Domino Liver Transplant Treats Two Rare Diseases, World First

Article Content

Robert Gish, MD, hepatologist, and Alan Hemming, MD, transplant surgeon.

For the first time ever, a surgical team led by Alan Hemming, MD, has successfully performed a domino transplant using a liver with a rare genetic disorder called methylmalonic acidemia (MMA).

“This extraordinary procedure allowed us to use one donated liver to save two lives,” said Hemming, professor and co-director of the Center for Hepatobiliary Disease and Abdominal Transplantation (CHAT) at UC San Diego Health System. “This procedure is technically more difficult but allows us to expand the number of patients who can benefit from this lifesaving surgery.”

The first transplant recipient, Rafael Bolanos, 28, suffered from MMA, a metabolic disease that causes a toxic build up of amino acids in the body. He faced coma and irreversible neurologic damage. The second patient, James Ogara, 62, was diagnosed with primary sclerosing cholangitis, a chronic liver disease caused by scarring of the bile ducts.

“Liver transplantation was the only solution for both patients,” said Robert Gish, MD, chief of hepatology and CHAT co-director. “The challenge is that donated livers are in short supply, even for patients who desperately need transplantation.”

With two transplant teams performing simultaneous surgeries, the patient with MMA, Bolanos, received a new liver from a donor. His liver was then transplanted or “dominoed” into the second patient, O’Gara. Even though O’Gara received a liver with a genetic disorder, it will not impact his health. His body will be capable of clearing the amino acids and will be symptom-free.

“I saw this as a tremendous opportunity,” said O’Gara, 61, a real estate developer from Ramona, California. “The doctors did not sugarcoat the risks of receiving this organ. They explained everything and even encouraged me to seek a third-party opinion. When the call came to get the liver, I said, ‘Sign me up.’”

O’Gara added, “I have had great results. I feel good and my spirits are high. They saved my life and I am deeply grateful.”

According to the U.S. Department of Health and Human Services, more than 16,170 patients await a liver transplant each year in the United States. Approximately 15 percent of patients on the transplant list will die while waiting for an organ to become available.

Hemming specializes in split, living-related, and domino procedures and has performed more than 700 liver transplants and 900 liver resections. He performs all aspects of hepatobiliary surgery including both open and laparoscopic liver resection for tumors, resection of the pancreas and bile duct, and portal decompressive procedures.

The Center for Hepatobiliary Disease and Abdominal Transplantation at UC San Diego Health System offers full spectrum liver care, from diagnostics and testing to novel therapies and clinical trials not found anywhere else in the United States.

The CHAT team includes: Ajai Khanna, MD, Yuko Kono, MD, Alexander Kuo, MD, Rohit Loomba, MD, Kristin Mekeel, MD, Michel Mendler, MD, Heather Patton, MD, and Rene Pink, RN.