Originally Released: October 20, 1999
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MAN DONATES OVER HALF OF HIS LIVER TO HIS SISTER IN UM MEDICAL CENTER'S FIRST LIVING DONOR LIVER TRANSPLANT

A 47-year-old North Carolina man has donated 60 percent of his liver to save the life of his 45-year-old sister who had cancer that had spread to her liver. The transplant, on October 12, was the first adult living donor liver transplant performed at the University of Maryland Medical Center in Baltimore. Both the donor and recipient went home the following week.

A year ago, the liver recipient, Kathleen Zieger from Germantown, Maryland, was diagnosed with a rare form of stomach cancer, called gastric leiomyosarcoma. She had surgery to remove part of her stomach and chemotherapy, but the cancer had already spread throughout her liver. Zieger's only option for a cure was to replace her diseased liver with a healthy one. Her brother, William Maryman, who lives with his wife and three daughters in Charlotte, North Carolina, offered to donate.

"We are aware of only three other liver transplants performed in the U.S. for patients with this type of stomach cancer. Our transplant was only the second of these that involved a living liver donor," says John Colonna, M.D., a transplant surgeon who is director of Liver Transplant Surgery at the University of Maryland Medical Center. Dr. Colonna is also an associate professor of surgery at the University of Maryland School of Medicine.

In 1984, Dr. Colonna was a member of the transplant team at UCLA that performed the first liver transplant for a patient with this rare form of stomach cancer. The liver came from a deceased donor, and the patient, a 16-year-old girl, survived 14 years following the surgery.

Medical centers around the country began offering liver transplants for adults from living donors in 1998. So far, about 100 have been performed.

"The results are very encouraging," says Dr. Colonna. "The biggest question had been whether you could take out a large enough section of the liver to enable an adult recipient to survive without compromising the health of the donor," he says. The first living donor liver transplants were adult to child, since a child only requires a smaller piece of liver. More than 1,000 of those have been performed in the last decade.

Typically, surgeons remove about 60 percent of the donor's liver for a transplant to save the life of an adult. The average adult liver weighs about three pounds. Unlike other solid organs, livers grow back to their original size within about six weeks.

The transplant for Kathleen Zieger, a mother of two teenagers, took about 12 hours, with two transplant teams. First, surgeons had to be sure that her cancer had not spread beyond her liver. Then, transplant surgeons removed her diseased liver.

Her brother was in an adjacent operating room. Surgeons carefully divided and removed the right side of Maryman's liver so that it could be transplanted into his sister. The complex surgery involves disconnecting dozens of blood vessels and two major bile ducts.

"The transplant went smoothly and neither patient required any transfused blood, which is unusual for these types of surgery," says Benjamin Philosophe, M.D., Ph.D., a transplant surgeon who is also an assistant professor of surgery at the University of Maryland School of Medicine.

Mr. Maryman's liver should be back to its original size in about six weeks, and his sister's new liver will also double in size. Zieger will need to take medication for the rest of her life to prevent her body from rejecting the new liver.

"This transplant gives Ms. Zieger the chance of a cure. Without her brother's donation, she may have waited at least a year for a liver from a deceased donor. Many people who wait for a donated liver do not receive one in time to save their lives," says Stephen T. Bartlett, M.D., head of transplant surgery at the University of Maryland Medical Center and professor of surgery and medicine at the University of Maryland School of Medicine.

While about 4,000 liver transplants are performed each year in the U.S., about 14,000 people are on waiting lists for a new liver. The most common reason for liver transplants is hepatitis C, an infection that causes liver failure in about 70 percent of cases. Because of an increase in cases of hepatitis C, demand for liver transplants is growing.

The liver is the largest organ in the body. It is important for many functions, including digestion, the creation of blood clotting factors, metabolism, regulation of blood sugar, and filtering out harmful substances so that they will not be absorbed by the body.

In addition to Dr. Philosophe and Dr. Colonna, the team that performed Ms. Zieger's transplant included Alan Farney, M.D., Ph.D., Michael Wachs, M.D. and anesthesiologists Mary Njoku, M.D., and Obe Udekwu, M.D.

The University of Maryland Medical Center has performed liver transplants since 1994.

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