Transcription:
Understanding Liver Transplants

Melanie Cole (Host):  The first liver transplant at UK took place in 1995 and since then, the surgeons at UK Health have performed more than 700 transplants at the UK Transplant Center using state of the art technology and leading edge medical and surgical interventions to really provide the best possible treatment in a caring and compassionate environment. My guest today, is Dr. Malay Shah. He’s the Surgical Director in the Liver Transplant Program at UK Health. Dr. Shah, what a pleasure to have you join us today. Tell us a little bit about liver transplant, how common it is and what conditions eventually lead to that kind of transplant.

Malay Shah, MD, FACS (Guest):  Well let me first start off by saying thanks for having me on. I really am going to enjoy the opportunity to talk to you a little bit about this. So, some of the most common conditions requiring people to have a liver transplant – all the common ones that probably most people have heard of like alcohol abuse, hepatitis C, and what’s becoming more prevalent in the last five to ten years is what’s called NASH cirrhosis which is fatty liver disease. You may know that obesity is becoming a kind of a national epidemic and people in this country are just becoming increasingly more obese and so therefore, there’s an increased risk of fatty liver disease which is becoming a more common indication now for liver transplant.

Host:  How does someone know that their liver is maybe going to be on that list, needing to be transplanted? Who qualifies for it and are there any symptoms that we know or is this something you would learn as you follow the disease course?

Dr. Shah:  So, it’s extremely variable as to how one figures out that they have liver disease. Some people just get diagnosed with liver disease when they go into the doctor for a routine check up and they get routine labs drawn and just something looks abnormal on their liver function panel and then kind of one thing leads to another and they get imaging studies done and all of the sudden they get diagnosed with liver disease and they are otherwise completely asymptomatic.

Now there are other people that basically they go into the doctor or the hospital – to the hospital emergency room if they start developing problems with swelling in their legs, fluid build up on their abdomen, some people have extreme confusion to the point where they are almost comatose. Other people have what’s called GI bleeds, so they are throwing up or passing blood from below and then they go into the hospital and then again, one thing leads to another in terms of diagnostic testing and then people discover that they have liver disease. And so, then whatever the case may be, is that then they get referred to a liver transplant center like ours either as an inpatient or outpatient basis and then we evaluate the patient to see do they need a liver transplant.

Now the ones that are kind of obvious are the ones that are what we call decompensated which is they have ascites, the fluid in their belly, confusion, they are jaundiced, things like that. And that’s more obvious that they need a transplant evaluation. The other ones that are feeling well that really just kind of got discovered by accident; not all of them need a liver transplant. So, it’s just kind of done on a case by case basis as to who needs a liver transplant, who doesn’t need a liver transplant and the one objective criteria we use is something called a MELD score, it’s M-E-L-D, MELD. And it’s just we basically calculate the score based on laboratory parameters and so the higher the score is, the sicker the liver is.

And so, it’s not – the way we decide is we - as I said is that we evaluate the patients on a case by case basis but it’s not – there are objective criteria we use to determine who ultimately needs a liver transplant.

Host:  Well thank you for explaining that. So, Dr. Shah, what can a patient expect once they’ve been place on that transplant list? Tell us about the wait list experience and how is that time calculated?

Dr. Shah:  Well, so once we work up patients and when I say work up, we do echoes of their hearts, pulmonary function tests to make sure their heart and lungs are in good enough shape to withstand the liver transplant operation and provided all of that checks out; we put them on the waiting list. From there, it just kind of becomes a waiting game. Unlike kidney transplant, liver transplant doesn’t have a certain amount of prescribed time to be on the wait list. Basically, the sicker you are, the higher priority you are for a liver transplant which is actually the way it should be rather than just saying oh if I’m really sick and I just got put on the list, I have to wait six months or one year rather it’s again, the spot on the list is determined by what the MEDL score is which can change positively or negatively over time.

While the patient is on the list, basically they are just living their life as best as they can trying to stay as healthy as possible. They come to our clinic anywhere from every other week to every three months just depends on how sick they are, and they will see our hepatologists who are liver doctors who are participating in or basically managing their liver disease and keeping them healthy enough and live long enough so that when a liver is available, they have an opportunity to get a liver transplant.

Host:  Dr. Shah, how do you find a donor and the right donor for someone?

Dr. Shah:  So, basically, organ procurement agencies, the organization is called KODA, they basically get referrals from other hospitals say like somebody goes into a hospital with a catastrophic injury that they can’t recover from and then basically, a local hospital whether it could be UK hospital, it could be Baptist Hospital down the street, any hospital. They will make a referral to KODA and then KODA will explore whether or not this potential candidate is a candidate to donate kidney, liver or heart, lungs, whatever. And they are the ones that make the approach with the family and when a family is gracious enough to donate an organ to help other people; which I think is an amazing thing because if you think about it, someone dies and their loved ones in a time of personal tragedy are thinking enough to want to help other people and that’s an amazing thing.

And so, when they do that, KODA starts evaluating the donor, looking at blood type and checking labs and things like that and once they do that, they basically run what’s called a match run list and so for a liver; it strictly just based on the blood type and so if the blood type is compatible then patient Joe Smith or Jane Smith, obviously I’m making up names; if they show up on the list then KOSA will call us saying heh, we have a potential liver available and they’ll go through the donor information with the transplant surgeon on call. Sometimes it’s me, sometimes it’s one of my other partners. And as long as we find that the liver is suitable and the donor is suitable then we accept the organ and then one of my partners will go do the procurement, meaning go get the liver and then I’ll start the liver transplant and then they come back with the liver and we put that liver into the recipient.

Host:  Isn’t that just absolutely amazing? One question many patients want to know is about rejection and how long a transplanted liver can last? What’s life like after the transplant for them Dr. Shah?

Dr. Shah:  So, it’s really cool to see how people recover from a liver transplant. What I always tell patients is, within the first year after transplant; their body is going through a lot of changes and there could be potential multiple hospitalizations due to infection, rejection or just various different medical ailments. But usually, by the time people get to six months to a year after transplant; they just look amazing and it never ceases to amaze me that the patient that I met for the first time in clinic or in the hospital who was really sick and they just looked like they were going to die; after their transplant, six months to a year after their transplant, I don’t even recognize them. They go back to looking – to their family and to themselves how they always used to look before they got sick but to me, that’s the first time I’m ever seeing them healthy again. And it’s a really cool thing.

And patients can expect to have a normal lifespan after a liver transplant. I think that within the first six months after a liver transplant; they have to be more cautious about infections and things like that but once they are at six months to a year out of a transplant; they go back to having normal lives. I mean young people will go back to work. A little bit older people maybe they are already retired or enjoying their retirement years, enjoying their grandkids, things like that and travelling. I want them to do – and I tell them this, I want you to do all the things you should be doing at whatever age you are at and enjoy life and get back to regular life. And what I tell them is I’m not transplanting you to put you in a box. I’m transplanting you to get you back to real life.

Host:  Well said Dr. Shah. Tell us a little bit about your team and why someone should come to UK for this type of care.

Dr. Shah:  Our team is great. I think that the reason anybody should come to UK, I mean there’s a lot of transplant centers out there and I’ll never say anything bad about other transplant centers, because we all are working hard to take care of the patients we have, and everybody is doing as best of a job as they can. I think when you look at our outcomes, our survival outcomes – after transplant are wonderful. They are actually some of the highest in the country. I think that our team, I as an example, trained in Alabama, one of the busiest programs in the country. My boss trained at Miami which is in transplant circles known as one of the most – one of the historically busiest liver transplant programs in America. Other partners of mine have trained Michigan, at University of Pennsylvania and so we bring just kind of a very diverse practice and education from so many different places and we’ve been trained by so many very world-renowned people that are just operative and – operative super stars and excellent clinicians and good human beings.

And so I think that’s the benefit of coming here is that the care – surgical care a patient receives is going to be second to none. I think the rest of the team though, honestly, we couldn’t really do our job without the rest of our team. Our hepatologists are amazing. They are very compassionate people. They love taking care of patients. But beyond the physicians, I think really what keeps our center going is our nurse coordinators and our clinic staff and our other transplant staff because I honestly could do my job, none of us could do our jobs without our nurse practitioners, our nurse coordinators, things like that because we would just die without them. And patients just know them, and they know that these people are the point of contact for everything and that’s what makes us special, I think. We provide great surgical care, our hepatologists provide great medical care but our staff are really what sets us apart from pretty much everything.

Host:  Well that certainly is a comprehensive program. Thank you so much Dr. Shah for joining us and sharing your incredible expertise with us today. That wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. For more information and to get connected with one of our providers please visit our liver transplant program page at www.ukhealthcare.uky.edu. If you found this podcast as interesting and informative as I did, please share on your social media. Share with friends and family and be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.