A Transplant for a 2 Year Old:
Maria Millan, M.D.

A normally bustling 2-year-old Jacob Hoyt sits on the lap of transplant surgeon Maria Millan, M.D., before jumping off and finding something else to climb. Jacob received a kidney transplant in January.

SPRING 2004 - Two-year-old Jacob Hoyt is at that wonderfully exuberant age when objects are meant to be thrown. First he launches a sealed tube of hand lotion over the side of his blue Graco stroller. Then he lets loose with a pen, and finally a coloring book. His mother, Anna, can't help but smile. It's a big improvement over the holidays, when the cherubic strawberry blonde toddler could barely eat, let alone play.

Back in 2001, while she was still pregnant with Jacob, Anna learned that her baby had a congenital abnormality that was blocking the proper flow of urine from his kidneys to his bladder. By the time Jacob was born, both kidneys were failing and it was clear that little Jacob would need a kidney transplant. Doctors in Arizona immediately put the baby on home dialysis to filter wastes and excess fluids from his blood until he reached the weight necessary to undergo a transplant.

Fortunately for the Hoyts, Packard Children's Hospital has an excellent record when it comes to giving small people new organs. "A lot of our patients are referred from around the country," notes Maria Millan, M.D., who recently was named director of Packard's pediatric kidney and liver transplant program. "We do approximately 30 pediatric liver transplants and about 25 pediatric kidneys a year. That's a significant proportion of the patients in this age group transplanted nationwide."

Millan and colleagues performed Jacob's transplant in January using a live-donor kidney from his father Paul. "The majority of our babies have living adult donors, usually a parent," the surgeon explains. In fact, she and her mentor, Packard's famed kidney transplant surgeon Oscar Salvatierra, M.D., have found that little ones often do better with grownup kidneys than with small donor organs, which tend to be more fragile. "In small infants and children, kidneys from live donors do significantly better and function for much longer periods of time – up to half will still function after 30 years – than kidneys from deceased donors, where half function at 10 to 20 years," she notes. "We’ve published results showing extremely high survival rates, 99 percent. And that far exceeds the national average."

Five weeks after the transplant, Anna, Jacob, and his 3-year-old brother, Jaden, are living in a temporary apartment in Mountain View. Jacob still has a feeding tube and is taking immune-suppressing drugs to prevent organ rejection. Already, though, Anna is seeing changes in her little boy. He's teething now, finally; talking up a storm, and his color is much better -- not to mention his throwing arm. She prays that he'll be on his feet soon, chasing after his older brother. Her third child, another boy, is due later this spring.