University Transplant Center houses central and south Texas’ only living liver donor program, which can provide shorter wait times and healthier outcomes for patients requiring liver transplants.
Tarunjeet S. Klair, MD, transplant surgeon for University Health System and Assistant Professor of Surgery, Abdominal Organ Transplantation at UT Health San Antonio
Approximatel people die every day waiting for an organ transplant, according to the Organ Procurement and Transplantation Network. In November 2018, almost 14,000 people in the U.S. were waiting for a liver transplant. More than 70 percent of those individuals have been waiting six months or longer for a transplant with more than 10 percent of the list having waited more than five years.
Most liver transplant recipients receive their organ from a deceased donor, which means patients cannot predict when a compatible liver will be become available. Living liver donations save lives by getting patients off the wait list and into the operating room faster.
The Benefits of a Living Liver Transplant
Established in 1999, the transplant program at University Transplant Center has the only living liver donor program in central and south Texas and the only living liver donor program for children in the state. The center also currently handles the second highest volume of living donor liver transplants in the nation.
Transplant surgeon Tarunjeet Klair, MD, examines living liver transplant donor Hector Gutierrez Jr. during a follow up visit to the University Transplant Center Clinic at University Hospital in San Antonio
“Our outcomes from living donor liver transplants have been encouraging,” says Tarunjeet S. Klair, MD, transplant surgeon for University Health System and Assistant Professor of Surgery, Abdominal Organ Transplantation at UT Health San Antonio. “Many factors are responsible for this success: adoption of state-of-the-art protocols for the workup of potential living donors, optimization of recipients for the transplants, appropriate timing of surgery, development of surgical expertise in terms of both technique and equipment, availability of a specialized transplant intensive care unit with specially trained nurses, availability of excellent support services, such as interventional radiology and advanced endoscopy, and training of transplant professionals who take care of living donor liver transplant recipients long-term.”
Common conditions that prompt physicians to refer patients for a liver transplant are chronic viral hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, liver failure and certain types of liver cancer. For children, cholestasis liver disease and metabolic conditions are more common causes of liver transplantation, although significantly fewer children require liver transplants than adults.
“After the need for a transplant is determined, patients undergo a quick but thorough evaluation process,” Dr. Klair says. “This involves undergoing medical, psychological and social evaluations to ensure the recipient will be able to tolerate the procedure, have a good support system and comply with prescribed treatments.”
Staff at University Transplant Center will spend time with recipients and their families to explain living donor liver transplantation and its benefits. If a patient decides to have a living donor liver transplant, the center encourages families to nominate a donor champion — someone dedicated to helping the patient find a living donor — and educate all parties involved about different strategies for finding a living donor in case one is not available in the immediate family, such as using social media or posting to community groups. After a donor is selected, the process typically begins to accelerate.
“Once a potential donor is brought forward, we can evaluate him or her within a very short time frame,” says Claudia Grimmer, BSN, RN, Assistant Director of the Living Liver Donor Program at University Transplant Center. “We schedule the potential donor’s evaluation within two days and present the results to a committee the following week. If he or she is a viable candidate, we schedule the surgery within a month, as opposed to waiting up to six years for a deceased donor organ. We’re shortening the time frame by years.”
The beauty of living donor liver transplantation is in the liver’s ability to regenerate. The surgeon can remove up to 70 percent of a donor’s liver, primarily from the right lobe due to its larger size, and the missing piece of the liver will begin to quickly grow back in both the donor and the recipient.
“The remaining liver in the donor starts regenerating immediately after surgery,” Dr. Klair says. “Clinical studies on living donor liver transplantation suggest that a significant amount of regeneration occurs within two weeks following resection and is nearly complete after three months.”
This streamlined process can reduce a patient’s chance of dying by nearly half, according to Columbia University Irving Medical Center, and offers a solution to patients disadvantaged by the current Model for End-Stage Liver Disease (MELD)-based system of liver allocation, which makes access to organs at lower MELD scores impossible in certain regions of the country.
By expediting this process, the recipient is also more likely to go into surgery in a healthier state.
“Waiting for a deceased donor transplant can create a desperate situation for patients and families. I can remember quite a few instances where the availability of a living liver donation led to the successful recovery of very sick patients. It is a life-transforming event for them. It is truly a gift of life.”
— Tarunjeet S. Klair, MD, transplant surgeon for University Health System and Assistant Professor of Surgery, Abdominal Organ Transplantation at UT Health San Antonio
“Patients on the transplant list can get progressively worse since they are prone to developing infections, bleeding, malnutrition, kidney failure and progressive loss of independence,” Dr. Klair says. “Transplanting prior to the development of these complications helps patients recover quicker and gives them a better chance at long-term survival.”
Another benefit of living donor liver transplantation is that the surgeon has access to more information about the donor’s medical history than with organs donated from cadavers. An extensive battery of tests performed prior to the surgery enables surgeons to determine if the donor is healthy and, in the case that a compatible donor has a transmittable disease, to treat the recipient effectively after surgery.
Additionally, living donor liver transplantation avoids physiological changes in the donor organ and reduces cold ischemic time between when the liver is removed from the donor and transplanted into the recipient.
“When a patient gets called in for a deceased donation, it could be up to seven hours before the organ gets to them, which means that much time without blood going through the liver,” Grimmer says. “Compare that to the short time frame of a living liver transplant where the liver can be walked across the hall and transplanted as soon as it is removed from the donor.”
Becoming a Living Liver Donor
Donors must have a compatible blood type and be between the ages of 21 and 55, in excellent physical and mental health, able to understand the risks of surgery, and be willing to undergo an in-depth evaluation — including blood work and CT and MRI scans, which are used to further determine if the donor is a good fit and how much of the liver he or she can safely give to the recipient.
Transplant surgeon Tarunjeet Klair, MD, checks the packing of the drains in the incision of living liver transplant donor Hector Gutierrez Jr. during a follow-up visit to the University Transplant Center Clinic at University Hospital in San Antonio.
The majority of living liver donors at University Transplant Center are family members or in-laws of the recipient and local to the Texas area. However, the center has had donors fly in from as far as Colombia, South America, as was the case for one man who traveled to donate to his brother.
University Transplant Center also welcomes altruistic donors, people who come forward looking to give without a specific recipient in mind. While living donor kidney donations are still more common in the U.S., Grimmer says the center has experienced an increase in the number of these altruistic living liver donors over the past three years.
Dr. Klair and Grimmer attribute this growth to the center’s increased efforts in providing education on living liver donations, dedicated liver donor coordinators on staff, improvements in the donor evaluation process and the staff’s flexibility and support in helping donors overcome barriers.
“I think that living kidney transplants are more well-known in the news, throughout other hospitals and with physicians who refer their patients to transplant programs,” Grimmer says. “That isn’t necessarily the case for living liver donation programs, but that is changing through education. Potential donors are learning that the liver grows back, for instance, unlike a kidney where once it’s gone, it’s gone.”
Most living liver donors will be able to return to their normal lives once they have recovered, which usually takes about eight weeks. Those with sedentary jobs that do not require heavy lifting are often able to go back to work after only four to five weeks.
“Living donors at University Transplant Center do great,” Grimmer says. “We haven’t had any donor deaths, major complications or cases where a donor required a transplant themselves after donating. All of our donors who work have gone back to their jobs. Some have gone on to have children. Others have gone on to run marathons. One donor actually went back to barrel racing.”
To refer a patient to University Transplant Center’s Living Liver Donor Program, call 210-567-5777 or visit universitytransplantcenter.com/referral.