Three decades ago, in the early days of liver transplant, babies with liver failure usually died. Transplants were saving adults and older children, but were not offered to patients younger than 2. For these youngsters, doctors thought, the operation was too risky and difficult. But an ambitious surgeon named Carlos Esquivel changed that.
Now chief of the division of transplantation at Lucile Packard Children’s Hospital Stanford, Esquivel, MD, PhD, is lauded worldwide for his skill at performing transplants in very sick babies and children. But 30 years ago, he didn’t know he would become both an advocate for pediatric liver transplants and the leader of an extraordinary transplant team that helps patients progress to healthier, happy lives.
In 1984, Esquivel began a fellowship with the University of Pittsburgh’s Thomas Starzl, MD, PhD, who had performed the first successful human liver transplants and was refining the difficult, esoteric procedure. Soon, Starzl guided Esquivel through a transplant on a man with acute liver failure who had come to the hospital in a deep coma. Two days later, the patient awoke.
“Once I saw that — somebody who was at death’s doorstep waking up — it was unbelievable,” Esquivel said. “I never looked back.”
Instead, he looked toward the babies who weren’t being offered liver transplants. Many had a congenital defect called biliary atresia, which causes liver failure in infancy or toddlerhood.
“There are huge difficulties with transplanting these patients,” Esquivel said. “They’re some of the sickest in the hospital.” But without transplants, they invariably died. So Esquivel began trying to transplant them.
“The whole field was just undergoing a revolution,” said Starzl, now professor emeritus at the University of Pittsburgh. Esquivel’s scientific inquisitiveness and warm, sensitive character made him a good person to advance the field’s transformation, Starzl said. But it was his surgical skills that really set him apart.
“He is instinctively a tremendously good surgeon,” said Starzl. Esquivel could consistently reconstruct infants’ tiny blood vessels and the ducts that feed their livers, a feat many surgeons could not achieve. “It takes a different level of skill than is required for adults,” Starzl said.
The liver transplant team Esquivel built, which has been at Lucile Packard Children’s Hospital Stanford since 1995, is now recognized as one of the largest and most experienced in the world. They have performed more than 600 liver transplants, including some in which patients also received another organ, such as a heart, kidney, lung or intestines.
In 2013, the team achieved 100 percent one-year survival for their liver transplant patients, a rate that is higher than expected given the acuity of cases they undertake.
“We have been able to put together an unbelievable team,” Esquivel said. The team joins everyone at the hospital in congratulating Esquivel on the 30th anniversary of his first liver transplant.
