Two-year-old Baelyn undergoes transplant after mysterious liver disease outbreak

Two-year-old Baelyn Schwab has a laundry list of allergies. When she woke up in late April with a runny nose and hives, her parents assumed it was an allergic reaction and contacted her doctor. 

Less than a week later, Baelyn was airlifted from her home in South Dakota to M Health Fairview Masonic Children’s Hospital. Her liver was failing due to acute hepatitis, or inflammation of the liver, and she needed a transplant to survive.

Baelyn received a new liver at Masonic Children’s Hospital on May 5 and is doing well post-transplant. She is now part of an investigation by the Centers for Disease Control and Prevention (CDC) looking into 180 possible cases of pediatric acute hepatitis that have no known origin.

“Roughly half of all pediatric acute hepatitis cases are idiopathic – which means we don’t know the cause,” said M Health Fairview Pediatric Gastroenterologist and Hepatologist Heli Bhatt, MBBS, MPH. “I’ve seen multiple cases of acute hepatitis and acute liver failure of unknown origin, but the fact that there are so many at the same time – I haven’t seen an outbreak like this.”

Bhatt and her colleagues at Masonic Children’s Hospital are working with the CDC to research potential causes of this outbreak, which has affected Baelyn and so many other young children. While adenovirus – a common illness which most often only causes cold or flu-like symptoms – is present in the majority of patients, Bhatt says it’s not yet certain if this is the cause.

First signs something was wrong

Kelsea Schwab had heard of the pediatric hepatitis outbreak before her daughter began showing symptoms. Still, she didn’t think it was possible that hepatitis could suddenly hit so close to home – in her two-year-old daughter.

“We took her to the allergist when she had hives,” said Kelsea. “The next day, I noticed that her eyes were more yellow than usual. I thought it could be due to the allergy medication, but they kept getting worse.”

That weekend, another family member pointed out how strange Baelyn’s eyes looked. Her suspicions confirmed, Kelsea brought her daughter into the doctor the following Tuesday. The whole time, Baelyn was acting completely normal and seemed healthy except for her yellowed eyes.

Kelsea was shocked when the doctor called after performing blood tests. Their physician referred the family to Masonic Children’s Hospital for treatment and said they needed to get to Minneapolis as soon as possible. Baelyn was airlifted to Minnesota later that day.

Keeping Baelyn healthy for transplant

A multidisciplinary team began testing Baelyn regularly as soon as she arrived at the hospital. The liver has many responsibilities – including managing glucose and filtering toxins like ammonia out of the blood.

Within the first day or two, it became clear that her liver failure was severe. But the ammonia in her blood wasn’t increasing. Baelyn’s care team – and family – held out hope that her liver may be able to repair itself without transplant. When the amount of ammonia in her blood began to increase, they couldn’t wait any longer.

“We monitored her very closely and sent her to the Pediatric Intensive Care Unit (PICU) at the first sign of deterioration so she could get the best possible care,” said Bhatt. “We were very aggressive in keeping her healthy enough for a potential transplant.”

M Health Fairview Transplant Surgeon Srinath Chinnakotla, MD, visited Baelyn every day to monitor her liver. Chinnakotla also serves as Surgical Director of Liver Transplantation and is a Professor of Surgery at University of Minnesota Medical School.

“When her ammonia started climbing, that’s when I got nervous,” he said.

Baelyn was put on the transplant waiting list on April 29 – less than a week after Kelsea first noticed the yellow in her eyes.

In preparation for transplant, Baelyn was put on an antiviral medication to treat her for adenovirus. While her liver didn’t test positive for the virus, it was found in her bloodstream. Because transplant severely weakens a person’s immune system, it was important to prevent the virus from spreading after transplant and attacking her new liver.

Rare transplant has immediate impact

A matching donor liver became available quickly and Baelyn underwent transplant on May 5, just over a week after being admitted to the hospital. Chinnakotla performed the operation – his second pediatric transplant for liver failure this year.

“The number of pediatric transplants done for acute liver failure are few every year” said Chinnakotla. “This year, we’ve already seen two children with liver failure and transplanted two children with liver failure. This is very unusual for us.”

Baelyn also had an unusual anatomy – she had two small vessels supplying blood to her liver, instead of one larger one. Chinnakotla used blood vessels from the same liver donor to create a unique bridge graft, known as an aortohepatic conduit.

The surgery was successful, and Kelsea noticed an almost immediate difference in her daughter. Before transplant, Baelyn’s skin had turned a dark yellow – almost orange – color. It had returned to normal by the time she woke up after transplant.

Since surgery, her fiery spirit has also come back. She’s playing, starting to walk, and even making life a little difficult for her parents again – like any normal 2-year-old. 

While Baelyn is expected to be discharged from the hospital after two weeks, the family will stay in the Twin Cities for a month so the doctors can closely monitor her liver function. Baelyn has come off the antiviral medication and her new liver seems to be doing well. Despite it being too big for her at first, it should adapt to her body and grow with her as she ages.