One of the greatest challenges facing patients who require a liver transplant is surviving the wait for a donor organ. Each year, nearly 16,000 patients in the United States are on the liver transplant waiting list, according to UNOS; yet only between 5,000 and 6,000 receive a transplant from a deceased donor.1 Zakiyah Kadry, M.D., said “Although liver transplant patients are stratified based on MELD scores, some die while waiting. To decrease wait times and associated mortality, some patients can receive grafts from live donors.”
In 2011, only 247 live donor liver transplants were performed in the United States, according to HRSA/ OPTN statistics.2 “Live donor programs must be UNOS-certified and require at least two surgeons trained in hepato-biliary surgery, as well as transplantation,” notes Kadry.
In 2008, she began the adult live donor liver transplantation program at Penn State Hershey Medical Center, and implemented a highly rigorous, selective process for screening donors and recipients, and for conducting transplant surgeries. “Only about 30 percent of live liver donor applicants in our program are accepted. First, an independent donor advocate team examines the applicant’s overall medical and psychosocial health. Applicants are excluded if donation presents risks to their health, psychosocial situation, employment, or if there is evidence of coercion to donate.” Applicants who remain eligible then undergo anatomic liver studies. Kadry explains, “Donors must be able to provide sufficient graft volume and still have approximately 40 percent remaining functional liver volume. Only those with a positive anatomical evaluation undergo liver biopsy. Based on the biopsy, we rule out individuals with 15 percent or more hepatic fat content, and we sometimes find unexpected congenital, metabolic, and infectious problems that may also exclude donation. The goal is to select healthy individuals for whom liver donation presents minimal risk. The recipients on our waiting list qualify for live donor liver transplantation but are required to have a MELD score ≤ 25. Patients with higher MELD scores are often too compromised to fully benefit from a live donor transplant and tend to develop ‘small-for-size’ syndrome, with prolonged jaundice and increased risk of infection and death,” says Kadry.
The program is unique in its adult focus; the majority of live donor programs focus on pediatric recipients. Adult live donor liver transplants are particularly challenging given the liver volume requirements and the technical complexity associated with this. The program, however, addresses a relatively larger need.
“We have been fortunate to have excellent results in our live donor liver transplant program,” explains Kadry. “Donors have fared well post-donation with a very low incidence of minor complications that have resolved without sequelae. The high level of success we’ve accomplished is not only related to our donor and recipient selection process, but also our sophisticated team. Everyone from the transplant coordinators, donor advocate group, nursing and OR staff, anesthesiologists, critical care team, histocompatibility group, hepatologists and surgeons, as well as well-defined protocols focus on identifying and following recipients most likely to benefit from live liver transplantation while minimizing donor risk.”
For more information, visit PennStateHershey.org/transplant
1. United States, transplant waiting list candidates, by organ; http://optn. transplant.hrsa.gov/data/default.asp, accessed June 26, 2012
2. United States, Liver Transplants Performed; Summary January 1, 1988 March 31, 2012. at: http://optn. transplant.hrsa.gov/latestData/rptData.asp, accessed June 26, 2012.
Professor of Surgery
Chief, Division of Transplantation
Penn State Hershey Transplant Surgery
FELLOWSHIP: Surgery, University Health Center of Pittsburgh
RESIDENCY: Surgery (General), Penn State Milton S. Hershey Medical Center
MEDICAL SCHOOL: Royal College of Surgeons in Ireland