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The Evolution of Liver Transplantation

Posted Mar 12 2010 6:01am
End-stage liver disease is best treated by a liver transplant, a renowned gastroenterologist said at yesterday's Sinai Hospital Department of Medicine Grand Rounds.

Paul Y. Kwo, M.D. , is an associate professor of medicine and the medical director of liver transplantation in the Division of Gastroenterology and Hepatology at Indiana University . His talk at Sinai was made possible by the Ellen Wasserman Lectureship.

The good news, according to Dr. Kwo, is that the increased use of the Model for End-Stage Liver Disease (MELD) gives more weight to disease severity than the patient's time on the wait list. At Indiana University, the median wait time for a liver transplant is 1.6 months versus 11.3 months nationwide, and the adult survival rate for the organ recipients is at 90.04 percent. Physicians are "inching our way" toward transplants for HIV-positive patients, and there's increasing evidence that age doesn't impact the success of a liver transplant.

Plus, transplantation in patients with severe obesity is "feasible," Dr. Kwo said. "The one-year survival rate is no different," he said.

Now for the bad news.

The demand for livers, along with other critical organs, continue to exceed what's available. Liver cancer (hepatocellular carcinoma) is the most rapidly increasing cancer in the United States . Hepatitis C is the most common indicator for liver disease; between 3 to 4 million people are infected in the United States; and half a million people have Hepatitis C-related cirrhosis. Cirrhosis is the slow degeneration of the liver, and while it's most commonly associated with alcohol, it can also result from hepatitis B, C or D or other diseases. Finally, while the death rate from liver disease has fallen overall, it is still highest in the African-American population.

What does this mean for you? Protect your liver by avoiding excessive alcohol consumption and eschewing drugs. Maintain a healthy diet and weight, and stop smoking.

Finally, remember that National Donate Life Month is around the corner. Talk to your family members about becoming an organ donor and sign up with your state registry .
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