Nationwide leader in pediatric transplant, Lucile Packard Children's Hospital Stanford performed 117 pediatric organ transplants in 2017

An ambulance rushed Dane to Lucile Packard Children's Hospital Stanford. "It was all hands on deck," says A.J. "He was dying quickly from bleeding internally."

Janene Fuerch, MD, clinical assistant professor of neonatology, was one of the neonatal intensive care unit (NICU) fellows during Dane's first several weeks at Packard Children's. "He was in fulminant liver failure, and we knew he was most likely going to die. Neonates in severe liver failure often don't survive," she explains.

Ultimately, it would take two separate organ transplants to save Dane's life. He was extremely fortunate to be cared for at Packard Children's, a longtime leader in pediatric solid-organ transplant. In 2017, Packard Children's led the way in pediatric transplant volume and outcomes nationwide, performing 117 pediatric organ transplants, including one of Dane's. Over the past five years, Packard Children's has performed more pediatric liver and kidney transplants than any other U.S. center.

To help him survive his failing liver, Dane's doctors stabilized him with several daily blood transfusions and continuous support. Over the next 10 days, rounds of testing revealed that Dane had an enterovirus, a relative of the polio virus.

"He was really a desperately ill little guy," says William Benitz, MD, professor of neonatology and Dane's attending physician in the NICU. "He demonstrated how sick a vulnerable baby can get from what would be a routine, ho-hum, everyday virus for most of us."

In a premature baby like Dane, enterovirus can cause liver failure, which can lead to brain damage and heart failure. With its wide range of potential symptoms, enterovirus has no available medical cure, so Dane's own immune system had to fight the disease.

The next six weeks were a harrowing, daily effort to keep Dane alive and help him grow healthy enough — and large enough — to receive a liver transplant. "We knew this was a stretch. He would be the smallest transplant the team had ever done," says Dr. Fuerch. "But he wasn't giving up, so we weren't going to either."

The team has a track record of succeeding with unusually challenging transplants. In 2017, 40 percent of Packard Children's liver-transplant recipients weighed less than 40 pounds, making it the national leader in transplanting babies and small children. The team also had much shorter mean wait times than most centers: 2.2 months, compared to 13.5 months across the nation.

And Dane needed a new liver quickly. Even as his care team worked to stabilize his blood levels every day, Dane's failing liver was not doing its job of clearing his blood of protein byproducts like ammonia. This meant he needed continuous hemodialysis, which circulated his blood to clean it externally and return it to his body. "We had to balance the risks of bleeding, clotting, and infection and work to optimize his nutrition," says Cynthia Wong, MD, medical director of chronic dialysis. "With his multiorgan failure, this was the only option to save his life."

"When the interventional radiologist put in a dialysis catheter, it was a tremendous moment of success," says Waldo Concepcion, MD, chief of pediatric kidney transplantation. "Being able to dialyze him so the medical team could stabilize him was very, very critical to his survival."

In the early hours of May 23, 2014, six-week-old Dane, weighing just under five pounds, received his new liver from a surgical team led by Carlos Esquivel, MD, PhD, chief of the division of transplantation, and Dr. Concepcion.

About six weeks after Dane's surgery and his slow, rocky recovery, A.J. and Ted were finally able to pick him up and hold him for the first time since his birth. But soon after his new liver stabilized, Dane's kidney failed. Dane now needed peritoneal dialysis to do the work of his kidneys.

On October 8, after six months in the hospital, A.J. and Ted were able to take Dane home, where he would need 11 hours of peritoneal dialysis each day until he could receive a kidney transplant.

Although they were concerned about their son, the family knew of Packard Children's outstanding kidney-transplant track record. In 2017, the program performed 46 pediatric kidney transplants, as well as nine transplants in patients aged 18 or over, making it a national leader in kidney-transplant volume. Patients come from across the Western United States and even internationally to benefit from the program's expertise.

A.J. hoped to be a living kidney donor for Dane. But Dane needed a perfectly sized kidney, which could only come from a deceased donor. "The odds were stacked against Dane both in terms of the complexity of the anticipated surgery and the scarcity of potential donor kidneys," says Ted.

On April 7, 2017, one day before Dane's third birthday, Dr. Concepcion and Amy Gallo, MD, assistant professor of abdominal transplantation surgery, performed Dane's pioneering kidney transplant.

"He was tiny, but we modified and tailored his own kidney vein to be able to drain the new kidney," says Dr. Concepcion. "It was a completely innovative process of doing the kidney transplant using only what the patient had available, which was that one vein." It was one of the most complicated of the kidney transplants performed at Packard Children's in 2017, though it was not unique: The team also transplanted two other children who had been referred from outside California due to challenging vascular access, as well as a patient who needed a second kidney transplant after becoming immunologically sensitized to the first transplanted organ.

Within 24 hours of his kidney transplant, Dane showed signs of dramatic improvement. He was discharged after 10 days.

Today, Dane loves playing with his little brother, Carter. "He's just really happy now. He's super social and loves his toys and going to music class," says A.J. "Finally, after three years, we're feeling relaxed — like, OK, he's going to be OK."

About Stanford Children's Health and Lucile Packard Children's Hospital Stanford
Stanford Children's Health, with Lucile Packard Children's Hospital Stanford at its center, is the Bay Area's largest health care system exclusively dedicated to children and expectant mothers. As a top-ranked children's hospital by U.S. News & World Report, we are a leader in providing world-class, nurturing care and achieving extraordinary outcomes in every pediatric and obstetric specialty. Stanford Children's Health provides everything from specialty care to general pediatrics and can be accessed through more than 60 locations across Northern California and 100 locations in the U.S. western region. As the pediatric and obstetric teaching hospital for the world-renowned Stanford University School of Medicine, we're cultivating the next generation of medical professionals and are at the forefront of scientific research to improve children's health outcomes around the world. We are a nonprofit organization committed to supporting the community through meaningful outreach programs and services and providing necessary medical care to families, regardless of their ability to pay. Discover more at stanfordchildrens.org.

Media Contact:
Samantha Beal
[email protected]
650-498-7056

SOURCE Lucile Packard Children’s Hospital Stanford