New Liver

Suddenly and mysteriously, when Jonathan was an infant, his liver began to fail. At 8 months, a transplant was his only hope. His parents took a chance on an unusual operation: He had a transplant, but part of his own liver was left in place in the hope that it might eventually recover so that the donor organ would no longer be needed. If that happened, the anti-rejection drugs would be stopped and, with luck, Jonathan’s immune system would destroy the transplant, leaving his own liver to do its job.

The advantage to this approach was that it would leave Jonathan free of the lifetime of powerful anti-rejection drugs that transplant patients normally require.

The gamble paid off. Jonathan’s liver grew back, the transplant is gone, and the once-fragile little boy is now a powerhouse in the gym.

But for all its apparent promise, the operation his family chose has not really caught on — to the dismay of Jonathan’s surgeon, Dr. Tomoaki Kato of NewYork-Presbyterian Morgan Stanley Children’s Hospital in Manhattan. Few children who need liver transplants are candidates for the procedure, and other surgeons are wary because it is complex, lengthy and riskier than a standard transplant. And it doesn’t always work: The children’s own livers do not always recover.

Even so, Dr. Kato believes that doctors should be performing the surgery, called auxiliary partial orthotropic liver transplantation — more often, and that it should at least be considered for any child under 10 who needs a transplant because of acute liver failure. The total who would qualify is small, maybe only a few dozen children a year in the United States, but the prospect of a normal life without anti-rejection drugs makes it well worth considering, Dr. Kato said. The drugs suppress the immune system and can increase the risk of infections, cancer and other health problems.

Article