Traveling to Australia and partying: the "normal life" of a young liver transplant recipient

BarcelonaAustralia is a destination for many young Catalans who finish their studies and are eager to travel, learn English, and work. This is the case for Joan Escolà, a 21-year-old graduate student in marketing and advertising who already has his sights set on the vast Pacific island. But unlike other young people, before deciding to embark on this experience, he had to consult with his referring hepatologist about whether he could do so.

When he was just eight months old, Escolà underwent a liver transplant because his liver wasn't functioning properly and it was the only option for his survival. His father gave him part of the organ, and twenty years later, he's doing well, almost finished his studies, plays handball, and goes out partying with his friends. With a mischievous smile, he admits he drinks from time to time, but he doesn't hide it because he's happy to be able to do the same things as other young people his age.

"This is the goal of the program. The success of the transplant is that the patient can lead a normal life; otherwise, it wouldn't make sense," says Jesús Quintero, head of the Pediatric Hepatology and Liver Transplant Unit at Vall d'Hebron. The Catalan center was the first in Spain to perform a liver transplant forty years ago and, since then, has operated on nearly 500 children who, like Escolà, needed a new liver to survive.

Beyond continuing chronic treatment, with routine hospital visits and daily medication to prevent decompensation, these patients can perform the same activities as everyone else once they leave the operating room. The expert explains that this is a type of organ that, in most cases, does not require retransplantation because it is highly tolerant and the body does not usually reject it. On June 7, 1985, Berta, a two-year-old girl with biliary atresia, the main liver complication for a liver transplant in childhood, was the first pediatric patient to receive a transplant in Spain. The first adult transplant had been performed just a year earlier when this scientific milestone was also achieved.

Berta was discharged from the hospital 56 days after the procedure, but died six months later because the immunosuppressive treatments at the time—which all transplant patients require to prevent the body's defenses from attacking the new organ—were not as effective as they are today. That first operation began at 11:00 p.m. and ended at 11:00 a.m. the following day. Now, however, a liver transplant for a pediatric patient takes about six hours.

Split the donor liver into two

The livers of these patients weigh about 150 grams, and some of the arteries operated on by the professionals are millimeter-sized, which adds complexity to the procedure, even though the results are "very good," Quintero says. Aside from the improvement in immunosuppressive treatments, another turning point in the history of pediatric liver transplantation in the state was the implementation of the transplant. split, which involves dividing the donor's liver into two parts to obtain two fully functional parts for two recipients. Since 2018, national regulations have established that a pediatric patient can receive the liver of a donor under 35 years of age using this technique, and, according to Vall d'Hebron, the waiting list for pediatric patients seeking a liver transplant has been reduced to zero for the first time in 36 years.

In Escolà's case, it was his father who offered, since they share a blood type and were compatible. In fact, his son laughs that when he goes out with his friends or commits mischief, his father reminds him (jokingly) that it was he who gave him the liver and that he should keep an eye on it. Now, when he goes to Australia, he'll have to continue making routine visits and taking his medication, but Quintero has already given him the go-ahead, and he'll be able to leave when he finishes his studies. For now, he's very clear about which beaches he'll visit first.