An 8-year-old girl named Wu was diagnosed with a rare cancer, Wilms' tumor, which severely deformed both of her kidneys, necessitating their removal. She had been surviving on dialysis for years, which led to heart failure and osteoporosis, leaving her with little hope for the future. The kidney transplant team at Taipei Veterans General Hospital (Taipei VGH) utilized an innovative approach called "liver-splitting kidney transplantation." They identified healthy hepatic veins in her liver, created an extended conduit using donated veins, and successfully transplanted an adult kidney into her liver, freeing her from dialysis.
Yesterday, Taipei VGH unveiled the details and outcomes of Wu's surgery. Dr. Ling-Ming Tseng, deputy director of Taipei VGH, highlighted the complexity of the procedure, noting that there have only been three such cases worldwide, with the other two in the United States. This case is the first in both Taiwan and Asia.
Wu was diagnosed with bilateral Wilms' tumor, a rare malignant kidney tumor linked to genetic mutations, at the age of two and a half. This tumor is typically asymptomatic but can grow large and compress other organs in its late stages, causing abdominal pain or inability to eat. The only treatment is surgical removal of the kidneys followed by chemotherapy. After the surgery, Wu had to undergo peritoneal and hemodialysis to remove toxins from her body.
Long-term dialysis resulted in developmental delays, heart failure, and severe osteoporosis due to imbalances in calcium and phosphorus electrolytes. She also suffered from recurrent peritonitis infections. Despite the cancer being cured after five years of chemotherapy and follow-up care at Kaohsiung Veterans General Hospital, her quality of life was severely compromised, and kidney transplantation was the only solution.
In May last year, Wu’s parents decided to seek an evaluation at Taipei VGH for a kidney transplant. Fortunately, they received a donated kidney within two months. However, Wu’s inferior vena cava had become fibrotic and completely obstructed due to the pressure from the large tumor in her early years. This rare condition meant that there was no usable vein for reconstruction, forcing the team to forgo the transplant at that time.
The team at Taipei VGH did not give up. After conducting venography, they discovered a small segment of healthy vein inside Wu’s liver, while all other veins were unusable collateral vessels. After thorough discussions, they concluded that splitting the liver to find a healthy vein for reconstruction was the only viable option.
In April this year, Wu received a second donated kidney. As transplant surgeon Dr. Yi-Fan Tsou retrieved the kidney from the donor, pediatric surgeon Dr. Hsin-Lin Tsai and Dr. Hui-Hsin Yang simultaneously performed the transplant surgery. They carefully split the liver to find the healthy hepatic vein, created an extended conduit using the donor's veins, and reconstructed the connection with the kidney's renal vein. Interventional radiologist Dr. Hsuan-En Huang placed an endovascular stent during the surgery to prevent the liver’s weight from compressing the transplanted kidney’s veins and impairing blood circulation.
Dr. Hsin-Lin Tsai explained that the procedure involved using the liver as a hub, nourishing the kidney with hepatic blood vessels, and creating an "extension cord" to connect with the renal vein. The surgery, which involved 11 medical staff members and took 12 hours, successfully transplanted the adult kidney into the low-weight Wu’s liver.
At the press conference yesterday, Wu read out a handwritten card to the donor in her childlike voice, saying, "Thank you for donating a precious kidney to me, allowing me to avoid dialysis. I will take good care of it and cherish it."
Resource (mandarin): 亞洲首例 8歲女童「分肝種腎」脫離洗腎命運
