Three decades ago, in the early days of liver transplant, babies with liver failure usually died. Transplants were saving the lives of adults and older children, but were not offered to patients younger than 2. For these youngsters, doctors thought, the operation was too risky and difficult. But an ambitious surgeon named Carlos Esquivel changed that.
At Lucile Packard Children’s Hospital Stanford, transplant innovator Carlos Esquivel, MD, PhD, is celebrating the 30th anniversary of his first liver transplant and the ground-breaking procedures that have helped him save hundreds of lives. (Photo: Business Wire)
Now chief of the division of transplantation at Lucile Packard Childrens Hospital Stanford, Esquivel, MD, PhD, is lauded worldwide for his skill at performing transplants in very sick babies and children. But in 1984, he was just a surgeon-in-training who wanted a challenge. He didnt know he would become both an advocate for pediatric liver transplants and the leader of an extraordinary transplant team that helps patients progress to healthier, happy lives.
Near the end of his surgical residency at UC Davis, the Costa Rican native realized that his planned career in vascular surgery would not challenge him enough. He sought a fellowship with the University of Pittsburghs Thomas Starzl, MD, PhD, who had performed the first successful human liver transplant a few years before and was refining the difficult, esoteric procedure. Soon, Starzl guided Esquivel through a transplant on a man with acute liver failure who had come to the hospital in a deep coma. The operation went well. Two days later, the patient awoke.
Once I saw that — somebody who was at deaths doorstep waking up — it was unbelievable, Esquivel said. I never looked back.
Instead, he looked toward the babies who werent being offered liver transplants. Many had a congenital defect called biliary atresia, which causes liver failure in infancy or toddlerhood.
There are huge difficulties with transplanting these patients, said Esquivel, who is the Arnold and Barbara Silverman Professor in Pediatric Transplantation at the School of Medicine. When the liver doesnt work, the blood doesnt clot, increasing blood loss during surgery. The problem is worse for a small patient who has less blood. Hooking up an infants tiny blood vessels to the donated organ is also difficult. And these children are small for their age because liver failure hampers growth. In short, said Esquivel, Patients with liver failure are some of the sickest in the hospital.
But without transplants, they invariably died. So Esquivel began trying to transplant them. At first, about 70 percent survived.
Going from 100 percent mortality to 70 percent survival was a huge improvement, Esquivel said. He published his results in 1987 and began advocating that infants and small children should be offered the benefits of transplant.
The whole field was just undergoing a revolution, said Starzl, now professor emeritus at the University of Pittsburgh. Esquivels scientific inquisitiveness and warm, sensitive character made him a good person to advance the fields transformation, Starzl said. But it was his surgical skills that really set him apart.
He is instinctively a tremendously good surgeon, Starzl said. He has the kind of virtuoso qualities that you cant teach. Those skills allowed Esquivel to consistently reconstruct the tiny blood vessels and ducts that feed the liver. It takes a different level of skill than is required for adults, Starzl said.
From Pittsburgh, Esquivel moved to San Franciscos Pacific Presbyterian Medical Center (now California Pacific Medical Center) to build a multidisciplinary team that addresses the many facets of transplant care.
In 1995, the team came to Lucile Packard Childrens Hospital Stanford, and built a program now recognized as one of the largest and most experienced in the world. They have performed more than 600 liver transplants, including some in which patients also received another organ, such as a heart, kidney, lung or intestines.
In 2013, the team achieved 100 percent one-year survival for their liver transplant patients, a rate that is higher than expected given the acuity of cases they undertake. Their advances include developing regimens of immunosuppressive drugs with fewer side effects; offering liver transplant for new indications such as inherited metabolic diseases; and pioneering a clinic where teenage transplant recipients learn to take responsibility for their own care.
We have been able to put together an unbelievable team, Esquivel said.
Meanwhile, Esquivel still cares for the tiny, fragile babies who inspired him decades ago. Biliary atresia is still the leading cause of childhood liver failure, and many hospitals still turn down difficult cases.
One of these was Zachary Teczon, whose health was deteriorating quickly when the team decided that, at 7 months old, he could wait no longer for a liver transplant. In an operation that made use of all of Esquivels years of surgical innovation, Zachary received his new liver on January 28, 2012. After months of watching Zachary get sicker, his mom, Jennifer Delia, will never forget how she felt that day.
I was scared but happy that he was going to have a new life, Delia said.
The next day, she was relieved and elated when Esquivel came out of the operating room to tell her that Zacharys operation was a success.
He saved my baby, Delia said. Theres really nothing I can ever do to thank him enough.
For Esquivels part, hes grateful to see transplant recipients grow and thrive. He loves getting messages from the families of young people, now in their 20s, like Kelly Olmo of Oakland, who was one of his earliest patients when she received her transplant 25 years ago at age 2. Hearing about the lives of former patients like Kelly and the joy their families feel from watching them grow convinces him that the difficulties of being a transplant innovator are worthwhile. Its very moving, he said. Its really the best possible reward.
About Stanford Childrens Health and Lucile Packard Childrens Hospital Stanford
Stanford Childrens Health, with Lucile Packard Childrens Hospital Stanford at its core, is an internationally recognized leader in world-class, nurturing care and extraordinary outcomes in every pediatric and obstetric specialty from the routine to rare, for every child and pregnant woman. Together with our Stanford Medicine physicians, nurses, and staff, we deliver this innovative care and research through partnerships, collaborations, outreach, specialty clinics and primary care practices at more than 100 locations in the U.S. western region. As a non-profit, we are committed to supporting our community from caring for uninsured or underinsured kids, homeless teens and pregnant moms, to helping re-establish school nurse positions in local schools. Learn more about our full range of preeminent programs and network of care at stanfordchildrens.org, and on our Healthier, Happy Lives blog. Join us on Facebook, Twitter, LinkedIn, and YouTube.
Lucile Packard Childrens Hospital Stanford is the heart of Stanford Childrens Health, and is one of the nations top hospitals for the care of children and expectant mothers. For a decade, we have been ranked as the No. 1 childrens hospital in Northern California, according to U.S. News & World Reports 2014-15 Best Childrens Hospitals survey, and are the only hospital in Northern California to receive the national 2013 Leapfrog Group Top Childrens Hospital award for quality and patient care safety. Discover more at stanfordchildrens.org.