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Melanie Cole, MS (Host): Welcome to UF Health MedEd Cast with UF Health Shands Hospital. I'm Melanie Cole. And joining me today is Dr. Thiago Beduschi. He's the Director of the UF Health Abdominal Transplant Center and the Chief of the University of Florida Division of Transplantation and Hepatobiliary Surgery. And he's here today to highlight new innovations for liver transplant and becoming the number one liver transplant program.

Dr. Beduschi, thank you so much for being with us today. As we get into this topic, please speak a little bit about how common liver transplant really is, how many are performed on a yearly basis or so. Tell us a little bit about your hospital's history with liver transplant.

Dr. Thiago Beduschi: Thank you, Melanie. Thank you for the opportunity to talk a little bit about liver transplants with you. So, liver transplantation, it's one of the most complex procedures the human can have, and it became common. It started in 1963, the first attempt, and now is a very well-established procedure across the world, I would say. United States leads the amount of transplants. And at University of Florida, we have a very robust program. And last year, we were top five in volume for adult transplants. It's a procedure that's performed since 1989 at University of Florida, and we've been growing consistently over the years.

Melanie Cole, MS: Well, thank you for that. And doctor, I said we were speaking about new innovations for liver transplant, but I also mentioned becoming the number one liver transplant program. Can you tell us what that means in the context of the University of Florida?

Dr. Thiago Beduschi: We are very proud about it. So, in the last two years, we've been topping the rank in the country about outcomes. Transplant is a specialty that's very regulated. And one of the agents that regulate is the SRTR, that's Scientific Registry for Transplant Recipients. So, we submit all the data of our transplants, and survival data, waiting time and follow up of these patients. And there's a system that's called five-tier system based on patient survival, waiting times, mortality, and waiting list. And they give like one to five bar for each item. So, University of Florida in the last two years has been the number one program in the country based on all these metrics. We have one-year survival above 99%. That gives us a hazard ratio of graft loss 81% below the national average. So, what it means is that the chance that a liver transplant fails at University of Florida is on average 81% less than the national benchmark. So, what makes us very proud about it? A lot of this is a result of a lot of innovations that we're going to talk about today.

Melanie Cole, MS: That's incredibly impressive, Dr. Beduschi. So, tell us a little bit about what that process looks like when a patient gets to your transplant center. I'd like you to speak about patient selection, indications for transplantation. Tell us a little bit about how that wait time is calculated and what makes you number one.

Dr. Thiago Beduschi: Melanie, when a patient is referred to University of Florida, the patient is evaluated for a multidisciplinary team that includes transplant surgeons, transplant hepatologists, transplant nephrologist, social workers, nurse coordinators, physical therapy, and many other specialties according with the patient needs. So, the way it works is all these specialties see the patient. The patient is discussed in the medical review board. And once the patient is approved or planned, we ask for authorization for the insurance company to put the patients on the waiting list. That's the moment that we count for the waiting time starts, the moment the patient hits the waiting list.

What made us number one on this, first is the outcomes. In the last four years, we have close to 600 liver transplants performed a year. And we have only two patients that did not complete one-year benchmark. That's the primary benchmark for survival based on the registry. So, that's one thing.

Another thing we developed, a very sophisticated liver unit. So, we have a lot of ways to support the patients that are in liver failure. So when the patient gets in liver failure, all the other systems starts to failure as well. Like the patient gets in renal failure, the patient gets in coma, need mechanical ventilation, they need extracorporeal support for dialysis and many other things. So, we have high technology, like different modalities of dialysis that help the liver patients. We're the only program in Florida that has something called MARS. It's almost like an artificial liver. It's the liver dialysis that helps to keep the liver function when the patient is on liver failure. And we have experts in liver critical care in the unit that's able to put the patient in better shape, when to get to the moment to get an organ. And that for sure leads to better outcomes.

Melanie Cole, MS: As we're speaking about that multidisciplinary care, doctor, I'd like you to speak about some of those new innovations and exciting new technologies used in organ preservation and transplantation and that multidisciplinary team who's all involved.

Dr. Thiago Beduschi: Well, it's a very exciting time for transplant now. We live in a very exciting time. Talking about the multidisciplinary team, it's pretty much everyone involved in high complex medicine nowadays. We have from the surgeon to even the financial people, that social worker that's going to address the needs of the patients pre and post-transplant. Make sure that you're going to have conditions to come to followups, going through psychologists, psychiatrists, physical therapist, occupational therapist, nurses, dentists, all these specialties, going through not only the main ones that the people usually think that the only one involved that's the transplant surgeon and the transplant hepatologist, but it's a huge group of people that's working together to get these outcomes.

And regarding the technology about organ preservation and organ repair, we count nowadays with perfusion machines that are not able to keep the organ for longer time, but they able to make the organ better. What does that mean? In 2024, we are able to use organs that we did not even consider few years ago. So, in liver, mainly, we have hypothermic and normothermic perfusion machines that, once the organ comes out of the donor body, it comes to our center and then we put this organ in a machine that's going to simulate the physiology of the human body. It circulates with human blood and then you can evaluate the liver to see the function, the anatomy, the way it looks. We have time to perform new biopsies and really make sure that the organs are good to the recipient that we're planning. So, that was a major advance and we do as a routine at University of Florida now.

Another big innovation in terms of organ procurement is the use of what we call NRP, that's normothermic regional perfusion for a type of donor that's becoming more common. That's called DCD, the donor after cardiac arrest. So, we have the brain dead donors and the donors that we wait for the cardiac arrest. So, these donors, historically, they had an inferior outcome. But with advent of the perfusion machines and the normothermic regional perfusion, the outcomes is as good as brain dead donors and that expands the donor pool tremendously. It's interesting to know how this NRP works is, once the donor has the cardiac arrest, we place this donor in an ECMO circuit. It's like an extracorporeal pump that makes the blood circulate again just in the abdominal area. So the donor is already in cardiac arrest, is dead by this time, but we're able to keep the circulations for a time between two and four hours to evaluate again, to repair, and to see the organ functioning inside the body before we're doing the transplant. That was a tremendous advance in the field of organ preservation and recovery, and allow us to really do more transplants and help more people with better outcomes.

I would like also to mention the research that we developed at the University of Florida regarding transplantation. We have a line that we incorporate in artificial intelligence in our decisions, in the critical care part of the patient care, and also management of immunosuppression and patient selection.

Another exciting area is in organ preservation with the use of the perfusion machines. We use pig models to study different technologies to see how can we improve the organs and to make marginal organs feasible to transplant in kidney, liver, and lung in our transplant research labs.

Melanie Cole, MS: That's absolutely fascinating. How exciting, really an exciting time, as you say in your field, Dr. Beduschi. As we get ready to wrap up, I'd like you to speak about the future of liver transplantations and the UF Health Abdominal Transplant Center. Give us some blueprint for ongoing research, what you see happening as far as donations and alternative therapies. Kind of wrap it up for us with what you see and what you'd like to see happen in the future.

Dr. Thiago Beduschi: So, one of the newest indications, and we're going to be seeing solidifying the next five years, and it's very exciting, is transplant oncology. So now, we're able to transplant patients with metastases of colorectal tumors that are not able to resect because they have diffuse but stable disease. And these patients had no other option that remained in chemotherapy until the tumor gets out of control and eventually they will die. Now, when the disease is stable and respecting a good biology of the tumor, we're able to offer liver transplantation with an excellent five-year survival. That's going to increase and broaden the indications of transplants for a near future. So, I really expect to see more and more transplant oncology.

And also, another area that is the hot topic of the moment in transplantation is the xenotransplantation. We are very close in the United States to start the first few clinical trials, initially with heart and kidneys. We've seen that they're done in other institutions. And I expect in the next five years also, we have trials with xenotransplantation in liver transplant utilizing pig organs genetically modified to serve the humans. So, we can definitely decrease the wait list and decrease the mortality in the waiting list.

Melanie Cole, MS: Thank you so much, doctor, for joining us and sharing all these exciting innovations in liver transplant and what you're doing there at the University of Florida College of Medicine. It really is so exciting. Thank you again for joining us and to learn more about this and other healthcare topics at UF Health Shands Hospital, please visit innovation.ufhealth.org. And to listen to more podcasts from our experts, please visit ufhealth.org/medmatters. That concludes today's episode of UF Health MedEd Cast with UF Health Shands Hospital. Please remember to subscribe, rate and review UF Health MedEd Cast on Apple Podcast, Spotify, iHeart and Pandora. I'm Melanie Cole. Thanks so much for joining us today.