With one of the most robust adult liver transplantation programs in the United States — and the largest organ transplant center in the tri-state area — University of Maryland Medical Center (UMMC) is now expanding these capabilities to children needing a new liver.
Dr. Bruno’s arrival in the summer of 2015 was, in part, prompted by the expansion of UMMC’s liver transplantation program to pediatrics. Specializing in pediatric and adult liver and kidney transplantation, Dr. Bruno was previously surgical director of the pediatric liver transplantation program at the Children's Hospital of Michigan.
“It makes sense that one of the busiest adult liver transplant programs would lend itself to a busier pediatric program,” Dr. Bruno explains, adding that he is one of four surgeons on UMMC’s highly experienced pediatric liver transplant team. “Probably 10 or 12 kids each year need a liver transplant in the state of Maryland, but just like our adult program, we’d try to extend our reach to those in Delaware and West Virginia as well.”
Acute or Chronic Liver Failure Prompts Transplants
Relatively few children develop liver failure necessitating the need for a donor organ. About 5,000 liver transplants are performed in the United States each year, but only a small portion takes place in children, Dr. Bruno notes. With a long history of success in organ transplantation, UMMC tackled about 150 liver transplants in 2015, “which is a remarkably large program,” he says.
Either acute or chronic liver failure might prompt the need for a new liver. In children, acute liver failure typically has no discernible cause, he says, though it can result from an overdose of acetaminophen or from Wilson’s disease, a rare, inherited condition causing too much copper to accumulate in the liver and other vital organs.
The majority of pediatric cases of chronic liver failure result from biliary atresia, a life-threatening condition in infants caused by malformed bile ducts. Biliary atresia traps bile in the liver, with the accumulation causing severe liver damage.
In children receiving donor livers, the organ can be obtained from either a living donor — a friend or family member who’s a tissue match and donates a portion of his or her organ — or a cadaver of any age. If an adult cadaver is the donor, the organ is cut down to the size needed for the child —roughly one-third the size of an adult liver.
Multidisciplinary Evaluation Process at UMMC
“The majority of living liver transplants are done in children,” Dr. Bruno says. “If you can identify a living donor, especially for the smallest children, that’s really advantageous … and optimizes the outcome.”
UMMC’s multidisciplinary transplantation team also optimizes outcomes by incorporating the expertise of staff members ranging from social workers and psychologists to hepatologists, gastroenterologists and, of course, surgeons. “One of the most important things in kids’ transplants is the presence of the social worker and psychologist, because often children’s parents are devastated by this, too, so we really need to help them through this,” he says.
UMMC’s emerging pediatric liver transplantation program builds upon the established excellence of its pediatric kidney transplantation program, and team members are extremely experienced.
“I’m really excited about this program,” Dr. Bruno says. “I love doing liver transplants and think it’s a really remarkable therapy. I’m always amazed at what a difference you can make in someone’s life, and to be able to extend that to children is really one of the most remarkable things.”
History of Transplanting Kidneys in Children
The start of this pediatric liver program comes at the same time the University of Maryland is celebrating more than 50 kidney transplants in children. Pediatric nephrology at the University of Maryland Children’s Hospital led by Susan Mendley, M.D., associate professor of pediatrics at the UM School of Medicine, has a long history of caring for children with complex kidney problems who ultimately need transplants.
For information about transplants at the University of Maryland, please call 410-328-5408.