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Spring 1998
To Save Two Lives
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Liver transplantation, as a specialty, is remarkably young. When Busuttil began working in the field in 1983, the University of Pittsburgh was the only institution in the country with an established program. Busuttil’s first subjects, as it happened, were pigs; their liver and biliary tree are similar to those in humans. Working alone nights and weekends in the vivarium of the UCLA medical center, he transplanted close to 100 of them. “Then I thought, well, I ought to go see how it’s done in humans,” he recalls, “so I went to Pittsburgh.” He studied under Dr. Thomas Starzl, the brilliant surgeon who headed Pittsburgh’s program, then Busuttil returned home to assemble his transplant team.

On February 1, 1984, Busuttil did his first liver transplant at UCLA, on a middle-aged man who had a tumor. “I told him I had never done one by myself, that UCLA had never done one before either. I told him this was kind of a first, that he had to have faith in us, that we had faith in him, and that we would do all we possibly could to get him through it.” The man lived, but eight months later his tumor recurred. For Busuttil, it was a sobering lesson about the kind of patients he could transplant successfully and the kind he could not.

In those early days, Busuttil and his team were pretty much flying by the seat of their pants. “What could go wrong?” asks the animated surgeon, throwing up his hands. “Not knowing how to select the donor. Not knowing how to select the recipient. The operation was still evolving. The use of drugs to immunosuppress the patient to prevent rejection of the transplant was in its infancy. We were in a real learning phase.”

In 1992, with nearly a decade of successful transplants behind them, the enterprising team attempted a new procedure, aimed at addressing the huge donor organ shortage (see sidebar, page tk). As it happens, the liver is the only organ in the human body able to regenerate itself. If you cut the heart, it will grow scar tissue. If you cut the kidney, it too will scar over. But the liver is like a salamander’s tail. “A transplanted liver completely regenerates to fill the cavity the old liver left behind,” says surgeon Drazen. “That’s a mechanism no one quite understands.”

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