Advances in Pediatric Liver Surgery
The Center for Liver Disease and Transplantation (CLDT) in collaboration with pediatric surgery at NYP/Columbia is making noteworthy advances in the care of children with serious liver conditions, and is a national leader in this field. “Our superior outcomes are the result of unique surgical training, high patient volume, and unsurpassed multidisciplinary collaboration,” says Jean C. Emond, MD, Chief of Transplantation Services at Columbia. “The CLDT brings together leading experts hepatobiliary surgery, hepatology, gastroenterology, oncology, radiology, diagnostic testing and pathology to provide exceptional patient care.”
“We have an impressive list of innovations in many areas,” says Tomoaki Kato, MD, Surgical Director of Pediatric Liver Transplantation. These include:
The CDLT is one of a few centers in the nation offering the full range of therapies for hepatoblastoma, the most common liver cancer in children. A multidisciplinary team consisting of oncologist Darrell Yamashiro, MD, PhD, liver surgeons Jean Emond, MD, Tomoaki Kato, MD and Adam Greisemer, MD, and pediatric gastroenterologist Mercedes Martinez, MD, has moved patient survival rates as high at 90%. Morgan Stanley Children’s Hospital is one of a small number of centers in the world researching the genetics of this disease and creating personalized treatments through molecular biology.
After recurring fevers, one year-old Skylar had high platelet counts and infection. Later a golf-ball sized lump appeared under her sternum and imaging showed hepatoblastoma. Dr. Yamashiro provided neo-adjuvant chemotherapy to shrink Skylar’s tumor and Dr. Kato was able to perform the surgery with fewer risks of complication. Through the Center for Comprehensive Wellness, Skylar’s medical team integrated alternative therapies, supportive care, and survivorship wellness into her treatment. She is a healthy, cancer-free 5 year-old.
New Fibrolamellar Program
Fibrolamellar hepatocellular carcinoma is a rare liver cancer generally found in adolescents and young adults with no history of liver disease. The CLDT has launched a comprehensive multidisciplinary program offering expert surgical removal of these tumors and employing other therapies to shrink the tumors and slow the spread of this disease.
The Kasai procedure for Biliary Atresia
The CLDT team collaborates with Dr. Steven Stylianos and the division of pediatric surgery at NYP/Morgan Stanley Children’s Hospital for the primary repair of biliary atresia, a congenital defect that causes bile to back up into the liver, usually resulting in the need for a liver transplant within the first two years of a child’s life. “Recent analysis shows that roughly 70% of children operated on for this condition at MSCHONY were jaundice-free two years after surgery, about 15 to 20% better than the national average,” says Dr Stylianos.
The combined expertise of our pediatric surgeons and the multidisciplinary CLDT team are world authorities on the Kasai procedure, developed in Japan to treat this condition. While most children with biliary atresia require a liver transplant a year or two after birth, those who undergo the Kasai procedure at MSCHONY may not require a transplant until age 10 to 15. By then the donor pool is larger and these patients will not have been on immune suppression from an early age.
The Mesorex Shunt for Portal Vein Thrombosis
The CLDT is one of the few specialized centers in the country to offer the Mesorex Shunt to children with portal vein thrombosis (PVT). This procedure is considered the gold standard for PVT in the absence of cirrhosis. “The original approach was a shunt that caused some subclinical issues with memory,” says Dr. Kato. “Yet the Mesorex shunt eliminates these side-effects, allowing us to restore the blood flow to the liver by bypassing the area of clotting.” First described in the 1990s, this procedure is so technically demanding that only a handful of surgeons, including Dr. Kato, have perfected it.
The CLDT has developed a partial liver transplant for pediatric patients, obtaining exceptional results. “In this approach, surgeons take a piece of the child’s liver out then attach the remaining portion to a partial donor liver,” says Dr. Kato. “The child’s own liver regenerates and after a while, the transplanted liver shrinks and disappears. Once that happens, there is no more need for immune suppression.”
"For years, parents endured the stress of being on the UNOS waitlist while watching their babies get sicker, says Alyson Fox, MD, Medical Director of the Living Donor Transplant Program. “Now they can schedule a life-saving surgery with a living donor.” ABC-TV recently featured a CLDT success story where a godmother gave a portion of her liver to save a child with biliary atresia. Friends and family members are often willing to step forward once they learn that the donor surgery is minimally invasive and recovery fairly fast.
Surgeons take the smallest portion of the donor liver—the left lateral segment—to implant in the child. The donor’s liver quickly grows back to normal size while the transplanted portion continues to grow with the child. The CLDT’s outcomes for pediatric living donor liver transplants are outstanding with a one-year survival rate of 100%. Emerging data also shows that children with liver transplants may eventually be able to go off immunosuppression medication, allowing them a better quality of life. This seems especially true for those with living donors. The CLDT is one of the largest living donor centers in the nation. Read more here.
Tumors Affecting Multiple Organs
The CLDT is able to help patients other medical centers turn away. Seven year-old Heather McNamara had a cancerous tumor entangled with her liver and other vital organs. Other hospitals refused to operate, telling Heather’s parents she had less than year to live. Dr. Kato, a pioneer in multiple organ transplantation, removed the affected organs, resected the tumor, and replaced them. Heather is a normal, healthy child today.