Traveling Liver Transplant Doctors Help Children

Disease knows no borders, and neither do our transplant surgeons and the pediatric liver transplant team.

UPMC Children’s transplant surgeons travel outside the United States to perform surgery on desperately ill children whose countries have yet to develop pediatric liver transplant programs capable of saving their lives.

“As an extension of our mission here to care for children through transplantation, we do surgery in other countries, when possible, or we assist teams there who are doing the surgery,” says George V. Mazariegos, MD, director of the Pediatric Abdominal Transplant Program.

UPMC Children’s Hospital of Pittsburgh also offers formal and informal training programs to share with doctors from other nations the knowledge its transplant surgeons have gained from decades spent investigating and advancing pediatric transplant techniques, immunosuppression, and post-transplant care.

UPMC Children’s Hospital operates one of the most experienced, active and successful pediatric liver transplant and pediatric intestine transplant programs in the world. The hospital has performed more than 1,900 abdominal transplants — including liver, kidney, small bowel, and intestinal transplants — since 1981 when the program was established by transplant pioneer Thomas Starzl, MD, PhD.

A willingness to accept the most difficult pediatric liver transplant cases has not prevented the Liver and Intestine Transplantation Program from achieving pediatric liver transplant survival rates that are among the best in the world. UPMC Children’s one-year patient survival rate for pediatric liver transplant patients is 95 percent. More than 96 percent of Children’s pediatric liver transplant patients are surviving beyond the three-year anniversary of their surgeries.

International Pediatric Liver Transplants

Pediatric liver transplants became possible in many countries when, in recent years, doctors began to successfully perform living donor transplants.

In the United States, most transplanted organs come from deceased donors. This reliance on cadaveric organs is possible because of the nation’s large and technologically advanced donor organ network. But many other countries do not have such a system and cannot reliably harvest and preserve cadaveric organs for transplantation.

Transplant surgeons are now able to take a section of an adult liver and transplant it into a child or an adult. In general, a person can survive with only 30 percent of his or her liver. Only 25 percent of an adult liver is needed by a child to survive, making it less risky to donate to a child than to an adult, who needs about 60 percent of the donor’s liver to survive.

Since 2001, Children’s transplant surgeons have twice traveled to Peru and once to El Salvador to perform pediatric liver transplants. In each case, the transplant surgeons donated their time and skills to perform these international pediatric liver transplants. The first took Dr. Mazariegos and John J. Fung, MD, PhD, formerly chief of the Division of Transplantation Surgery at the Thomas E. Starzl Transplantation Institute, to Peru to give an 18-month-old boy a section of his mother’s liver and a chance to survive liver disease. Today, the boy is doing well.

Although Children’s doctors cannot remain in a country while the child recovers, they are able to monitor the child’s postoperative progress over the Internet through e-mail from attending physicians in the child’s country. In both Peru and El Salvador, efforts are under way to develop their own pediatric liver transplant programs.

Training Other Doctors and Surgeons in Pediatric Liver Transplant

Children’s transplant surgeons are helping address the needs of children in other countries who someday may need a pediatric liver transplant or intestine transplant by offering extensive training for foreign doctors and medical students.

The hospital offers a formal, two-year transplant fellowship program, which covers all aspects of care of transplant patients and patients with end-stage organ failure. In addition, an informal visiting surgeon program allows foreign doctors to spend time at Children’s learning about transplantation, primarily by observing operating room procedures, attending conferences and joining rounds with hospital transplant services.

These training programs have attracted doctors from a broad range of countries, including Brazil, China, Colombia, Croatia, Dominican Republic, Germany, Iran, Japan, Mexico, Peru, the Philippines, Russia, Saudi Arabia, Turkey and Venezuela.

Intestine Transplants: In the Future

Small bowel transplant survival rates among Children’s young patients are among the highest in the world. Unfortunately, transplant surgeons so far have been unable to perform these operations in countries that lack the system necessary to procure intestines from deceased donors.

Live-donor intestine transplantation is still in its early stages. The procedure, at the moment, is very labor-intensive and requires extensive postoperative care. The intestine, in general, is a difficult organ to successfully transplant. Small bowel transplants expose patients to a greater likelihood of organ rejection and infection than do pediatric liver transplants, pediatric kidney transplants and pediatric heart transplants.

Traveling to other countries to perform living-donor intestine transplants will likely become more feasible in coming years with further medical advances and experience. In recent years, advances in immunosuppression protocol and ways to reduce the risk of infection have greatly improved the survival rates of children who receive an intestine transplant at UPMC Children’s Hospital of Pittsburgh and have contributed to a better quality of life following surgery.