UF Shands Transplant Team Performs Rare Combined Liver-Pancreas Transplant

December 10, 1997

GAINESVILLE—A 14-year-old Orlando girl with cystic fibrosis was discharged from Shands Children’s Hospital today after undergoing a rare combined liver-pancreas transplant, the state’s first for this particular disorder.

Kasey Barger received the life-saving transplant Nov. 22 during an eight-hour operation led by UF surgeons Max Langham Jr. and Alan Reed. Only a dozen or so of its kind have ever been performed worldwide, Langham said.

“This operation was unique because we actually took the liver and pancreas out together and maintained their anatomic relationships, placing them into Kasey while keeping those relationships intact,” said Reed, director of the pancreas transplant program. “This is known as a ‘cluster transplant,’ and is very different from a regular liver transplant in a patient of her size for this particular disease.”

The operation is noteworthy, said Andreas Tzakis, professor of surgery, director of the liver GI transplant program and co-director of the division of transplantation at the University of Miami School of Medicine.

“This is the first time this has been done in the state, particularly for this indication (cystic fibrosis),” he said. “It’s a wonderful achievement, and we’re very happy to hear of it.”

Unlike many cystic fibrosis patients, who are commonly predisposed to chronic lung infections, Kasey’s disease attacked her digestive system. Her pancreas failed to produce critical hormones as well as enzymes that convert food into energy. She developed diabetes and frequently was forced to give herself insulin shots up to six times a day. She also regularly swallowed enzyme supplements to help digest the food she ate.

In addition, the disease damaged the cells of her liver, studding it with scar tissue and impairing its ability to effectively remove toxic substances from the blood, a condition known as cirrhosis. She had a constant stomachache and episodes of internal bleeding that temporarily affected her vision.

“In one fell swoop, we were able to take care of not only her liver disease but also her diabetes and possibly even some of the other problems associated with her cystic fibrosis,” Reed said.

In cases such as this, surgeons face the difficult choice of whether to perform a combined organ transplant or to separate the organs and transplant them individually, Langham said.

“Those are value judgments we have to make based on the size of the organs [and other factors],” he said. “The procedure Kasey had is not routine; only a handful have been done in the world because it is extremely complicated. You have two organs to monitor — two organs to watch for complications. And the way the blood vessels are hooked up is considerably more complicated because you transplanted a larger group of organs.”

Kasey, an honors student at Orlando’s University High School, where she is a freshman, said her illness forced her to forego some of her favorite activities, including gymnastics, softball, soccer, bowling and track. It also affected her growth. At 4 feet 7 inches and 65 pounds, her size posed a particular challenge in finding donor organs to match, Reed said.

Kasey’s mom, Annette McFarland, is an Orange County sheriff’s deputy. Her co-workers have rallied around the family, even contributing their own vacation hours so McFarland can care for her daughter.