Rare domino liver transplant saves two lives

Domino liver transplant saves two at University of Maryland Medical Center

Betty Dzielski's liver was slowly destroying her heart.

If the Pasadena resident didn't get a liver transplant, she would die eventually, doctors told her.

The 52-year-old suffered from a rare genetic disease, familial amyloid polyneuropathy, that caused her liver to produce a protein that travels to other organs and sickens them. She had a stroke after the protein had begun to deposit in her heart, and she also had trouble walking.

Dzielski underwent a lifesaving liver transplant in October. And although her old liver threatened her life, in the end it saved someone else's.

During a nearly five-hour procedure at the University of Maryland Medical Center called a domino liver transplant, Dzielski received a liver from a deceased organ donor and then gave her liver to an Owings Mills woman.

Other than the protein defect, Dzielski's liver was healthy, so it could be transplanted into someone else. But it needed to be an older person who likely wouldn't live long enough for the symptoms of familial amyloid polyneuropathy to appear. It typically takes years for the disease to show, which is why Dzielski didn't have problems until her 50s. In domino procedures, these livers are given to people at least 60 years of age.

"Liver transplants are already complicated, and adding the domino aspect makes them even more so," said Dr. John LaMattina, director of the living donor liver transplant program at the University of Maryland Medical Center, who was part of the team that performed Dzielski's transplant.

Dzielski had to go through extensive testing to ensure that her liver was healthy. A group of doctors decided that a domino procedure could work in her case.

"We decided that not only could we help her with her problem, but she could help someone else," said LaMattina, also an assistant professor at surgery at Maryland.

Dzielski said it didn't take much to convince her to agree to the procedure.

"Here, I had this liver that was only bad for me, why not give it to someone else that it could help?" she said. "I needed a transplant either way."

Dzielski's liver was given to Michelle Martin, a 70-year-old who recently moved into an assisted-living home in Owings Mills after complications of liver disease made it hard to take care of herself. She had tremendous fluid buildup in her belly and had developed a hernia. Her intestines got stuck in the hernia sac, her doctor said. She also complained of memory problems, which can occur when toxins build up in the brain.

Dzielski was higher on the national registry based on three universal measurements of liver and kidney function and was told she would have a better chance of a transplant because she would be helping someone else.

Martin wasn't as high on the registry based on those measurements, though still quite sick. But LaMattina said she was the best candidate at the Maryland hospital for Dzielski's liver, based on her age and disease. (Living donors typically know the recipients of their livers, but if not U.S. policy allows the organs to stay at the same hospital.)

LaMattina and the other doctors made the swap. It was only the third time doctors at Maryland had performed the surgery, a rarely used procedure that has been around since the 1990s. A total of 1,085 domino livertransplantations had been performed around the world as of 2012, according to The Domino Liver Transplant Registry. Of those, 66 were in the United States. (The list only includes transplants registered by doctors, so it may not include all of them.)

The surgery went smoothly for both women, who say the recovery, as expected, has been slow. Like anyone who gets a transplant, both must take immunosuppressants so their bodies won't reject the livers. They met six days after the procedure in the hospital, where they were neighbors and would talk and socialize.

Dzielski, a credit manager, said her quality of life has gotten much better. There is no longer numbness in her legs. Family members, including her sister, have died from the genetic disorder from which she suffers, but now she hopes for a long life.

"Some of the deterioration in the heart will be there forever, but it won't get any worse," she said.

Martin also is grateful an alternative came along. She used to get sad about not being able to live at home and decorate her house for the holidays as she once did. Doctors say her symptoms are now gone and she continues to improve at the assisted living center for now.

"If they had not been able to get me this liver, what they were doing for me would notlast that long and I would getmuch sicker," Martin said. "I was thinking I wouldn't have very much time, but now I think I'll live long enough to see my granddaughter, who is only 3, grow up and get married."

amcdaniels@baltsun.com

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