is so long that one of the benefits of this surgery is that we can do it electively before the patient gets very ill," Slakey says. "Because of the shortage of livers nationally, surgeons are using organs from donors that we would not have used a few years ago. These donors are older and sicker."
Liver transplants from a living donor are possible because the organ can regenerate to the approximate size of the original liver. Surgeons removed about one-third of Micah Hardy"s liver to transplant into his daughter.
"The liver expands to meet the demands of the body," Slakey says. "[Myiesha's] liver is bigger than she actually needs. As she grows, the liver will grow."
A condition called biliary artesia caused Myiesha's liver to produce insufficient amounts of bile, a substance that aids in the digestion and absorption of fats. A Baton Rouge doctor made the diagnosis when Myiesha was 6 weeks old and referred her to Youhanna Al-Tawil, a pediatric liver specialist and assistant professor of pediatrics at Tulane.
Here, Al-Tawil worked to stabilize the disease and placed Myiesha on a list to receive an organ transplant. After months of waiting, Micah and the girl's mother, LaTonya Fisher, decided that Myiesha should undergo a live-liver transplant before she grew sicker. The family decided that Micah would be the parent to undergo the operation after deliberation with other family members.
"We decided that [Micah] would have the operation," Fisher says, ?"and I would give her care once this was all over."
Only one other live-donor liver transplant had been previously performed in Louisiana, said Steven Cheng, clinical assistant professor of surgery and a transplant surgeon who helped with the operation. Last year, doctors performed 66 such transplants in this country, according to the United Network for Organ Sharing, an organization that maintains waiting lists and scientific data on organ transplants.
Cheng said that most living-donor liver transplants are from a parent to a small child, where a strong emotional attachment outweighs the donor's aversion to painful surgery. Concerns about organ rejection are fairly minimal with livers-the donor and recipient need only to have the same blood type, he said. The outcomes of these types of transplants are excellent, Slakey said.
"The one-year survival rate for living-donor liver transplants is 90 percent or greater," he said."Our liver-transplant patients at Tulane have had a 94 percent survival rate for one year."
Slakey added that if liver transplant recipients survive through the first year, "their chances of living a full normal life are excellent." This operation opens the door for more of these types of liver transplants at Tulane, Slakey says. "We expect living-donor transplants eventually to account for 10 to 15 percent of the liver transplants we perform here," he says.
Slakey and Cheng have performed 35 liver transplants since they joined Tulane in August 1997. Tulane is one of only a few institutions in the country to perform living-donor liver transplants, Slakey says. The nearest medical centers that perform these operations are Baylor University in Houston and Emory University in Atlanta.
Of the 45 people on Tulane's waiting list for livers, three children and their families are preparing for similar surgeries, he says. Three adults on the list may also receive parts of a living donor's liver if they can identify an appropriately sized donor.
"With adults, it usually has to be a larger donor giving to a smaller person," Slakey says. As for Micah Hardy, he should recuperate fully within the next three months and experience no lasting effects, doctors say. Myiesha must remain on the drug cyclosporine for the rest of her life to prevent rejection of the organ.
Micah, who said the pain from the operation was worse than when he had separated his collarbone as a teen-ager, said he has no regrets about donating part of his liver to Myiesha. "That's what a father is supposed to do-be there for his child," he said. (Inside Tulane, 7/99)
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