Woman Dies After Brief Survival With Pig’s Liver : Medicine: Historic transplant at Cedars-Sinai was intended as stopgap until human organ was found.

A Burbank woman who was kept alive with a transplanted pig’s liver in an unprecedented procedure died Monday night before she could go into surgery to receive a human liver, a spokesman for Cedars-Sinai Medical Center said.

The pig’s liver kept Susan Fowler, 26, alive for more than 30 hours until a donated human liver became available Monday, hospital officials said. But the surgery to transplant the human liver never got under way, said hospital spokesman Ronald Wise.

“Shortly before she went into the operating room, there was a serious decline in her condition,” Wise said. “She was very unstable. The team tried but couldn’t stabilize her.

“It was a heroic effort. We hoped that we could preserve her life. It was not to be.”

The effort by the Cedars-Sinai surgeons to save the woman’s life is believed to be the world’s first such use of a pig’s liver.

It follows similarly historic surgery last June at the University of Pittsburgh Medical Center involving the first use of a baboon liver in a human. The recipient of that organ, a 35-year-old man whose liver had been damaged by the hepatitis B virus, lived 71 days, then died Sept. 6 of a massive stroke.

Fowler was comatose and hours from death when she arrived by helicopter at the hospital before dawn Sunday, Wise said. She did not regain consciousness.

“We are making fresh footprints in the snow,” Wise said before Fowler died. “It is hard to say what is going to happen because it has never been done before.”

Unusual secrecy surrounded the first operation, which involved surgically attaching the pig liver to Fowler’s failing liver to take over its blood cleansing and metabolizing function.

The surgery took place early Sunday, but was not announced by Cedars-Sinai until Monday.

Wise refused to identify the six surgeons in the case, saying that they were tending to the patient round the clock and were extremely concerned about protecting her privacy.

Nevertheless, the surgical team on the pig liver transplant is believed to have been headed by Dr. Leonard Makowka. He is head of transplant surgery at Cedars-Sinai, a leading researcher in liver transplants and a protege of transplant pioneer Dr. Thomas E. Starzl, who directed the baboon liver transplant in Pittsburgh.

The use of animal parts as replacements for damaged organs in humans--called xenotransplants or xenografts--is viewed in the medical community as one answer to the critical shortage of human donors. Nationwide, at least one patient dies every day while waiting for a liver transplant, according to data compiled by the University of Pittsburgh.

Until now, however, researchers have relied upon organs from animal species most closely related to humans. Since the early 1960s, chimpanzees and baboons have supplied the kidneys, hearts and livers tried in humans. None of the patients survived more than a few months with these cross-species transplants.

Indeed, the failure to solve problems with long-term survival have led many in the transplant community to consider xenotransplants most useful as life-extending measures until compatible human donor organs are found.

Pigs’ livers have been studied for some time as temporary replacements for a failed human liver, largely because of their anatomical similarity to the human organ.

“Its size is comparable, unlike the baboon’s, which is very small,” said Dr. Ronald W. Busuttil, director of the liver transplant program at UCLA. “The vessel hookups and the bile duct hookups are also very comparable to what we see in the human.”

However, because pigs are so dissimilar to humans in other respects, such a transplant has little chance of succeeding more than a few days, Busuttil said.

He said pigs are also attractive as donors because they are not endangered species, and their use for this purpose might be less objectionable to ethicists and animal rights activists.

One of the nation’s largest animal rights groups nevertheless expressed outrage Monday at the use of the pig liver.

“We are pretty shocked that they tried it again so soon after that man died in Pittsburgh,” said Dan Mathews, a spokesman for the Washington-based People for the Ethical Treatment of Animals. He described the transplant surgeons at Cedars-Sinai as “modern-day Frankensteins” and said his group would rally outside Cedars-Sinai in protest this week.

The liver acts primarily as the body’s sewage treatment plant. It filters out toxins from the blood, routing them away from vulnerable tissues through the waste tracts.

Added to this important function are key manufacturing roles critical to human survival. The liver makes bile to aid in digestion and produces clotting factors and other components of blood.

When the liver fails, toxins are able to flow freely through the bloodstream to the brain, producing swelling, coma and, ultimately, death.