5-month-old, 4 pound infant receives lifesaving liver transplant

A 5-month-old New York infant received a lifesaving liver transplant for advanced liver failure diagnosed following her birth 10 weeks premature. One of the smallest babies ever to successfully receive a liver transplant, she weighed 4 pounds at the time of the surgery.

The surgery was performed in February and was led by Dr. Tomoaki Kato, surgical director of liver and intestine transplant programs at NewYork-Presbyterian Hospital/Columbia University Medical Center, and chief of abdominal organ transplantation and professor of surgery at Columbia University College of Physicians and Surgeons.

"Performing a transplant in a premature infant this size is a major challenge where any technical issue would have been fatal, but it was the only option," says Dr. Kato. "Most babies born with her condition would not have the chance to grow up. This surgery shows that transplantation is possible -- although only at an academic medical center with appropriate resources and only with focused teamwork and dedication."

In the weeks after being born on Dec. 3, the patient was referred to NewYork-Presbyterian/Morgan Stanley Children's Hospital where she was diagnosed with an irreversible liver injury of unknown origin. Cared for in the neonatal intensive care unit, she was on a ventilator and had dangerous fluid buildup in her abdomen and difficulty feeding. After being on the organ waitlist for two weeks, a replacement liver became available in Florida.

"The donor organ wasn't a matching blood type and it was substantially larger than her diseased organ, but it was critical that we proceed. To accommodate its size we created an artificial abdominal wall using a Gore-Tex mesh," explains Dr. Kato. "Unlike other organs, the liver has the unique ability to adapt itself to the patient's body. In this case the organ is making itself smaller. As she grows, her new liver will grow with her."

In the weeks following the surgery, the patient started recognizing her mother and responding to her by smiling. The child has also gained the ability to get nutrition through a feeding tube rather than intravenously. Her liver function normalized, and soon after the Gore-Tex mesh was removed and her abdomen closed.

Her medical care has been overseen by Dr. Steven Lobritto, medical director of pediatric liver transplantation at NewYork-Presbyterian/Morgan Stanley Children's Hospital and associate clinical professor of pediatrics and medicine at Columbia University College of Physicians and Surgeons.

"While she is on immunosuppressant medication and received a blood-type mismatched organ, rejection is usually not a major issue in babies, whose bodies can more easily accept an organ than someone who is full grown," says Dr. Lobritto.

Collaboration With the Neonatal Intensive Care Unit
According to Drs. Kato and Lobritto, the success of this transplant was a direct result of a novel transplant collaboration with the neonatal intensive care unit.

The patient's tiny size and medical issues related to prematurity meant that she may not have received optimal treatment in the pediatric intensive care unit, where childhood transplant patients are normally treated. "Accommodating the patient in a NICU setting required thorough on-the-spot training for clinicians and caregivers at every level," says Dr. Lobritto.

Dr. Ulana Sanocka, the neonatologist in charge of caring for this transplanted child at NewYork-Presbyterian/Morgan Stanley Children's Hospital and an associate clinical professor of pediatrics at Columbia University College of Physicians and Surgeons, says: "It was a very rewarding collaborative experience. Everyone worked around the clock to ensure she received the best care possible."

Special Note to the Media: NewYork-Presbyterian physicians and surgeons are available for interviews about the surgical procedure. At the parents' request, the patient is not available for media interviews.