A British woman has become one of the first to benefit from pioneering surgery that uses tissue taken from a cow’s heart to rebuild the liver.The operation brings the possibility of whole donor organs being taken from animals – known as xenotransplantation – ever closer. Michelle Morgan-Grainger, 42, from Liverpool, was diagnosed with a rare form of liver cancer in October 2010. Doctors initially told her she could not be cured. But two months later, she underwent a procedure to remove the tumour in her liver along with a large portion of her Inferior Vena Cava (IVC).
This major blood vessel is positioned close to the back of the liver and returns blood from the lower half of the body back to the heart. The IVC was then reconstructed with a patch made from the outer lining of a cow’s heart, a material called bovine pericardium. The procedure is likened to an art form by Hassan Malik, consultant hepatobiliary surgeon at Aintree University Hospitals NHS Foundation Trust, Liverpool.
‘This was a long and complex procedure and is offered only in a handful of places around the world,’ he says of the operation, called a right hepatic trisectionectomy with enblock resection of the IVC.
‘There are only five centres in Europe with experience in such cases. To date about 150 patients have been treated worldwide. The bovine patch has been used in heart surgery for a while but employed in just six liver surgery cases, four of which we’ve performed.’
According to Mr Malik, what makes Michelle’s operation so specialist is the use of this bovine material, as well as the fact so much of the IVC was removed.
‘Usually, if the IVC needs reconstruction, a plastic-type synthetic material rather than the natural bovine material has been used,’ he says. However, this carries a higher risk of infection and also of blood clots forming after surgery.
‘With the bovine material, the risks are dramatically reduced,’ he says. ‘Patients avoid the need for long-term use of drugs to thin the blood, which have side effects. The bovine material is pre-treated and has gone through chemical processes to remove the risk of infection, which means it is as close as you can get to the IVC, without taking part of another human vein.’
WHY USE A COW GRAFT?
‘The material is a similar thickness, it’s flexible and easy to cut to shape and suture in place,’ says Mr Malik. ‘Synthetic materials tend to be more rigid. And if the synthetic material becomes infected, it will need replacing.
‘The bovine material becomes a part of the patient and will last as long as they do. The choice of synthetic or bovine material comes down to an assessment made by the surgeon. We find it seems to work without any problems.’
Each year in the UK, 3,400 people are diagnosed with primary liver cancer, when a tumour originates in the liver. The outlook is often poor. Liver cancer usually presents with few symptoms and most cases are detected once the cancer is advanced. There are different types of primary liver cancer but possible symptoms can include jaundice – this causes the skin and whites of the eyes to go yellow – discomfort in the stomach, weight loss, and loss of appetite.
Suitability for surgery depends on various factors, including the size and position of a tumour and whether the liver is damaged by cirrhosis (scarring). But for some, it can offer the chance of a cure.
PAIN IN THE SIDE WAS CANCER
Michelle visited her GP after experiencing a pain in her side, similar to muscle strain, for a couple of weeks. Doctors thought she may have gallstones, but the pain persisted and later scans revealed the worst.
Indeed, by the time Michelle’s cancer was diagnosed, her tumour was 6in in size – though fortunately it hadn’t spread elsewhere in her body – and she was told by doctors that it was inoperable.
But after her case was referred to the specialist liver surgery centre at Aintree University Hospital, Mr Malik, along with surgeon Mr Stephen Fenwick, offered her a surgical solution.Mr Malik says: ‘As we had experience of this kind of surgery, we thought we could help her. As it turns out, her operation was life-changing.’
A TEN-HOUR OPERATION
Michelle, who is married and works as a health director for BT, says: ‘The surgeons told me about the procedure and explained they could give it a try, but they didn’t know if it would work. It was my decision, and I wanted to try something rather than do nothing.’
During the ten-hour operation, performed under general anaesthetic, Mr Malik and Mr Fenwick removed 80 per cent of Michelle’s liver. As the tumour was wrapped around the tubular IVC, three-quarters of the vein had to be removed.
‘The liver is the only organ in the body with the ability to regenerate,’ says Mr Malik. ‘Over three months, the piece of remaining liver regrows to its original size. But you have to try to recreate the structure of the IVC. Imagine a can of drink: if you cut a hole in the side, three-quarters of the way around the can, then one side is intact and the rest is open. You have to try to close that gap and this bovine material acts as a wall.’
Eleven days after surgery, Michelle left hospital. Three months later, she was back at work. And less than 18 months on, she is cancer-free.‘I made a joke about mooing when I found out about the bovine material,’ says Michelle. ‘But I’m thankful it was used. I know I’m very lucky. I have scans and blood tests quarterly, so I live each three months at a time.‘I recently raised £42,000 for charity and I want to continue to fundraise to increase awareness of liver cancer and also to raise awareness of my surgeons and the hospital, because if it wasn’t for them, I wouldn’t be here.’