Hacker News Reader

Comment by libpcap | Hacker News Reader

Is there a chance of a liver transplant?

Unlikely, as his cancer diagnosis puts him below other patients with an higher chance of survival, and the chemo will likely be too much for a patient recovering from a transplant.

Lab-grown organs can't come soon enough :(

I'm not an expert here, but I doubt that he would qualify for a transplant given the heavy toll that the future leukemia treatment would put on the transplanted liver. It's sad, but sometimes there really aren't any more options.

The fact that he mentions GvHD would indicate that not to be an option, unfortunately. IANAD.

100% not the same as Alex's sad situation, but for kidneys a dual stem-cell-transplant and kidney-transplant has been done[1]. It was NOT done due to cancer (but due to kidney scarcity) and was NOT done for the liver. I don't think it could ever even be done for the liver because stem-cell-transplant cannot (to the best of my knowledge) be done from a cadaver-donor. Maybe some medical center would be willing to try a living-donor for SCT and partial-liver...but I'm not sure it would get past the ethics committee.

[1] https://clinicaltrials.gov/ct2/show/NCT00319657

Warning! This is not a replacement for medical advice and I could be wrong. This is not my speciality!

If I'm understanding correctly seems like Mr. Mills had a marrow transplant, and the white cells in the marrow from the donor had attacked his liver. Chemoterapy is a poison, and liver's work is to deal and be distroyed by poisons, so this does not help.

Without donor's white cells, the Leukemia gets worse, but without liver, people die fast. It seems that restoring liver function would be the higher priority now.

Liver has evolved to be destroyed and regenerated. Is able to create new hepatocites massively if needed. Is said that you can remove 2/3 of the liver and the remain cells will regenerate a complete liver in only 2 weeks. Is an awesome organ if we think about it.

The options are, I suppose, a liver transplant/liver graft, that is expensive procedure but very effective.

or a liver support device that could buy a precious time until a liver donor is available

It seems that in USA there are around 4000 liver available from donors each year, and a list of around 17000 receptors. Liver transplant is expensive. You need to invest maybe $12000-250000 only for the operating teather part. Plus post-operatory procedures.

An alternative could be to take a chunk of liver of Mr. Mills and cultivate it in a laboratory, far from chemoterapy and vicious white cells and then create a bio-system that could act as an artificial liver for some time. A possibility maybe could be to make a self-transplant in the future. Even small chunks can regenerate a much bigger chunk of liver

Several types of artificial livers could help also to alleviate the liver work, like a Molecular Adsorbents Recirculation System (MARS) or/and fractionated plasma separation and adsorption (FPSA, Prometheus)

This is a question coming from complete layman. In fact, I'm ashamed to ask such a stupid question. But I'm still curious:

> Is said that you can remove 2/3 of the liver and the remain cells will regenerate a complete liver in only 2 weeks.

Does this mean it's possible for one to donate liver (say, half a liver) and live like nothing happened (except a scar)? Then why don't everyone donate their liver like this? Why are there only 4000 livers in the US?

You can donate part of the liver, but it isn't "like nothing ever happened". This followup[1] of donors from 2011 found that 53% suffered long-term complications (though 93% would have gone through with it again). Notably missing from those stats is the percentage of donors who died after donation, either due to direct effects, indirect effects, or totally unrelated things.

Donating one of your two kidneys is maybe a "like nothing happened" experience, but donating a partial liver is much more complicated with worse outcomes.

[1] https://journals.lww.com/annalsofsurgery/Abstract/2011/11000...

> Donating one of your two kidneys is maybe a "like nothing happened" experience

https://news.ycombinator.com/item?id=12629724 <-- Here's an HN post I remember about donating kidneys

> it's possible for one to donate liver (say, half a liver) and live like nothing happened (except a scar)

There is a risk to manage, but is possible, yes. (Liver regenerates itself, so maybe even without leaving a scar. I'm unsure about that).

> Why only 4000 livers...

Probably a bottleneck and main factor is the money and finding somebody with experience that would want to do it. Is not a trivial procedure and there is also a risk for surgeons to be sued if things go down.

The technique is relatively new, starting at 1989 with Alyssa Riggan, a toddler girl 21 months old from Texas that is still alive and living a normal life currently. The donor was her 29yo mum. The technique has being adopted regularly since 2014 (if I'm not wrong). More than 4000 patients had received such treatment in USA since them. Ms. Riggan has a normal life now and does not even need her anti-rejection medecines anymore. The survival rate in adult patients at 3 years is > 95%, and 100% in children patients.

For the donor, will feel some pain (that can be alleviated with medication) and will feel very tired for the first month. Around half liver of the donor is taken. Most regeneration will happen in the first 2 weeks.

https://www.webmd.com/hepatitis/features/living-donor-liver-...

After Mayo Clinic [1] two months are enough to recuperate the liver in the donor. Other hospitals talk about one month.

[1] I can't find an english page to cite, is automatically translated to spanish in my case, but shouldn't be a problem for most adults: https://www.mayoclinic.org/es-es/departments-centers/transpl...

Having cancer, Mr. Mills would be elected [2] to receive the liver of a dead people instead a live donor, unless a relative or a friend would agree to donate him part of their liver.

[2] I'm not expert in your health system, Just guessing that he has a low score in the list.

http://columbiasurgery.org/liver/living-donor-liver-transpla...

Reply on news.ycombinator.com