One hundred young patients have now received liver transplants at A.I. duPont Hospital for Children

Wilmington, Delaware
Wednesday, July 15, 2009 @ 03:16 PM EDT
by: Kelly Bothum, The News Journal

When he gets older, Ellison Moore probably will have to rely on photographs and stories from his parents in order to remember details about his stay at Alfred I. duPont Hospital for Children.

But it's a good bet the 1-year-old Memphis, Tenn., boy will always have a place in the memory of Dr. Stephen Dunn and his staff. After all, Ellison is the 100th patient to undergo a liver transplant at the hospital since the organ transplant program started in 2000.

The milestone highlights the success of the multidisciplinary transplant team, which has a reputation for tackling complicated cases like Ellison's.

The duPont Hospital is one of three pediatric transplant programs in the region -- Children's Hospital of Philadelphia and St. Christopher's Hospital for Children in Philadelphia are the other two -- and has a one-year survival rate of 92 percent for transplant recipients.

"We were so lucky to be brought here," said Lauren Moore, Ellison's mother, who is staying at the Ronald McDonald House while he recuperates. "We feel truly blessed."

Ellison was just 10 months old in December when he was diagnosed with hepatoblastoma, a childhood cancer of the liver. He underwent chemotherapy treatments at St. Jude Children's Research Hospital in Memphis and twice had surgery there to remove cancerous cells that spread to his lungs.

Because of the aggressiveness of Ellison's cancer, a liver transplant was recommended as his best course of treatment. But the transplant doctors at St. Jude weren't comfortable handling a case as complicated as his.

Dunn was involved in Ellison's case because of his affiliation with the Children's Oncology Group, a clinical trial cooperative that works with hospitals across the globe. As one of four pediatric surgeons serving on an oncology committee for children with hepatoblastoma, he reviews patient cases for possible treatment.

Seeing that Ellison's cancer was aggressive -- he was diagnosed with stage IV hepatoblastoma, a disease with an 80 percent mortality rate -- it required an equally aggressive treatment. He offered to step in and handle the transplant if the family came to Delaware.

"He was the only doctor to take an interest," Moore said.

Children needing transplants face different challenges than adults, most notably, the lack of pediatric organs, said Richard Hasz, vice president of clinical services for Gift of Life, the nonprofit organ and tissue donor program that serves Delaware, southern New Jersey and eastern Pennsylvania. When a child receives a pediatric organ, it's because another child has died and the family has agreed to donation. About 60 percent of families who lose a child say yes to donation when given the opportunity, Hasz said, but it requires the family to make a difficult decision during an already agonizing time.

Nationwide, there were 613 liver transplants performed on children under the age of 18 last year, according to statistics from the Organ Procurement and Transplantation Network.

Technical aspects of the transplant operation also present challenges. Blood vessels are smaller in children than adults, complicating the surgery. Kids also tend to get sick more from colds, the flu and other ailments than adults, and those illnesses can increase their risk of transplant-related problems, Dunn said. But in general, children's bodies accept transplants pretty well, increasing their chances for long-term survival. In many cases, children undergoing transplants eventually get off the immune-suppressing drugs that reduce the chances of the body rejecting the transplanted organ.

One of the biggest causes of liver transplants in children is biliary atresia. It occurs in newborns when the common bile duct between the liver and the small intestine is blocked, damaged or never formed before birth. About 90 percent of children diagnosed with the condition will need a transplant, usually by the time they are 2, Dunn said. Autoimmune diseases and some metabolic conditions also can cause illness in children to the point that a transplant is needed.

Hepatoblastoma typically is one of the rarest causes for a liver transplant, but because of Dunn and his team's expertise in dealing with the condition, 15 of the 100 liver transplants at duPont Hospital have involved children with the disease.

Locally, 66 children are on the United Network for Organ Sharing waiting list, mostly for livers, kidneys and hearts, Hasz said. There's no set amount of time that a child will wait because the list is driven by who is in most critical need. For example, children with hepatoblastoma who don't get a liver within the first month on the list are bumped up to higher priority because of the severity of their condition.

In Ellison's case, he waited more than a month without an offer of a liver. Plans were readied for his mother to donate about 20 percent of her liver -- the amount needed for a child's liver to function -- through a procedure called a living donor transplantation. But late last month, just before Moore was to donate, a donor liver from a 2-year-old child was made available.

Ellison had the surgery on Memorial Day and has made significant strides since.

"He's just doing wonderful," said Moore. "He's smiling and he's laughing and he's eating."

The family will be able to go home in another week or so, Dunn said. Ellison will have more chemotherapy once he returns to Memphis. He will continue to be closely monitored for cancer recurrence and potential organ rejection.

The five-year survival rate for children undergoing liver transplants is about 75 percent, Dunn said. Success also depends on what other interventions were involved prior to the transplant and if there are complicating factors, but advances in transplantation continue to push survival rates higher.

"It's very clear if you can make it five years and show no signs of recurrence, you're probably going to be very old by the time you die," Dunn said.

modified: Wednesday, August 19, 2009 @ 09:17 AM EDT
created: Wednesday, July 15, 2009 @ 03:22 PM EDT

About Nemours

Nemours, one of the nation’s largest pediatric health systems, is dedicated to achieving higher standards in children’s health. Nemours offers an integrated spectrum of clinical treatment coupled with research, advocacy, and educational health and prevention services extending to all families in the communities it serves. Starting with Alfred I. duPont’s bequest over seventy years ago, Nemours has grown into a multi-dimensional organization offering personalized clinical and preventive care focused on children.

Nemours owns and operates the Alfred I. duPont Hospital for Children in Wilmington, Delaware and major children’s specialty clinics in Delaware (Wilmington), Florida (Jacksonville, Orlando and Pensacola), Pennsylvania (Philadelphia and Bryn Mawr) and New Jersey (Atlantic City and Voorhees). Having recently received preliminary approval from the State of Florida, Nemours will establish a new full-service children’s hospital as part of an integrated pediatric health campus in Orlando. KidsHealth.org, the world’s most visited pediatric health care Web site for parents, kids and teens, is a project of Nemours.

Nemours employs over 4,400 individuals, including 430 pediatric physicians, specialists and surgeons who cared for approximately a quarter of a million children in 2007. The organization’s goal is to align with parents, physicians, community leaders, children’s advocates and elected officials to ensure optimal wellness for every child. Additional information about Nemours can be found at www.nemours.org.