'One in six billion miracle'

January 25, 2008 6:57 AM

Demi-Lee Brennan received a liver transplant at the age of nine. Her doctors were rather surprised when her body subsequently took on the immune system of the organ donor and her blood type changed from O-negative to O-positive.
posted by the duck by the oboe (35 comments total)

They were further surprised to find that she turned into a serial killer. It was only years later that Demi-Lee -- with the help of one of her would-be victims -- found out that the donor who had given her the liver years ago had actually been a serial killer. Through years of therapy, Demi-Lee can now function normally in society despite the fact that she carries inside her a homicidal liver.
posted by flarbuse at 7:02 AM on January 25, 2008 [7 favorites]

The liver is evil. It must be punished!
posted by b1tr0t at 7:08 AM on January 25, 2008 [2 favorites]

Maybe some of our livers don't want to be such O-negative nancies anymore.
posted by basicchannel at 7:14 AM on January 25, 2008

Remarkable. This girl's body basically took on the role of a bone marrow transplant to change her blood completely to the liver donor's blood type.
posted by misha at 7:14 AM on January 25, 2008

This is amazing news. I got chills of amazement reading that article.

"We did her blood tests and she had no immunity to measles and no immunity to mumps, even though she'd had the immunisations as a baby."

Just fucking amazing. The moment when the doctors realized they need to *let* her new immune system finish destroying her old one has got to go down in medical history.
posted by mediareport at 7:15 AM on January 25, 2008

So, if her liver effected a system-wide blood type change, what happens with the DNA in her blood cells? Throughout her body? Is it technically chimerism?
posted by potch at 7:17 AM on January 25, 2008

Type O Negative?
posted by Bathtub Bobsled at 7:20 AM on January 25, 2008

StephenKingFilter.
posted by ZenMasterThis at 7:26 AM on January 25, 2008

So, if her liver effected a system-wide blood type change, what happens with the DNA in her blood cells? Throughout her body? Is it technically chimerism?

The article is reporting that stem cells from the donor liver populated her bone marrow, and futhermore that her native stem cells were killed off when they stopped immunosuppresive therapy. So her new bone marrow stem cells have the donor's DNA and so would her red cells--if red cells had nuclei, of course. ;-)
posted by Turtles all the way down at 7:30 AM on January 25, 2008

This case and a similar one involving a kidney transplant are described in detail in this weeks NEJM (subscription required, unfortunately). To answer potch's question, yes,they are calling it chimerism. In the case of the kidney transplant it was done intentionally by doing a bone marrow transplant at the same time as the kidney transplant; that patient was the first in a series of six they plan to do as a study. There is also an editorial about the topic by Thomas Starzl where he describes the precise balance between different immune cells needed to achieve this result.
posted by TedW at 7:34 AM on January 25, 2008

This is fascinating. I don't know what I'm more excited about, the implications for treatment of autoimmune disorders, or the possibility that the publicity will prompt the band to reform.
posted by stupidsexyFlanders at 7:35 AM on January 25, 2008

In the Malay archipelago, the liver is considered a locus of emotion.
posted by Burhanistan at 7:45 AM on January 25, 2008

the implications for treatment of autoimmune disorders

What? What? Can you elaborate?
posted by craichead at 8:43 AM on January 25, 2008

possibility that the publicity will prompt the band to reform.

Love that dirty water!
posted by ZenMasterThis at 8:46 AM on January 25, 2008

What? What? Can you elaborate?

I think my meaning - if they can figure out how to replace a bad immune system with a good one -- was fairly obvious. I'm pretty sure it wasn't literally a "miracle."
posted by stupidsexyFlanders at 8:51 AM on January 25, 2008

I think my meaning - if they can figure out how to replace a bad immune system with a good one -- was fairly obvious. I'm pretty sure it wasn't literally a "miracle."

Well, I must be a moron, because I actually didn't make that connection, but I guess that makes sense. Wow. The idea of never having to take prednisone again is pretty damn alluring.
posted by craichead at 9:00 AM on January 25, 2008

That's some science fiction shit right there. I mean, seriously, if an author used this as a plot device, I would have had a hard time suspending my disbelief enough to enjoy the story. To find out it really occurred is just too weird.

Hopefully they can figure out how the hell it happened.

That would be a good thing.
posted by quin at 9:01 AM on January 25, 2008

As I understand it (not nearly as well as I'd like to, in other words), the liver is the source of the red blood cells of the fetus.

I wonder if this implies the liver could be making more of a contribution than that to fetal blood cell populations, and whether, since the liver concentrates and metabolizes toxins, and many of these toxins and their metabolites are carcinogenic, the liver should be investigated as a possible source of the cancerous white blood cells of leukemias, particularly childhood leukemias.
posted by jamjam at 9:15 AM on January 25, 2008

Hopefully they can figure out how the hell it happened.


From the NEJM case report:

The change in this patient from group O, RhD-negative blood to group O, RhD-positive blood suggested the development of chimerism by engraftment of the recipient marrow from passenger hematopoietic stem cells within the transplanted liver. Fluorescence in situ hybridization studies for the X and Y chromosomes were performed on a bone marrow aspirate and peripheral-blood lymphocytes 3 months after the onset of hemolysis (post-transplantation day 395).2 Analysis of cells from the marrow, sorted by means of flow cytometry, showed that they were male (XY) in myeloid, erythroid, and CD19+ B cells. Analysis of peripheral-blood aliquots revealed a predominantly male (donor) population: of 50 T cells, 94% were male and 6% were female; of 50 B cells, 98% were male and 2% were female; of 50 granulocytes, 100% were male; and of 50 natural killer cells, 100% were male (Figure 1). A total of 190 sorted peripheral-blood cells were further assessed on post-transplantation day 417, and 250 cells were assessed on post-transplantation day 492 (2 months after immunosuppressive therapy had been discontinued); all of these cells were male.

In other words there were enough stem cells in the transplanted liver that they eventually took over and replaced the patients immune system cells, which were supressed by drugs.
posted by TedW at 9:24 AM on January 25, 2008 [1 favorite]

Hopefully they can figure out how the hell it happened.

It's a miracle, we will never understand how god did it.
posted by Mr_Zero at 10:27 AM on January 25, 2008 [1 favorite]

Could this have happened because she was so young? (Don't have access to the NEJM report.)
posted by effwerd at 11:19 AM on January 25, 2008

This is amazing. I wonder if a CCR5-∆32 mutation could be imparted to AIDS patients by swapping out their immune systems?
posted by Blazecock Pileon at 11:27 AM on January 25, 2008

craichead, sorry to misread your comment. Got to turn down my snark sensitivity.
posted by stupidsexyFlanders at 11:36 AM on January 25, 2008

This is not the panacea that some people are making it out to be. If it were, we'd just be doing bone marrow and peripheral stem cell transplants willy nilly for all sorts of diseases already. Being the recipient of a hematological stem cell transplant comes with its own, numerous complications. The challenge of balancing the risk of GVHD and infectious complications due to immunosuppression ain't an easy tightrope to walk folks.
posted by drpynchon at 11:44 AM on January 25, 2008

Effwerd: in the article about the renal transplant and another article I didn't see when I made my first post, the patients ranged from 22 to 47 years old, so this isn't limited to children.

Drpynchon makes a good point that this is not a simple thing, and although these findings will definitely advance the field of organ transplantation it was not an easy achievement. And of course, the limited supply of donor organs will continue to be the limiting factor in transplantation.
posted by TedW at 12:17 PM on January 25, 2008

Why is her new immune system not attacking the rest of her?
posted by dsword at 2:11 PM on January 25, 2008

Effwerd: in the article about the renal transplant and another article I didn't see when I made my first post, the patients ranged from 22 to 47 years old, so this isn't limited to children.

Missed that. Thanks.
posted by effwerd at 3:06 PM on January 25, 2008

Her name is Demi- and she becomes half-someone-else. What are the odds?

Also, wow. *dreams of future pancreas transplant possibilities*
posted by ilana at 3:18 PM on January 25, 2008

I for one welcome our new hepatic overlords.
posted by XMLicious at 4:53 PM on January 25, 2008

There are so many problems that could be fixed by an immune system swap. My mom's rheumatoid arthritis would get a solid ass-kicking, which would be great.
posted by mullingitover at 7:14 PM on January 25, 2008

Why is her new immune system not attacking the rest of her?

Just a guess, but becuase she is she is 0-?
posted by afu at 5:54 AM on January 26, 2008

Okay, I'm admittedly pretty uninformed about medicine, but...

Why would you transplant an O+ anything into and O- system? I'm O-, and had always been taught the the Rh would be essentially poisonous in any transfusion I could ever receive. Was I simply misinformed, or what's the deal here?
posted by Navelgazer at 11:28 AM on January 26, 2008

I can't explain about transplants, but for transfusions the deal is that an Rh-negative has to be exposed to Rh factor once before the response develops. So technically, you could receive O+ once. Still doesn't explain why they'd do it for a liver, unless they really had no choice; but then, they were giving her immunosuppressants, so they knew that they were delivering a mismatch ...
posted by eritain at 9:25 PM on January 26, 2008

This goes right along with a report in 2003 that a 60-year-old man, who had no history of nut allergy, suffered an anaphylactic reaction to a cashew nut just 25 days after he received the liver transplant. The 15-year-old boy (liver donor) did have the allergy and had died after eating a peanut.

It seems pretty obvious to me that the immune system is over-reacting to substances harmless to the body when there is an allergic reaction (even treating pollen as an enemy to be attacked). I think that any diseases will eventually be tracked down to find at their core a malfunctioning immune system.
posted by spock at 11:25 PM on January 26, 2008

Forgot the link: Nut allergy transfered via liver transplant.
posted by spock at 11:26 PM on January 26, 2008