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Second baboon to human liver recipient dies

PITTSBURGH, Feb. 5, 1993--The 62-year-old recipient of a baboon liver died on Feb. 5, 1993 at 6:50 p.m., 26 days after his transplant operation at the University of Pittsburgh Medical Center. Surgeons say his death was caused by sepsis, a widespread infection, that may have resulted from a recent diagnosis of peritonitis. More conclusive information will be available following an autopsy.

The patient, who had been dying of hepatitis B, remained in critical condition after his transplant on Jan. 10 and never fully regained consciousness. Surgeons had said that without the transplant he would have lived no more than 30 days.

The transplanted baboon liver functioned and produced bile, and grew four times its original size to fit the recipient's cavity.

Four biopsies of the liver were performed by surgeons after the transplant. Surgeons said the results of the first biopsy performed on Jan. 14 were inconclusive, but based on their visual examination of the liver, they treated the patient as if there were signs of rejection. To this end, they removed the patient's spleen to allow increased doses of immunosuppressive drugs to be administered.

Other biopsies, including the fourth one completed Wednesday, Feb. 3, indicated no further signs of rejection, surgeons say. But during Wednesday's biopsy, surgeons noticed a leak in the small intestine and an infection surrounding it. Thursday, surgeons removed the section of the intestine where the leak was located, and Friday morning, the day that he died, they re-examined the abdomen in the operating room. At this time they made the diagnosis of peritonitis -- the infection had progressed and was present throughout the peritoneum, the membrane that surrounds the cavity containing the abdominal organs. Peritonitis is especially difficult to treat in transplant recipients, whose immune systems are suppressed with drugs to control rejection.

Surgeons say the peritonitis developed into the system-wide infection called sepsis, which is a common cause of death in organ transplant recipients.



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