Rare back-to-back cesarean and liver transplant surgeries rescue dying mom and preemie baby
STANFORD, Calif., Dec. 9 /PRNewswire/ -- "We were thinking we'd be lucky to get one live person out of this situation, and we didn't know which it would be," said William Benitz, MD.
Benitz, the chief of neonatology at Lucile Packard Children's Hospital at Stanford, was describing an extraordinary and intense collaboration by doctors from Packard and Stanford Hospital & Clinics that rescued a young mom from death - and also saved her premature baby. Now, Michelle Mattingly, husband Leonard and daughter Elektra are thankfully celebrating baby John's first Christmas, a holiday that almost didn't happen for mom or baby.
At the peak of the August crisis, doctors had no idea whether they could rescue Michelle from liver-failure-induced coma and death, let alone save the baby who was still 14 weeks before his due date. And doctors at both hospitals believe that never before have back-to-back cesarean and liver transplant surgeries rescued both a mother so ill and an infant so premature.
"We were treading into unknown territory," said Maurice Druzin, MD, the obstetrician who delivered John. Druzin is chief of obstetrics at Packard Children's and a specialist in high-risk deliveries.
The drama started Aug. 3. Michelle was nauseated and in pain when she and Leonard came to Packard Children's labor and delivery department. The couple wanted to be sure everything was OK for Michelle and their eagerly awaited son. As the Packard staff monitored Michelle, they detected an alarming spike in blood indicators of liver failure. They rushed her next door to the adult intensive care unit at Stanford Hospital. Over the next several hours, Michelle's liver stopped filtering toxins from her bloodstream.
On Aug. 4, the toxic build-up in her blood caused her to slip into a coma. As Michelle grew sicker, Stanford's adult liver transplantation team carefully evaluated her case. After determining that the liver failure was not caused by pregnancy, the team decided against an immediate cesarean.
"With the mother in that condition, she would have died from a cesarean, no question," said Carlos Esquivel, MD, PhD, chief of the division of transplantation surgery at Packard Children's and Stanford. "Patients in liver failure cannot tolerate the stress of surgery." The liver makes blood clotting factors, and Michelle's clotting-factor levels were so low that her risk of bleeding to death during cesarean was extreme. With her pregnancy just 6 months along, an immediate cesarean risked the baby's life, too. Leonard Mattingly and Michelle's doctors had to make some extraordinarily difficult choices.
"We decided we would do whatever it took to save Michelle, even if it meant losing the baby," said Tami Daugherty, MD, a clinical assistant professor of gastroenterology and hepatology at Stanford who coordinated Michelle's care by the transplant team. They hoped they could ensure Michelle's safe return to her life as a homemaker and mom to daughter Elektra.
On Aug. 5, the doctors opted to stabilize Michelle and wait for a donor liver, placing her on the national list for an urgent transplant. They gave her steroids to help the baby's lungs mature and transfused blood to reduce her levels of blood toxins and raise her clotting factor levels. It was a race against time, as a donor organ was needed before Michelle died or suffered permanent brain damage from the toxins in her blood.
"They told us we had 72 hours to get her a new liver," said Leonard, who is stationed with the U.S. Navy in Sunnyvale, Calif.
By Aug. 6, the transplant team had rejected two successive donor livers. The first did not match Michelle's immune system; the second contained cancerous cells.
Then, on Aug. 8, with time running out, a third liver became available. "They told me if that liver wasn't a match, Michelle's chances were very slim," Leonard said.
Luckily, the organ matched. At 11:03 a.m. Aug. 8, Druzin's high-risk obstetrics team delivered John, who was rushed to Packard, where he was cared for by Benitz and colleagues in the neonatal intensive care unit. Then, Esquivel's transplant team immediately began operating to give Michelle a new liver. The transplant worked.
"To end up with the mom and child surviving all this is unbelievable," said Esquivel. "The strength of being at a place like Packard and Stanford is the ability to have world experts in all fields, both pediatric and adult, collaborate on very complex cases like this," Druzin added.
After the operation, Michelle spent about a month in the hospital, gradually regaining awareness and healing from her surgeries. As a preemie, John stayed nearly three months at Packard Children's before his mom, dad and sister welcomed him home in November.
Michelle is still adjusting to her unexpected transplant and the unexpected birth of her son while she was in a coma. "When I was told what happened, I thought, OK, it's done," she said. "I wasn't mad or angry. I just thought, what am I supposed to learn from this? What can I teach someone else?" One thing is certain. Her entire family has a new appreciation for organ donation. "You don't realize what it means until you see it in action," Leonard said.
Doctors at Packard Children's and at Stanford Hospital say both mom and baby have excellent prospects, and the family is now joyously preparing for John's first Christmas.
"We're going to go a little crazy with gifts for the kids," Michelle said happily. "It's definitely their Christmas this year, and we are very, very thankful."
About Lucile Packard Children's Hospital
Ranked as one of the nation's top pediatric hospitals by U.S. News & World Report, Lucile Packard Children's Hospital at Stanford is a 272-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children's offers patients locally, regionally and nationally the full range of health care programs and services, from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit www.lpch.org.
About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiac care, cancer treatment, neurosciences, surgery, and organ transplants. Ranked #16 on the U.S. News and World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The Hospital is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford. For more information, visit www.stanfordhospital.com.
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SOURCE Lucille Packard Children's Hospital