Liver Transplant Research | Overview
Each specialist within the Liver Transplant Program has at least two fields of expertise. One is providing compassionate care to families. The other is learning more about ways to advance care for the diseases and treatments that brought them to Boston Children’s.
Avoiding liver transplant for patients with metabolic disorders and liver tumors
Boston Children’s Hospital surgeon Khashayar Vakili, MD, specializes in liver, kidney and intestinal transplant surgeries, while in the lab he is doing work which, for some patients, could eliminate the need for a transplant surgeon altogether.
One of Vakili’s most promising research projects involves autologous hepatocyte transplantation — transplanting not the liver but only the liver cells, and doing so using cells from the patient to avoid the need for immunosuppression. Although the project is in its early stages, the potential implications are promising.
Khashayar Vakili, MD, Pediatric Transplant Center surgeon at Boston Children's Hospital
In a separate line of research, Vakili is looking for a mechanism to decrease the growth of hepatocellular carcinoma, the most common primary cancer of the liver. Transplant and surgery alone are usually ineffective for hepatocellular carcinoma because of the aggressive nature of the disease and the fact that there is no chemotherapy that actually works against the tumor.
Eliminating waitlist mortality for children
Infants and young children have the highest risk of death on the liver transplant waiting list, mainly due to the shortage of appropriately sized organs. But Heung Bae Kim, MD, director of Boston Children’s Pediatric Transplant Center, has been researching ways to change that statistic.
Kim led a team of Boston Children’s researchers who examined pediatric data mortality and graft survival rates of patients under the age of two who received liver transplants. Published online in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, the data suggested that both split and whole organs had similarly low rates of both graft failure and mortality, suggesting that their use could be increased to meet the demand for smaller grafts.
In a separate study, data on graft survival and mortality for adult recipients was compiled. The research showed that with the exception of a small, very sick population of patients, adults who receive a split graft can expect to fare as well as those who received a whole organ.
Based on his findings, Kim is advocating for changes in how donor livers are allocated — automatically placing infants and small children at the top of the liver waitlist, thereby giving pediatric transplant surgeons the option to split the first graft to become available. Once the liver has been split, the smaller portion is transplanted into a child and the larger portion is transplanted into the next appropriate adult on the list.