Girl Who Got Section of Mother’s Liver Has Surgery to Stop Bleeding

Alyssa Leanne Smith, the 21-month-old Texas girl who made medical history Monday when she received a fist-sized section of her mother’s liver, underwent a successful second operation early Tuesday morning when physicians detected blood leaking from the tissue.

The small leakage, called a hematoma, was stopped quickly, and by the time of a mid-morning press conference, physicians said Alyssa was awake, alert and doing “quite well.” Dr. Peter J. Whitington, chief of pediatric hepatology at the University of Chicago Medical Center, where the transplant took place, also noted that the transplanted liver was “functioning perfectly.”

The mother, 29-year-old Teresa Smith of Schertz, Tex., was also doing “extremely well” Tuesday morning, Whitington said. Physicians hope to have her out of bed and walking around today.

Alyssa’s father, 27-year-old John Smith, appeared at the press conference and said he had just seen his daughter. “Her eyes were kind of open and, when she saw me, her face just lit up a little bit,” he said. Alyssa was not able to speak, however, because of a breathing tube in her mouth.

“She looks great, even with the surgery and everything, she just looks great,” Smith said. He also noted that his wife, an elementary school teacher, was “in very good spirits.”

The prospects did not look so bright, however, for 15-month-old Sarina Michelle Jones of Millington, Tenn., who had been scheduled to receive part of her father’s liver today. Over the weekend, the infant developed a rare, life-threatening infection called meningococcal peritonitis, and physicians transferred her to the waiting list for a donor liver from a cadaver.

Surgeons want to implant an intact liver because it is less likely to become infected. When part of a liver is removed from a living donor, as was the case with Alyssa, the membrane that normally surrounds the liver is cut open, thereby increasing its susceptibility to infection.

Whitington said, however, that if the infection can be cleared up in a week surgeons will go ahead and transplant part of the liver from Sarina’s father, John, 20. Although the surgeons hope to perform the procedure on as many as 20 patients within the next year, Whitington said no other such surgeries are planned in the near future.

Whitington also noted that he had received many calls from other parents of children needing liver transplants and emphasized that he would consider only patients that had been referred by physicians.

Alyssa and Sarina suffer from biliary atresia, a severe and usually fatal liver disease that affects as many as 500 U.S. children each year. This is the most common reason for pediatric liver transplants.

The liver itself is a complex organ that, among other functions, produces the bile that is released into the intestine for digestion of food. The liver also removes sugar from the blood for storage and detoxifies many poisons that enter the bloodstream.

In biliary atresia, whose cause is not known, the bile ducts are blocked, producing scarring of liver tissue and loss of function. The only effective therapy for the disease is a transplant.

But as many as half of the children who need a transplant do not receive one, said Christoph Broelsch, the surgeon who performed Alyssa’s operation, primarily because of a shortage of donor livers from children who have died in accidents. The entire adult organ cannot be used because it is too big to fit in an infant’s chest cavity.

Many children with severe liver disease are not even referred to transplant centers, Whitington noted, “because their doctors don’t think we can do anything.”

Broelsch has pioneered a technique in which two of the eight distinct lobes of a liver are pared off from a cadaveric organ and implanted in the children, thereby greatly easing the need for donor organs from children. With this technique, one adult organ can be shared by two children. The liver segment grows as the child grows.

In the past three years, Whitington said, because of their use of pared down cadaveric organs, fewer than 2% of the children on the waiting list for liver transplants at the University of Chicago have died before receiving a transplant, a remarkably low percentage.

In contrast, at the University of Pittsburgh, a major transplant center that uses the technique much less frequently, 25% of the children on the waiting list have died before receiving a donor organ, according to published reports.

As many as 15 groups around the world are now using his technique for using part of adult organs, Broelsch said, although the only other group that has used one organ for two children is at University of Nebraska.

With their success in splitting cadaveric organs, the researchers said, it seemed only logical to proceed with living organ donors. ‘We were convinced from day one that that was the way to go,” Whitington said.

The use of living donors is based on the fact that as much as 80% of an adult’s liver can be removed--during surgery for liver cancer, for example--without harm to the patient. After the surgery, the liver regenerates until it reaches its previous mass.

And there are many benefits from using a living donor, Broelsch said. If the liver is from a parent, it may be less likely to be rejected, as about 20% of transplanted livers now are. And the liver is not subjected to the trauma that is normally associated with the death of the cadaveric donor and that often causes the transplanted liver to malfunction.

“I am encouraged for them,” said Dr. Ronald W. Busuttil, chief of the liver transplant program at the UCLA Medical Center, who talked with Broelsch by telephone Tuesday. But Busuttil emphasized that the surgery needs to be kept “in perspective.”

He explained: “It is totally experimental. It is going to be a while before this can be established, if ever, as a real therapeutic option.”

Times Medical Writer Robert Steinbrook in Los Angeles contributed to this story.