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Renton, WA - On Martin Luther King day, Michelle Rowan and her three daughters decided to spend the holiday ice skating with some friends.  That day she noticed the whites of 5-year-old Annie's eyes were yellowish, but she didn't think too much of it.  A couple of days later, when bathing her two youngest daughters, Michelle noticed that Annie's skin was a very different color than her 3-year- old sister's.  "I tucked Annie into bed that night and raced to the internet to start looking up what might be causing this jaundiced condition.  Nothing I found was comforting."  The next day, and for several days following, Annie went to the doctor for blood tests to try to solve the mystery.  Her liver enzyme numbers were highly elevated, indicating great irritation, but all tests for diseases and viruses came back negative.  Next Annie's doctor referred her to Seattle Children's Hospital.  There Annie underwent more blood tests, urine tests, and an ultrasound... but still no conclusions.  Because her liver enzymes continued to elevate, the doctors at the hospital scheduled Annie for a biopsy (right on her 6th birthday) so they might get to the bottom of what was happening.  But the results still produced no answers.

Two days later, Annie woke up in great pain and her skin was very sore to the touch (this was caused by high levels of ammonia).  She was also more yellow than ever.  "Even when I was doing her hair, I noticed her scalp was yellow.  I became afraid that she might not live to see her next birthday," said her mother, Michelle.  Joseph, Annie's father, rushed her to Seattle Children's Hospital where she was immediately admitted to the ICU.  Annie was in the end stages of acute liver failure... with no known cause.  "When Joe called me to tell me the news, I was in complete shock and disbelief.  He told me to come to the hospital as quickly as possible because the transplant team was there to discuss her need for a new liver," said Michelle.

The following 24 hours were spent consulting with transplant coordinators, getting Annie listed for a deceased donor liver, and sending Michelle to UW Hospital to begin testing for living donor surgery in case another liver didn't come through in time.  Michelle was turned down because of low iron levels.  But within hours, over twenty applications were submitted by friends and family to begin testing to donate to Annie.  "The love and support was so overwhelming," said Joe.  "People were willing to go through major surgery to help our daughter."

An old college roommate of Michelle's was selected as the next possible living donor.  She had packed her bags and was about to begin traveling to Seattle, when she received a phone call telling her there was some new information and that she was "on hold."  A few hours later, Annie's parents were informed that a deceased donor liver match had come through, and the doctors had accepted it.  "It was a relief and very frightful at the same time," said Michelle.  "My heart sank thinking about what she would go through to receive the transplant, but I was so grateful beyond description that hope for her life was on the horizon."

On the morning of February 4, 2010, after the longest night of their lives at the hospital, Joe and Michelle watched as anesthesiologists and nurses wheeled Annie down a long hallway to prep her for her life- saving surgery.  The transplant procedure lasted a total of 11 hours and 59 minutes.

Annie spent 3 days in ICU and 3 more days on the surgical floor.  She was able to go home only 6 days after the transplant.  She has healed very well, and has bounced back incredibly fast.  But she is also depending on 9 expensive medications, and as expected, she has experienced some rejection and other bumps in the road.  Over the past 4 weeks she has returned to the hospital for 2 biopsies and 3 ultrasounds.  "Finding the perfect balance between medicines and rejection is what we're working on now," says Joe.

With the financial burden of a transplant often exceeding $500,000, the Rowan family has asked for assistance from the Children's Organ Transplant Association (COTA), a national charity dedicated to organizing and guiding communities in raising funds for transplant-needy patients.  In Renton, WA and St. George, UT, volunteers are raising funds in behalf of Annie.  More volunteers are needed to assist with fundraising activities.  Individuals and groups interested in more information can contact Community Coordinator Janaea Riddle at 425.241.8557 or riddlejs@gmail.com.

Donations may be made in person at any Wells Fargo Bank branch location using account number 6733375908 or mailed to the Children's Organ Transplant Association, 2501 West COTA Drive, Bloomington, Indiana, 47403.  Checks or money orders should be made payable to COTA, with "In Honor of Annie R." written on the memo line of the check.  Secure credit card donations are also accepted online at www.COTAforAnnieR.com.  One hundred percent of all funds raised will be used for transplant-related expenses.

ACUTE LIVER FAILURE

Definition: Acute Liver Failure is characterized by severe and sudden liver cell dysfunction leading to coagulopathy (lack of blood clotting) and hepatic encephalopathy (altered mental state, loss of cognitive function, lethargy) in previously healthy persons with no known underlying liver disease.

It is thought to affect approximately 2,000 persons per year in the United States.

This catastrophic illness can rapidly progress to coma and death from cerebral edema and multiorgan dysfunction.

39% of cases are caused by Acetaminophen overdose

13% of cases are caused by drug reactions

12% of cases are caused by hepatitis A and B combined

17% of cases (340 cases per year) are of an indeterminate cause - Annie is in this category

Survival of Acute Liver Failure (in a recent study):

43% survived without transplantation

57% were listed for transplantation

Of those listed --

29% received a transplant (84% lived, 16% died)

28% died before transplantation (did not receive a graft in a timely fashion)

Outlook for those with a liver transplant: The 1-year survival rate after liver transplantation is about 90% for patients living at home and about 60% for those who are critically ill at the time of surgery.  At 5 years, the survival rate is about 80%.  Survival rates are improving with the use of better immunosuppressive medications and more experience with the procedure.  The patient's willingness to stick to the recommended post-transplantation plan is essential to a good outcome.