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Liver Transplantation

Posted Aug 24 2008 1:49pm
VAREN BLACK: Hi. I'm Varen Black, and welcome to our webcast. Organ transplants have always represented the cutting edge of medicine, and liver transplants are no exception. Today we'll learn all about this miracle of medicine, how far it's come and where it's headed.

Our guest today is Dr. Michael Abecassis, Director of the Liver Transplantation Program at Northwestern Memorial Hospital.

What are some of the current challenges facing liver transplantation?

MICHAEL ABECASSIS, MD: The challenges that face us in liver transplantation today are very, very different from where they were a decade ago. A decade ago, we worried about technical considerations. We worried about the types of drugs to prevent rejection and worried about success rates. Liver transplantation today is extremely successful. As a result, it has become a victim of its success, and the major hurdle that we face today is that there are not enough organs to go around, and so patients die waiting for transplantation.

The challenges have led to very innovative techniques to allow us to expand the donor pool. The ways that we have attacked that have been to first of all accept what are called marginal donors, and we keep pushing the envelope on what is a usable liver. The second way that we've done that is, as I mentioned, split livers. So one liver can be enough for two patients, and we do that routinely here.

The third way that we've expanded the donor pool is to use live donors. Now, live donors have been used for about ten years for pediatric recipients, and we certainly perform a large number of these at Children's Memorial. The newest technology has been to use live donor liver transplantation for adult recipients, and the reason that that is trickier is that we have to take a much bigger piece of liver in order to do that. We roughly take between 50 and 60% of the donor's liver to accommodate a recipient, and that is a risky proposition, and that is an operation that cannot be taken lightly. And we have assessed the situation, and are presently one of the leaders in adult-to-adult living donor transplantation.

So I think that we've gotten away and we've resolved a lot of the challenges that we were facing ten years ago, that we've opened up a whole new set of challenges today.

VAREN BLACK: What are some of the outcomes, the success rates of liver transplant in general? You know, quality of life after the transplant? First of all, the outcomes or the success rates?

MICHAEL ABECASSIS, MD: Well, liver transplantation is extremely successful. The one-year survival, which is what we use as a measure of long-term survival is in the range of 85 to 90%. When you compare that to the survival of not having a transplant in these patients being zero percent, that is very successful by definition. The complication rate is very low, and in general these patients have a normal lifestyle, with the exception of having to take lifetime medications.

As far as being able to go back to work, being able to go back to school, our goal is to get every patient that we transplant back to either school or work, and we're very successful at doing that.

VAREN BLACK: Do you feel that it will get better down the road as far as the shortage of organs? I mean, what is your feeling or thought on that? Are you encouraged?

MICHAEL ABECASSIS, MD: Well, I'm encouraged by some of the initiatives that have taken place recently with the Department of Health. I am concerned that they're probably not enough, and I think that increasing donor awareness is probably our biggest task in order to elevate the awareness about organ transplantation and increase the numbers of donors that are available for transplantation.

VAREN BLACK: All right. Thank you, doctor, very much.

MICHAEL ABECASSIS, MD: You're welcome.

VAREN BLACK: And thank you for being with us. I'm Varen Black.

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