By Pauline W. Chen, M.D.
Gina (not her real name) had been born with a defect in her liver, with ducts so damaged and narrow that the bile could not drain. In the first year of her life, she underwent two urgent operations. The first was an unsuccessful effort to convert a loop of intestine into a drainage system for her bile; the second was a lifesaving liver transplant.
Other than a single episode of rejection a few months later, Gina’s new liver worked perfectly. Her visits to the hospital were limited to an annual clinic visit; as the years passed, she became a stunning example of pediatric transplantation’s success.
Then Gina turned 14. Like other young patients I had cared for, she began having problems with her transplant as soon as she hit adolescence.