Transplant saves 4-week-old Elsie Freeman after sudden liver failure

Liver transplant is a complex procedure in adults – let alone a four-week-old infant. But when Elsie Freeman went into liver failure just weeks after birth, there was no other option.

Elsie was born in October 2021 along with her twin brother, Ethan. Both babies seemed healthy at first, but within a couple weeks Elsie’s skin began to turn yellow – a condition called jaundice. Elsie’s parents, Stacie Haverkamp and James Freeman, brought her into urgent care. From there, Elsie was referred to M Health Fairview Masonic Children’s Hospital.

Doctors discovered that Elsie had gone into severe liver failure, which caused her jaundice and other symptoms like abnormal bowel movements. She was connected to a dialysis machine, which helped remove toxins from Elsie’s body – performing part of the liver’s normal function. She was also placed on a breathing machine, and through testing it became clear that the only long-term solution would be a new liver.

“We still don’t know for sure what caused Elsie’s liver failure, but we suspect it could have been a genetic defect in the liver itself,” said M Health Fairview Transplant Surgeon Srinath Chinnakotla, MD, who went on to perform Elsie’s transplant. “Liver failure is a rare cause of liver disease, and it’s even more rare in an infant this age.”

Chinnakotla worked closely with M Health Fairview Pediatric Gastroenterologist and Hepatologist Sarah Jane Schwarzenberg, MD, to evaluate all options. When the hepatology and transplant teams agreed that a transplant was Elsie’s only hope, he sat down with the family to talk about next steps.

“Everything happened very quickly. Not even six hours after our initial discussion, Dr. Chinnakotla called and said she was on the waiting list for an organ,” said Haverkamp. “Less than a day later, she had a donor and was going into surgery.”

One of the smallest liver transplant patients in Minnesota

Elsie received her new liver just before Thanksgiving 2021 – less than one week after arriving at the hospital. She weighed less than seven pounds at the time of transplant.

Elsie had four surgeries within six days, due to the complexity of transplanting a liver into an infant. Chinnakotla and his team placed the new liver, then slowly worked to close Elsie’s abdomen around the new organ.

“It takes anywhere from one to three months for a transplanted liver to assume the correct size within a patient’s body,” said Schwarzenberg. “We can’t wait for the liver to shrink in children, we have to close the wound, and gradually we see this remarkable adaptation as the liver shrinks itself to fit.”

Elsie was four weeks old and weighed just under seven pounds when she received her transplant. Her care team believes she may be the smallest child in Minnesota to receive a liver transplant.

“It’s a brave undertaking, but the technique has evolved so that in the right hands it’s possible,” said Schwarzenberg, who has been with M Health Fairview for over three decades. “Our team has the skill and willingness to give every child a chance. In this case, our team didn’t only give Elsie a chance – we were successful in giving her a new liver.”

Masonic Children’s Hospital has one of the oldest pediatric transplant programs in the world. Surgeons have performed over 540 pediatric liver transplants since the program began in 1964. This history of innovation has helped us perform life-saving procedures on younger and more complex patients like Elsie. In 1982, we transplanted an 11-month-old patient who went on to become the world’s longest-living pediatric liver recipient – a testament to the hope that liver transplant provides.

Elsie’s transplant was also made possible by the Pediatric Intensive Care Unit (PICU) at Masonic Children’s Hospital, who were able to keep her alive through severe liver failure in order to get her to surgery.

“She didn’t just have the transplant team – she had her hepatology team and her PICU team,” said Haverkamp. “Everyone collaborated and worked together to find a solution.”

Elsie was one of 116 liver transplants – including 10 pediatric liver transplants – performed by the M Health Fairview Liver Transplant Program in 2021.