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UCSD PERFORMS SAN DIEGO'S 1st PEDIATRIC LIVER TRANSPLANT

Father Donates Part of Liver to Baby Daughter

UCSD Transplant Center surgeons performed a liver transplant on an 18-month-old girl from San Diego, marking the first time such a procedure has been performed south of Los Angeles. The 14-hour emergency procedure, which took place Thursday, May 6, also makes history as the region's first pediatric liver transplant from a living donor.

Karla Ortega was admitted to UCSD Medical Center, Hillcrest on Friday, April 30, following a rapid onset of liver failure. Prior to her hospitalization, Karla had been a healthy, active toddler. Today she is alive, thanks to her father donating a portion of his liver. The father, Carlos Brito Aranda, and his daughter are recovering well, according to doctors.

The father's left lateral lobe, which is the smallest of the liver's three lobes, was transplanted into Karla. This segment constitutes about 15 percent of his liver, according to Marquis Hart, M.D., UCSD director of abdominal transplantation.

"A liver transplant is a very delicate, lengthy and complex procedure," said Hart. "The fact that this kind of procedure involves major surgery on a healthy donor, and a tiny, critically ill recipient, brings this to a new level of complexity. Even so, both procedures went very smoothly."

Approximately 450 pediatric liver transplants are performed each year, and of those, about 50 are from living related donors. There are only about five centers nationwide performing pediatric liver transplants from living related donors.

"We are extremely pleased with everything about this case," said Ajai Khanna, M.D., UCSD's director of pediatric liver transplantation. "Both patients are doing very well, and the initial function of the baby's new liver looks excellent."

Karla is listed in critical but stable condition, which is normal following an operation of this magnitude. Her physicians anticipate a minimum hospital stay of two to three weeks. Carlos is listed in good condition, and is expected to be released within about one week.

Karla was admitted to UCSD Medical Center, Hillcrest by Joel Lavine, M.D., director of pediatric hepatology at UCSD. When he saw her, Lavine said Karla had extreme jaundice and her blood was not clotting. After performing a liver biopsy, he found that 90 percent of her liver was not functioning, diagnosed her with idiopathic fulminant hepatic failure (rapid-onset liver failure of an unknown cause), and immediately listed her for a liver transplant. According to Lavine, the national Centers for Disease Control and Prevention reports that, for unknown reasons, there has been an increasing rate nationally in this sort of liver failure.

With her condition deteriorating, physicians felt they could not wait for a donor liver from a deceased person to come available and asked Karla's parents, Carlos and Leticia Ortega, if they would consider donating a portion of their own livers. Both agreed without hesitation. Blood tests and a physical exam indicated that her father was a good match.

The surgical team led by Hart included Khanna, James Cashman, M.D., an organ transplant fellow; Erik Wahlstrom, M.D., associate surgeon; David Frankville, M.D., chief of pediatric anesthesiology; Mark Greenberg, M.D., pediatric anesthesiology; and Joseph Kimbro, M.D., adult anesthesiology.