UCSD Surgeons Perform First “Domino”
Liver Transplant In San Diego County
By Jeffree Itrich
Two Rancho Penasquitos
residents, who did not know each other, recently benefited from
the first “domino” liver transplant procedure in
San Diego County.
On May 28, 2004, UCSD
Medical Center surgeons Ajai Khanna, M.D., and Marquis Hart
M.D., Director of Abdominal Transplant, transplanted a cadaver
liver into Brock Wiles, a 25 year-old patient with a metabolic
disorder who was not able to use his functional liver due to
a genetic metabolic disorder. Wiles’ liver was consequently
transplanted into My Huynh, a married father of three suffering
from liver cancer.
would likely have died without the transplants,” said
Khanna, M.D., Director of Pediatric Abdominal Transplantation
and Transplantation Research, “It was the first time we
attempted a procedure of this type in San Diego County. And
it was the first time anywhere, as far as we know, that a patient
with this type of metabolic disorder and a liver cancer patient
underwent this unique procedure. We felt confident the patients
would do well, and in fact their recoveries have exceeded our
Wiles suffered from
Maple Syrup Urine Disease (MSUD), a rare metabolic disorder
that occurs in one in 225,000 births.
affects the way the body metabolizes certain components of protein.
MSUD patients are not able to digest protein and must follow
an extremely strict diet,” said Bruce Barshop, M.D. of
the UCSD Division of Biochemical Genetics in Pediatrics.
The condition is life-threatening
and surfaces during the first week of life; many, if not most
patients lose their lives in childhood or suffer permanent neurological
damage. MSUD derives its name from the maple syrup smell of
“With a new liver
Mr. Wiles is now cured of the disease,” said Barshop.
“He can now get on with his life.”
Wiles mother, Celeste,
said she was looking forward to a more normal life for Brock
and the entire family. She said it has been a difficult struggle
to manage the unusual disease. Brock said he’s looking
forward to eating hamburgers.
Khanna said surgeons
transplanted Wiles’ liver into the patient with liver
cancer for several reasons.
“First and most
importantly, due to the long transplant waiting list Mr. Huynh
would not have survived long enough to receive a cadaver liver;
the rapidly growing cancer would have made him untransplantable,”
Khanna said. “Because Mr. Huynh did not suffer from Maple
Syrup Urine Disease and his body was not lacking the enzyme,
we felt the lack of the enzyme in the liver would not hinder
his body’s ability to use Mr. Wiles functional liver the
way Wiles’ body was unable to utilize it. It was a win-win
situation for everyone.”
Elliott Alpert, M.D.,
UCSD Liver Center Hepatologist agreed saying “the domino
liver transplant was a very unusual procedure because rarely
do we get a liver like Brock’s with just a genetic defect
that we can overcome. It gave us an opportunity to give Brock’s
liver to Mr. Huynh and help save his life.”
Although Brock had
to follow a restricted diet consisting mostly of vegetables,
doctors anticipate Huynh will not have to follow similar limitations.
The two patients finally
met at UCSD Medical Center – Hillcrest on June 9th, the
morning of their discharge and learned they lived in the same
San Diego neighborhood, Rancho Penasquitos.
The UCSD Center for
Transplantation stands alone in the region as a nationally recognized
multi-organ transplant program. No other health care network
offers such a broad spectrum of transplant programs, including
kidney, combination kidney-pancreas, pancreas, liver, heart,
lung, combination heart-lung, and bone marrow/stem cell. By
providing this array of programs in a single setting, the UCSD
Center for Transplantation offers its patients the unique advantage
of a medical team that has shared expertise across the spectrum
of transplant options. With over three decades of experience,
the UCSD Center for Transplantation has given thousands of patients
of all ages a new chance at life.
Contact: Jeffree Itrich (619)