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People waiting for kidney transplants are
usually on dialysis - their old kidneys
given up, and the robot sustains them
until new ones are available. A person
who needs a liver transplant walks
with the old liver doing the best it can -
there is no dialysis equivalent. Livers
unusual in that they try to heal - if you
quit drinking, or control your hepatitis,
your liver will start to grow back. If it is
gone past the point of no return, it may
not be able to grow back, and you need a
In a kidney transplant, the old kidneys
left in place and the new one hooked up.
For a liver transplant, the old one must
removed to make room. I propose that
some cases, the old liver might provide
fertile substrate for individual liver cells
from a new liver. These would be
directly into the old one in the hope that
they would grow and provide islands of
new liver capacity. Perhaps this would
hold the line for a little while until the
whole new liver comes along - or maybe
after a very successful ILT a conventional
transplant would not be necessary.
Rejection or graft failure would not be
such a big deal - you wind up where you
started - with a bad liver, but not dead.
might even be possible to repeat ILT a
number of times - which would result in
genetically heterogenous liver, but who
cares as long as you're not yellow?
The patient who receives ILT would need
immunosuppression, just as with a
conventional transplant. However the
operation would be much safer. In
addition, one donor liver might be
distributed among a number of
in this way: the donor liver is dissolved
into its component hepatocytes, which
injected into 10 or more recipients. This
idea could be tested using a small
of a donor liver and a volunteer recipient
from the transplant list. Later, when the
volunteer actually comes to transplant,
old liver can be examined to see what the
ILT did. Of course if it works great, the
recipient might never come to transplant!
Donation of liver to be used for ILT might
be more like donating bone marrow -
several cores of liver are taken from the
donor in the same manner as one might
do a liver biopsy. The donor spends the
night in the hospital to watch for
bleeding, then heads home.
A final use for ILT would be for the
treatment of inherited metabolic diseases
in infants. In many of these diseases, the
infant has a fine liver except it is unable
process one particular substance - which
then builds up in the blood or elsewhere.
These infants would actually be the best
candidates for ILT because the existing
liver does not have cirrhosis,
autoimmune destruction, or some virus
already messing with it. It is healthy.
A few islands of donor liver within the
infant liver should be able to handle
metabolism of the substance in question.
||I think they have to remove the old liver to be sure they have removed the cause of its failure. Kind of like a bone marrow transplant where the first thing they do is irradiate you to kill off all your original bone marrow.
||It is possible that the liver scarring is the real damage, which cuts off circulation to fresh liver areas. If this is the case, we would first need to remove the scar tissue, and a more extensive donation, say of a "core" or such, might indeed be necessary.
||This might work well with stem cell research... if you can stomach destroying an embryo to save a life.
||With some of the new "mini" bone
marrow transplants, they no longer kill
off the original marrow - they just
soften it up with some chemo so it is
not too tough on its new roommate.
||//Rejection or graft failure would not be such a big deal - you wind up where you started - with a bad liver, but not dead.// Rejection or graft failure is a very, very big deal. You probably WOULD wind up dead.