Regarding other needs for bilirubin testing:
Friday May 15 6:00 PM EDT
Liver cells used instead of transplant
NEW YORK (Reuters) -- A 10-year-old girl with a rare liver disease was successfully treated with an infusion of donor liver cells, rather than having an entire organ transplanted. The donated cells have so far persisted for nearly a year in the girl's body, at least partially correcting a metabolic disorder that prevented her liver from producing an important enzyme, according to a report this week in The New England Journal of Medicine.
The case provides hope that liver cells can be used in some cases instead of donor livers, which are in exceedingly short supply.
The girl was born with Crigler-Najjar syndrome type I, an inherited enzyme deficiency that results in an inability to break down bilirubin, a yellow-orange pigment that is normally processed and excreted by the liver. The disease can be treated with phototherapy, exposure to ultraviolet light. However, the phototherapy can take up to 16 hours a day and only partially controls the disease. Ultimately, most patients require a liver transplant.
According to the report, the girl was treated with immune-suppressing drugs, and was injected with cells collected from a donor liver that could not be matched to any available recipient currently on the waiting list for the United Network for Organ Sharing. After the procedure, the amount of phototherapy needed to control the girl's condition went from 10 to 12 hours a day to 6 to 7 hours a day. This suggests that the transplanted liver cells survived and are functioning.
"Because the patient has not had opportunistic infections, the consequences of immunosuppression have been minimal," reported Dr. Ira Fox and colleagues from the University of Nebraska Medical Center. "Furthermore, rejection has not been a problem to date."
The researchers have shown that infusion of liver cells is safe and "relatively easy to accomplish," according to an editorial by Dr. John Lake of the University of Minnesota School of Medicine in Minneapolis.
However, there are many questions that still need to be answered, he noted. It's not clear if enough donor liver cells would be available and it is unknown how long the cells will last in the body. SOURCE: The New England Journal of Medicine (1998;338:1422-1426)
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