A Good Match: Liver Transplantation Fits Seamlessly Into Avera's Transplant Program
Oct 30, 2017 08:23AM
● By Digital Media Director
By: Alex Strauss
It has been nearly a year since South Dakota medicine reached a major milestone when Avera Transplant Institute performed the region’s first-ever liver transplant in Sioux Falls.
Since that time, Avera surgeons have performed seven life-saving liver transplants in the culmination of an evolution that began in 1993 with the region’s first kidney transplant. Avera Transplant Institute has also established the region’s only pancreas and bone marrow transplant programs. In total, they have performed more than 1,000 transplant operations.
“Just as with kidney’s, we were always aware that there were patients in our area who could benefit from liver transplant,” says transplant surgeon, Jeffrey Steers, MD, who joined Avera in 2012 and helped to build the liver transplant team. “Historically, many of these patients were never referred for transplant at all. Some were lucky enough to get referred to places like Minnesota or Nebraska. Having local access to the service means more people are going to benefit.”
The Evolution of a Liver Program
Over the course of time, Steers says, Avera developed an extensive hepatology program, including four full-time hepatologists. As the number of patients with cirrhosis and end-stage liver disease grew, so did the number of physicians and allied health professionals needed to support them. The program’s integrated team now includes nurses, surgeons, anesthesia and critical care specialists, pathologists, nephrologists, and others - all with expertise in the special care of liver patients. Liver transplantation was the natural next step.
“Liver transplant is part of the spectrum of care for patients with liver diseases and liver cancer,” says Dr. Steers. “We see ourselves and our expertise as caring for all patients with liver diseases, whether they need a transplant or another option. We now have the capacity to provide anything a patient with liver disease would need.”
“Administration has also been a strong component in the program’s success,” adds fellow transplant surgeon Christopher Auvenshine, DO. “My colleagues in other hospitals have nightmare stories of their administration’s inability to stay focused on a common goal. In contrast, our administration has stayed steadfast in their support.”
Lack of Organs Keeps Some on Waiting List
With the team in place, the requirements met for active statue with the United Network for Organ Sharing, and the administration firmly on board, Steers says the only thing now standing in the way of the program’s continued growth is the availability of donor livers. LifeSource, the region’s organ procurement organization, does well in this altruistic part of the country, but organs are shared over a large multi-state area and there are never enough to meet the need.
“We could probably do 30 to 40 liver transplants [the number of people added to the waiting list in the state each year] if we had enough donors,” says Steers. “In our area, there are a lot of people on the transplant waiting list. Unfortunately, patients have to get pretty sick to get to the top of the list.”
Seeing these sicker patients safely through a transplant operation can be especially challenging.
“Liver transplant is a much bigger and riskier operation than kidney transplant, which is not especially physiologically stressful,” says Steers. “But we recently had a liver transplant candidate who was in the ICU here for a month and somewhere else before that. If they are healthy, they might bounce back in a week, but most of our patients have been extremely ill.”
Even so, all of Avera’s liver transplant patients have done well, to date, reflecting a national trend. Nationwide, there is now an 80 to 90 percent survival rate a year after liver implant, compared to just 60 percent in the 1990s.
New Options May Grow the Program
“We all expect the program to grow,” says Steers’ colleague, nephrologist Robert Santella, MD, who has been with Avera’s transplant program since the beginning. “Eventually, we would expect to be doing up to 40 to 50 kidneys a year and probably 20 livers.”
Living donor livers might help them get there. Living donor liver donation involves removing a portion of the liver from the donor and transplanting it into the patient whose liver has failed. But there is a downside. While the risk associated with living donor kidney donation has dropped steadily, thanks to minimally invasive techniques, the risk of living donor liver transplantation is much higher, for both recipient and donor.
Another option may be a liver support device, now in development. The machine would contain liver cells and may have the potential to help keep patients alive while waiting for a transplant or may support people whose livers could recover without a transplant. Steers say such a device might even be an alternative to transplantation for people who are not good candidates, and he is hopeful that Avera could be involved in any clinical trials.
Avera Transplant Program By the Numbers
First kidney transplant - 1993
Patients on the kidney transplant waiting list - 243
First bone marrow transplant - 2000
First pancreas transplant - 2003
First liver transplant - 2017
Physicians with transplant fellowship credentials on Avera campus - more than 12