Summer 2013

Interdisciplinary Care Facilitates Successful Liver Transplants in Children

Dr. Sue Rhee

Dr. Sue Rhee

"In the ideal pediatric liver transplant program, an interdisciplinary, expert team evaluates the need for transplant, completes the procedure and follows up to keep patients and their new livers healthy," says Sue Rhee, MD, medical director of the Pediatric Liver Transplant Program at UCSF Benioff Children’s Hospital.

When the team has experience that is both broad and deep, the chances for successful outcomes increase substantially.

The Pediatric Liver Transplant Program at UCSF Benioff Children’s Hospital performs 10-15 transplants each year; in addition to the transplant surgeons, the team includes pediatric transplant hepatologists, a transplant nurse practitioner, dietitians, social workers and child life specialists. The program’s collaboration with referring physicians includes outreach clinics in Greenbrae (Marin County) and Pleasanton (Alameda County), and its pediatric transplant hepatology fellowship is one of only five nationwide.

This depth and breadth of expertise includes extensive experience with:

  • Transplanting livers in very small infants
  • Performing living donor transplants
  • Performing partial liver transplants
  • Minimizing and, in some cases, eliminating immunosuppressive drugs

The Value of Living Donor Transplants

Dr. John Roberts

Dr. John Roberts

Experience with infants and toddlers has become especially important, says John Roberts, MD, chief of the Division of Transplant Surgery at UCSF Benioff Children’s Hospital. According to recent United Network for Organ Sharing (UNOS) data, children under the age of 5 receive 65 percent of all pediatric liver transplants, and those under the age of 1 receive 28 percent of such transplants.

"But because the transplant list is prioritized based on how sick a child is, many children with liver disease who have significant early complications – in particular, a failure to grow – may not have a high enough priority and are not well served by the shortage of livers," says Roberts.

Living donor transplants – which typically involve taking a graft from the liver of an adult relative – expand a child’s transplant options. UCSF has 20 years of experience in the living donor procedure. "One clear advantage," says Roberts, "is that we can transplant before the child gets really sick."

Another alternative is the use of partial livers from deceased donors, particularly splitting a liver so that one piece is transplanted in the pediatric patient and the other in an adult. UCSF also has extensive experience with this approach.

Hope for Reducing Immunosuppressive Medication

Another potential advantage of living donor transplants is the reduced risk of rejection when the donor is a close relative. UCSF was the leader in an NIH-sponsored study demonstrating that many patients can be weaned entirely from immunosuppressive medication following living donor transplantation.

"Minimizing immunosuppression is a priority for us, because doing so reduces the risk of infection, long-term kidney problems and development of lymphoma," says Rhee. "Our goal is to improve outcomes so these children can enjoy normal growth and development, and this is best achieved with a team approach."

For more information, contact Dr. Rhee at (415) 476-5892 or Dr. Roberts at (415) 353-9321.

Donor liver resection

Living donors can donate part of their liver (segments 2 and 3, or 2 - 4 as shown) to an infant or child. Living donor liver transplant can reduce waiting times for many patients with severe liver disease.

     

Summer 2013 Table of Contents

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