UCSD Patient Given 2nd Liver Transplant

A middle-aged Linda Vista woman who became UC San Diego Medical Center’s first liver transplant patient almost a month ago underwent surgery a second time Sunday night because her body rejected the first organ.

At an evening press conference held minutes before the complicated procedure was to begin, the woman’s doctors announced that she had failed to respond to drugs aimed at preventing her immune system from rejecting the new liver.

“On Friday we knew we were in a desperate situation,” said Oscar Bronsther, who heads the liver transplant team of 16 surgeons and support staff. “We knew there was no way to stop the rejection and that a second operation was necessary.”

The transplant was expected to last six to 36 hours. Bronsther, who listed the woman’s chances of survival at 50-50, said the second surgery would be “much, much more difficult” because it will involve the intricate reconstruction of arteries and the bile duct.

The recipient, a mother of five children, is in her mid-40s and has requested anonymity. She suffers from primary biliary cirrhosis, a disease caused by obstruction of the bile ducts that was expected ultimately to prove fatal.

On March 9, the woman received the new liver in a 10-hour operation that doctors immediately proclaimed a success. It was the first surgery under UCSD’s new transplant program. The hospital intends to cover the cost of both of this patient’s surgeries--estimated at $160,000 apiece--because she cannot afford it.

Bronsther said that his patient had left the intensive care unit and appeared to be “recovering very well” until the seventh day after the transplant, when she began to show signs of rejecting the organ.

Because some measure of rejection occurs in approximately 80 to 90 percent of all liver transplant patients, doctors were not yet alarmed. They began treating her with a monoclonal antibody that has been available for only eight months.

That drug, however, can only be administered for two weeks because of side effects. When it was discontinued, her condition worsened, and another line of therapy was tried. In all, a combination of four drugs was administered, to no avail.

On Sunday, the woman’s bilirubin level was 18 times normal. Bilirubin is secreted by the liver; when the level rises, it is an indication of malfunction and can cause jaundice.

The new liver was obtained from the body of a small child and flown down from a hospital in Washington state Sunday by a “harvesting” team from UCSD. Unlike the first implanted organ, this liver is of a different blood type--a situation likely to cause additional complications for the patient.

“We waited three months for (an organ of) the right blood group the first time,” Bronsther said. “We can’t do that now. Her life is measured in days. In our judgment, this is the right move.”

When asked whether the patient’s setback has raised doubts about UCSD’s fledgling liver transplant program, Bronsther said, “A single case going bad is not going to shake my confidence or the (surgical) team’s confidence.”

The surgeon noted that statistics gathered from studies at UCLA and the University of Pittsburgh transplant centers have shown that a second organ is necessary in about 20 percent of all liver transplant cases, Bronsther said.

Meanwhile, a second liver transplant patient at UCSD is in critical but stable condition. The recipient, a 42-year-old North County man whose name also has been withheld, underwent surgery on April 1.