Troy Yoder powers through the hospital hallway on his orange Harley-Davidson plastic trike, unaware that he's a miracle boy.
The only thing Troy probably notices is that he feels better.
But a few weeks ago, doctors worried Troy wouldn't make it until his third birthday.
Instead, he woke up the morning of his birthday with balloons decorating his hospital room and a new liver supplying his body with much-needed nutrients.
“He just had a couple of days left, maybe just a day or so,” said Troy's mother, Kristina Yoder. “He got the transplant — we just didn't know if he was going to get it in time.”
After battling illness for most of his short life, Troy received a split-liver transplant in January that doctors say should relieve symptoms of his liver disease.
The Inola boy suffers from alpha-1 antitrypsin deficiency, the most common genetic cause of liver disease in children and the most common genetic disease for which a liver transplant is done, according to the Cincinnati Children's Hospital.
There is no cure for alpha-1 antitrypsin deficiency, according to the children's hospital. If liver disease develops, a liver transplant is currently the only option available for survival, according to the hospital.
Alpha-1 antitrypsin is a type of protein made in the liver that works to protect the lungs and liver. People with a lack of this protein can develop liver disease, like Troy did, or also develop lung disease.
It's the same genetic disorder that can cause people to develop chronic lung disease, or COPD. People who suffer from this disorder might develop chronic bronchitis or emphysema between ages 20 and 50, according to the National Institutes of Health.
Troy has suffered with health problems for most of his life.
Troy was born Jan. 8, 2010. When he was 2 months old, his skin was yellow from jaundice, which causes a person's skin and eyes to turn yellow and can be the result of liver disease.
Troy's parents, Kristina and Norman Yoder, took him to see a doctor, and several tests and doctor's visits later, Troy was diagnosed with alpha-1 antitrypsin deficiency. He was 4 months old.
Troy is among about 10 percent of children with the alpha-1 deficiency who develop significant liver disease, according to the Cincinnati Children's Hospital.
In December, Troy's health was quickly deteriorating.
He wasn't thinking clearly, and his skin was again yellow from jaundice. About Christmas, he was transferred from an intensive care unit in a Tulsa hospital to Integris Baptist Medical Center in Oklahoma City.
When Troy arrived in Oklahoma City in December, he had to be placed on a breathing machine. Because of all the fluid building up in his body, his stomach looked like it had a bowling ball inside of it.
His spleen was larger than it should be, and he was suffering from cirrhosis of the liver, in which the liver can no longer repair itself. He also was suffering from bacterial peritonitis, in which the inner wall of the abdomen becomes inflamed, according to the National Institutes of Health.
In short, he was dying.
“If Troy had not had this transplant, he probably would not have been able to celebrate his third birthday,” said Dr. Vivek Kohli, director of hepatobiliary and liver transplant surgery at Integris Nazih Zuhdi Transplant Institute. “It was very serious ... if he had not received his transplant, we would not be seeing him here with us today.”
Doctors performed a split-liver transplant on Troy. The procedure is exactly what it sounds like — doctors take an adult liver and split it.
Troy received about one-third of an adult liver from a donor in Texas, and an adult patient received the rest. This was only the third time doctors at Integris have performed a split-liver transplant on a child patient, Kohli said.
The liver can regenerate tissue, meaning Troy's liver will grow as he grows, Kohli said.
“(The liver) has the ability to regenerate and then stop at the right amount of size,” Kohli said. “It doesn't just continue regenerating. If it just continued to regenerate forever, it would be a cancer growth.”
Troy had been on the liver transplant waiting list for a while. Most of the people in Oklahoma who are on the liver transplant waiting list have been waiting at least a year.
Nationwide, about 16,500 people are waiting to receive a liver transplant, according to the Organ Procurement and Transplantation Network.
In Oklahoma, about 220 residents are waiting for a liver transplant, according to the network. Of that, more than half of the people waiting, or about 136 people, are between ages 50 and 64. Two children in Oklahoma less than 1 year of age are waiting on a liver transplant.
Troy's 2-year-old brother, Kyler, also suffers from the alpha-1 antitrypsin deficiency. So far, he's healthy. His parents are working with doctors to monitor both boys.
Children included in a study regarding pediatric split-liver surgery showed overall good outcomes.
A study published in Annals of Surgery regarding the results of split-liver transplantation in children found that those with acute liver disease had a one-year survival rate of about 94 percent and a three-year survival rate of about 76 percent. Overall, the children included in the study had a six-month survival rate of 96 percent.
“These results, which represent the experience of a single institution over the last six years, indicate that ex situ split-liver transplantation can be performed in children with good overall outcome and acceptable morbidity,” the article reads.
Troy went home from the hospital Feb. 11. The day he went home, he didn't have much to say about his procedure. Rather, he was busy requesting orange sherbet from a nurse he has befriended during his time in the hospital.
“Ice cream,” he whispered to his mother until a Popsicle showed up from one of the nurses.
Troy and his parents spent Christmas, New Year's and Troy's birthday in the hospital. The Yoder family hopes that Troy's time in and out of the hospital is over.
Kohli said Troy is taking about eight medicines each day, and that should decrease to minimum medications over time.
“He's doing very well, and things are going well with him from the transplant standpoint,” Kohli said. “We have to be observant for simple things, like rejection and certain kind of infections that you're a little bit more prone for after transplants. We'll have to closely follow-up in that respect. He should have a normal life after this.”