DACULA - "The puppet show must go on now," Caroline Clayton announced to her audience.
"And now presenting ... Marley," big brother Jackson called from behind a door, as Caroline, 4, stuck out her arm, which was covered by a large, furry dog puppet.
Flyflicker, a big, green frog that covered Jackson's right arm, and Waterball, a light blue, stuffed whale, soon joined the cast of fuzzy animal characters.
"This is amazing compared to what she was," Heidi Clayton said of her daughter during a pause between acts at the family's Dacula home Tuesday.
Before undergoing Children's Healthcare of Atlanta's 300th liver transplant in April, Caroline spent months in the hospital as her body refused to accept the first liver she had received when she was just shy of her first birthday.
When Caroline was an infant, she caught the flu, and due to a previously undetected rare metabolic problem called urea cycle disorder, her body stopped being able to process proteins.
"It sent her into acute liver failure," Heidi Clayton said. "She got the flu, the first time she was sick, and within three weeks she had a liver transplant."
Caroline's first transplant was a left lateral segment of a liver donated by a
"It saved her life, but it just never really worked for her," Heidi Clayton said. "She had multiple rejection episodes, five-plus within three years."
Rejection occurs when a transplanted organ isn't accepted by the recipient's body.
"Her body started reacting with ulcers all in her esophagus and her stomach and then the liver just started shutting down," Heidi Clayton said. "That's when (her doctors) knew that the body just wasn't accepting that liver."
Caroline was hospitalized from October to January, experiencing high fevers daily through mid-December. She was placed on the waiting list to receive a transplant in early March, just after her fourth birthday on March 1.
On April 9, Caroline received a second liver, this time from a 4-year-old girl. Two-and-a-half weeks later, she came home from the hospital.
Children's Healthcare of Atlanta celebrated Caroline's recovery and the 300th transplant performed by its transplant team July 28 with a party, attended by mom and dad (Heidi and Michael Clayton) and big brother Jackson, in the outdoor garden at Children's Healthcare at Egleston.
"I'm just so thankful to the team and I feel so lucky to have such a skilled team in our area," Heidi Clayton said Tuesday. "I feel like Caroline is a miracle and they are miracle workers."
Although Caroline has experienced one episode of rejection since her second transplant, Heidi Clayton said her daughter is doing very well and she hopes the PICC line in Caroline's chest, which makes the weekly blood draws she undergoes easier, can be removed before cooler weather sets in. With the PICC line in place, Caroline can't go swimming or take baths.
"That would open up a whole new kid world for her," Heidi Clayton said.