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November 2010 | Volume 2, No. 4

Pediatric living-related liver transplant at ISMETT

For the first time in Italy, a laparo-scopic, pediatric living-related liver transplant was performed, at the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT). The left liver lobe was totally procured in a laparoscopic procedure, a technique that has been used mostly for kidney procurement.

The surgery was performed in May on a 10-month-old baby girl from Sicily. The child’s 20-year-old mother donated the left lobe of her own liver. Since birth, the patient has been affected by a severe form of cholestatic liver disease impairing her liver function. Transplantation was her only hope of survival. Living-related liver transplantation is a viable option because of the organ’s ability to regenerate. In just a few weeks’ time, both the donor’s and recipient’s livers have regenerated to normal size.

Laparoscopy is minimally invasive, with a shorter recovery time than conventional surgical procurement, reducing risks for the donor. In addition, it affords a more detailed view of the liver’s anatomical structure, making the procedure safer. The procurement was performed by ISMETT’s team in collaboration with the General Surgery and Transplant in Uremia and Diabetes Patients Unit of Pisa’s University Hospital, headed by Prof. Ugo Boggi. The portion of liver was isolated with instruments inserted through small holes in the abdomen and procured through a small incision over the pubis. The transplant followed immediately and the procedure was a success.

ISMETT surgeons in the operating room

The child’s mother was discharged nine days after the procedure, and the baby girl was discharged in the following days. She stayed in Palermo for several weeks for routine follow-up before returning home.

“Mother and daughter are fine,” says Marco Spada, MD, PhD, chief of Pediatric Surgery at ISMETT. “The procedure was a success and the child’s liver has started to function properly. At ISMETT, for some months now we have had a minimally invasive laparoscopic surgery program performing very complex procedures. Laparoscopic liver procurement is a very complex technique used only in top European and North American centers.”

ISMETT is a center of referral for everything concerning pediatric liver surgery. ISMETT ranks among the most active centers in pediatric liver transplantation for both volume and quality of procedures.

“This minimally invasive technique makes liver donation more tolerable and safe,” says Bruno Gridelli, MD, medical and scientific director, ISMETT. “ISMETT continues to bring advanced techniques and therapies in the field of transplantation and highly complex diseases to Sicily. ISMETT is becoming more and more a point of referral not only for Sicilian patients, but for other regions and countries as well.”


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