New laparoscopic procedure for living-donor liver transplantation makes donation easier

Pon family picture

It was only after his liver transplant that Felix Pon’s personality began to shine. His rare liver disease left him pale yellow, itchy, exhausted and barely able to smile. He makes up for that today by greeting everyone he meets with a big grin and a cheery hello.

“It was like a veil being lifted after his liver transplant. His good-natured, friendly personality came through,” says his mother, Katie Gilmer Pon.

Felix is ​​special in that he is the first infant to receive a living-donor liver transplant using an organ laparoscopically harvested from an adult donor. Stanford Medicine Children’s Health is the first hospital to perform this procedure on the West Coast. Katie gave up a small segment of her liver to save her son.

“The surgery was more successful than our wildest dreams,” said Andrew Bonham, MD, surgical director of the Live Donor Liver Transplant Program and Pediatric Intestinal Transplant Program at Stanford Children’s Health and associate professor of surgery at Stanford Medicine. “We’re used to complications from liver surgery, so I’m very glad this went smoothly.”

The advantage of the laparoscopic procedure is that donors spend less time in the hospital, recover faster with less pain, and avoid the scarring of major open surgery. It requires six small incisions instead of one large incision that standard open surgery requires. Katie was doing well enough to visit Felix at his bedside the day after the operation.

“Living-donor laparoscopic surgery is common in Korea and other Far Eastern countries, but in the United States only a handful of medical centers perform the procedure, which is complex and technically demanding,” says Dr. Kazunari Sasaki, clinical associate professor of surgery and new member of the liver transplant team.

dr Sasaki was recruited to Stanford because of his extensive experience in laparoscopic donor organ harvesting, which requires two surgeons to ensure patient safety. Stanford Children’s Health has been performing living-donor transplants for more than 20 years. Having a minimally invasive option for potential donors is exciting.

Felix was born with biliary atresia, a rare liver disease that affects tubes in the liver called the bile ducts. It often leads to liver damage and cirrhosis, which can be fatal if left untreated. Biliary atresia is the most common reason for liver transplantation in infants. It causes jaundice, a buildup of bilirubin, the yellow substance that normally passes through the liver. Jaundice causes yellow eyes and yellow, itchy skin.

“A few days before his 1 month spa appointment, Katie noticed that his eyes looked yellow. She spoke to the pediatrician about it and Felix had a Kasai procedure the next week,” says Evan Pon, Felix’ father.

Felix received the Kasai Procedure at his local hospital in Portland, Oregon. Part of his intestines was passed up to the liver to create a channel for bile to escape. The Kasai is usually the first treatment for babies with biliary atresia.

“We knew the Kasai probably wouldn’t work long-term and that he would need a liver transplant. But the living donation process is daunting to think about. We had to persuade ourselves to do it, but once we did, we were relieved and wanted to move on,” adds Evan.

Felix was ill, but not ill enough to be at the top of the transplant list. According to figures from the United Network for Organ Sharing, the average waiting time for a liver transplant nationwide is 8.7 months. Stanford Children’s Health, which has one of the busiest liver transplant programs in the country, has a better record, with an average wait time of 2.8 months.

“With a living donor, the procedure can be scheduled if the recipient is not seriously ill and is therefore reasonably well,” says Dr. Bonham. “The liver is the only organ that can regenerate, with donors making a full recovery in about six weeks. But living donors still face risks.”

The family chose the living donation option because Felix was low to medium on the donor waiting list, which could have meant a longer wait for him and a higher risk of dangerous complications over time. At first, Evan was rated as a living donor, but he wasn’t a good match. So Katie stayed, who didn’t hesitate.

On the day of the procedure, the surgical team – consisting of three doctors, two anesthesiologists and specialist nurses – assembled in an operating room to remove part of Katie’s liver. To perform the laparoscopic live liver donation surgery, they inserted surgical instruments with a tiny light and a camera attached to it. The camera provides a three-dimensional view of the donor’s anatomy, making it easier for doctors to navigate inside.

“The use of a 3D camera in laparoscopy speeds up the operation and leads to better results,” says Dr. sasaki

dr Bonham has performed many laparoscopic surgeries on patients with liver tumors and cysts, but operating on a person with a healthy liver presents unique challenges. You need to keep blood flowing to keep the donor’s liver alive, so blood vessels need to be preserved . In the end, the surgeons removed just 15 percent of Katie’s liver and extracted the tissue through a 3.5-inch skin incision along her bikini line.

The fresh organ was rinsed with preservative, placed in an ice bucket and taken to a neighboring operating room where baby Felix was waiting. A separate team of surgeons, led by Carlos Esquivel, MD, PhD, director of the pediatric liver transplant program, and Amy Gallo, MD, surgical director of the pediatric kidney transplant program, stitched the liver in place. They watched it spring to life as it turned a healthy pink and began producing bile.

The couple chose Stanford Children’s Health because of its reputation and also because Evan’s parents live in nearby Sunnyvale, making it convenient. They also appreciate that the liver transplant program has an outreach program in Portland, one of several locations out west. In this way, Felix can be looked after close to home for the rest of his life.

“We felt good about having chosen Stanford. We knew we were going to get great care,” says Evan. “We were impressed by all the doctors and nurses.”

Felix with siblings

Within a few weeks, Katie’s pain subsided. For the first month she felt weak as her liver grew back to its original size. The help of the family who served as caretakers to Katie, Felix and his older brother Kieran was needed and appreciated. It has been three months since the transplant and both mother and baby have made a full recovery.

“Felix’s liver values ​​are great. He’s off some immune-suppressing drugs, gaining weight, and hitting milestones,” says Katie.

dr Bonham hopes the prospect of a laparoscopic procedure will encourage more people to donate liver tissue. People get back to normal fairly quickly, with minimal scarring and, most importantly, with the satisfaction of giving a child the chance to live a full life.

Learn more about becoming a living donor >

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