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July 7, 1989

...Two Organs, One Patient

JAMA. 1989;262(1):15. doi:10.1001/jama.1989.03430010017007

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PARTIAL LIVER GRAFTS are also being used as heterotopic transplants to rescue patients from hepatic coma, according to another report in Chicago.

Michael Moritz, MD, Jefferson Medical College, Philadelphia, Pa, said that he and his colleagues had performed a heterotopic partial-liver graft on a 19-year-old woman with hepatitis leading to fulminant hepatic failure. The surgeons had taken an aggressive approach because the patient had progressed rapidly into stage IV coma with elevated intracranial pressure and cerebral edema.

Although the patient's liver was riddled with necrotic hepatocytes, the team chose to leave it in place to avoid the anhepatic phase of orthotopic transplantion during which cerebral hemodynamics and intracranial pressure are difficult to control.

They decided on a partial auxiliary graft because the only cadaver liver available was from a donor who weighed 40% more than the recipient. The team reduced the donor liver by removing segments II and III.