Boston-Surgeons at the Beth Israel Deaconess Medical Center have successfully transplanted part of a woman's liver into her sister who was ill with end-stage liver disease. On August 28, Maureen Martin, M.D., chief of the division of liver surgery and transplantation at BIDMC, and her colleagues surgically removed a portion of Virginia Shea's liver and transplanted it into Patricia Shea. Both women are East Boston residents. Virginia was released from BIDMC on September 4 and Patricia is scheduled to leave the hospital this week.
This is the first living donor liver transplantation (LDLT) procedure at BIDMC since Martin was recruited to direct BIDMC's Liver Center's transplantation and surgery program. Since April, the Liver Center faculty has performed seven cadaveric transplantation surgeries in addition to the LDLT case.
The procedure took place in adjacent operating rooms. In one room, surgeons prepared Virginia's healthy liver to be divided while in the other room, surgeons prepared Patricia's diseased liver to be removed. The surgeons then divided Virginia's liver, removed Patricia's liver and transplanted half of Virginia's liver into Patricia. Both livers are expected to regenerate to full size during the next three weeks. Members of the surgical team included Martin, David Shaffer, M.D., surgical director of kidney and pancreas transplantation, and Pierre Saldinger, M.D., a hepatobiliary surgeon.
"This is a wonderful thing that my sister did for me," said Patricia, 41, who was chronically ill with hepatitis C and Laennec's cirrhosis. Liver transplantation was her only medical option. She had been on the national waiting list for a donor liver for 18 months. "This has given me a new chance at life."
Virginia, 42, said the procedure scared her, but she added that she was happy that her sister's health was improving. "I am in pain every now and then, but I have learned to live with this pain knowing that I have helped out my sister and my family. My sister looks so much better than she has in years. It is well worth it. I would do it again if I knew it would make her look and feel as good as she does."
Patricia and Virginia had to complete a battery of examinations before they were approved for the LDLT procedure including blood and tissue typing to determine compatibility and a comprehensive medical physical. Virginia also underwent radiological exams to assess the size of her liver and its vascular structure, a liver biopsy and psychiatric evaluation to ensure that she donated part of her liver under her own free will.
Most liver transplantation cases utilize cadaveric livers, or livers recovered from donors who are brain dead. Nearly 16,000 people currently are on the waiting list for liver transplantation in the United States, but on average less than 4,600 cadaveric livers are available during a given year. Approximately one out of 12 people who have registered for a new liver will die while on the waiting list.
"The demand for donor livers in the United States - and throughout the world - exceeds the supply, and this tragic problem is growing as more people are being diagnosed with hepatitis C," Martin explained. "Clearly, living donor liver transplantation surgery is as an important step towards reducing this large and increasing gap between demand and supply."
Liver disease, while not as well known to the public as heart disease, is a significant national health problem due to the seriousness of its disorders and the numbers of people affected. It is the 10th leading cause of death in the United States. In addition, there are an estimated 3.9 million Americans chronically infected with hepatitis C, a disease that sometimes shows no symptoms until well advanced in its severity. The hepatitis C virus is the leading cause of liver transplants in the United States. Studies suggest that 20 percent of the chronically infected will develop cirrhosis or severe fibrosis (scarring) over time, resulting in an estimated 8,000 to 10,000 deaths per year. It is estimated that this death rate could triple during the next two decades.
The BIDMC Liver Center utilizes a multidisciplinary approach to treating liver diseases and conditions, with an emphasis on four areas: liver failure, liver tumors, liver transplant, and viral hepatitis. Martin and Nezam H. Afdhal, M.D., a leading medical expert in hepatitis C, comprise the Liver Center's medical leadership team. Martin was recruited from Iowa to direct the liver transplantation and surgery program. Recruited from Boston University, Afdhal is the medical director at the Liver Center and the chief of hepatology at BIDMC. He is the principal investigator of a national study aimed at determining if a tandem of two drugs can prevent liver damage from hepatitis C. He also heads the Liver Center's viral hepatitis program.
Beth Israel Deaconess Medical Center is a major patient care, research and teaching affiliate of Harvard Medical School and a founding member of CareGroup Healthcare System. BIDMC is the third largest recipient of National Institutes of Health research funding among independent U.S. teaching hospitals.