Milana: Living Donor Liver Transplant and Cure for Hepatitis C

For the first time in the world, a little girl with hepatitis C has been “cured” – after a liver transplant – with new drugs with direct antiviral action to defeat the virus.

The delicate procedure combined with the pharmaceutical protocol was performed in 2017 at UPMC ISMETT in Palermo by the team led by Dr. Jean de Ville de Goyet on a little Ukrainian patient just two years old.

Milana was diagnosed with biliary atresia since birth, a condition that causes obstruction of the bile ducts and which in a short time had led to her terminal liver failure. In Ukraine where she was initially treated, she had also contracted the hepatitis C virus, probably from a blood transfusion. She presented, therefore, with two diseases at the same time – biliary atresia and hepatitis C – that had compromised her health status.

The association of these two diseases in a small child is very rare and, until now, represented a contraindication for liver transplantation, the only possible therapy to treat her end-stage liver disease.

“The hepatitis C virus,” explains Jean de Ville de Goyet, “in children has a very slow progression and in some cases it cures spontaneously. Normally, you follow the little patient and wait until the child is cured or reaches a certain age to start treating him or her with drugs. The situation changes, when you are forced to proceed with the transplantation of the child at an early age, in fact, in this case, the progression of the disease is very fast and the risk of the transplanted organ getting sick again making the transplant in vain is very high.”

The little girl underwent a living-donor liver transplant, thanks to her mother's donation of part of her liver, and then an experimental protocol was applied to “treat” the little girl with the new antiviral-acting drugs to eradicate the hepatitis C virus infection. The transplant was performed in April 2017, then drug therapy began.

“That of our little patient,” de Ville further explains, “is, to our knowledge, the first case of treatment of a transplanted child of HCV infection with these new drugs. It should also be emphasized that the one at hand is a pioneering treatment even outside the transplantation field: Milana is, to date, the youngest patient ever treated with ledipasvir+sofosbuvir, independent of transplantation. We think, therefore, that this case may help pave the way for the wider scale use of these new drugs in children as well, improving their life expectancy.”

Milana arrived in Palermo thanks to a solidarity circuit; in fact, several Ukrainian associations and private citizens who joined the appeal launched by her mother online financed her journey.

“We had great donors,” says Olga, the little girl's mother, “but also many ordinary people who wanted to help us, donating what they could. Their generosity allowed us to be able to come all the way to Italy and help the little one.” Before arriving in Palermo, Olga had approached other transplant centers in Poland and Belgium.

Before Palermo, Olga had consulted other transplant centers in Poland and Belgium. “In Poland, they told me that there was no cure for hepatitis C to treat such young patients,” she said. Hence, the choice to contact ISMETT and travel to Italy. “I met a woman whose son had been transplanted by Dr. de Ville de Goyet, so I tried to get in contact with him. I found his e-mail address, and here we are.”

Today Milana is well: her liver is functioning perfectly and there is no longer any trace of the hepatitis C virus in her system. “Milana,” Olga says excitedly, “has resumed eating everything, sleeping through the night, and playing with her brother. She has returned to being a normal two-year-old girl.”

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