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Rare Transplant Performed At U.VA. Gives Child Second Liver, Second Chance At Life

Surgeons at the University of Virginia Health System performed a rare type of liver transplant several months ago to save a seven-year-old boy's life. The transplant, the first of its kind performed at U.Va., involved inserting an additional liver next to the boy's natural liver with the hope that his natural liver would begin to function again and he would be spared a lifetime of dependency on immunosuppressant drugs.

Nicholas Ribble of Winchester, Va., underwent the transplant, called an auxiliary heterotopic transplant, on August 14th after suddenly going into liver failure for no apparent reason. A biopsy of his liver showed that it was trying to regenerate, yet it wasn't happening fast enough, said Dr. Timothy Pruett, professor of surgery and chief of the Transplantation Division for U.Va.'s Charles O. Strickler Transplant Center. Without a transplant, the chances were greater than 90 percent that Nicholas would have died. Fortunately, a donor organ became available within a few days.

We decided on this type of transplant because it gave him the best possible chance of a normal life, Pruett said. In the best-case scenario, the donor liver serves as a backup generator until his natural liver comes back, and he won't need immunosuppressant drugs for the rest of his life. Worst-case scenario, his liver doesn't come back and the donor liver functions in its place just like a regular transplant.

According to the United Network for Organ Sharing, auxiliary heterotopic liver transplants are extremely rare. A study published in the journal Hepatology in 1996 reported only 30 such transplants in all of Europe. Pruett believes that fewer than 75 have been performed in the United States.

After several common post-transplant complications, Nicholas is back at home and has normal liver function. Pruett said that if Nicholas' natural liver has resumed functioning, he will gradually be removed him from immunosuppressant drugs, causing his body to reject the donor liver. If his natural liver has not resumed functioning, it will shrivel away and the donor organ will take over. Pruett's team plans to perform tests in December to determine if it's the natural or donor liver that is functioning.

It's been an unbelievable experience that we've been through, said Teresa Ribble, Nicholas' mother. Nicholas went from being perfectly healthy to on the brink of death in two weeks. Now his strength is coming back a little more each day. We're so grateful to everyone at U.Va. for saving his life. This Thanksgiving will be especially meaningful for our family.

For more information, call Dr. Timothy Pruett, professor of surgery and chief of the Transplantation Division for U.Va.'s Charles O. Strickler Transplant Center, at (804) 924-9462.

November 23, 1998