If your child needs a liver transplant, you'll have a team of specialists at UVA. This team approach ensures your child receives the best therapy during this highly complex process.
How is a new partnership between UVA and Children’s Hospital of Pittsburgh at UPMC expanding access to pediatric liver transplants in Virginia?
Learn more from Dr. Kenneth Brayman, a UVA transplant surgeon.
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New Partnership Expands Access to Pediatric Liver Transplants
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Learn more about Dr. Kenneth Brayman
Learn more about Charles O. Strickler Transplant Center at UVA
Kenneth L Brayman, MD
Dr. Kenneth Brayman is a board-certified surgeon and the division chief of transplant surgery at UVA.Learn more about Dr. Kenneth Brayman
Learn more about Charles O. Strickler Transplant Center at UVA
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New Partnership Expands Access to Pediatric Liver Transplants
Melanie Cole (Host): If your child needs a liver transplant, you’ll have a team of specialists at UVA. This team approach ensures that your child receives the best therapy during this highly complex process. How will the new partnership between UVA and Children’s Hospital of Pittsburgh expand access to pediatric liver transplants in Virginia? My guest today is Dr. Kenneth Brayman. He’s a board certified surgeon and the Division Chief of Transplant Surgery at UVA. Welcome to the show. Dr. Brayman, tell us why did UVA and Children’s Hospital of Pittsburgh establish this partnership?
Dr. Kenneth Brayman (Guest): The partnership was established in an effort to improve access to high quality liver transplantation for pediatric age patients in the Commonwealth of Virginia that require liver replacement. Arguably, the University of Pittsburgh has the premier pediatric liver transplant program in the United States and, in fact, in the world. They have a large number of patients that come to their center seeking liver transplantation. For us in Virginia, we don’t have that high concentration of patients but we have some and we were able to create a win-win situation with the group at Pittsburgh in an effort to increase access to care and quality of care for pediatric age patients that require liver transplantation.
Melanie: So, how does this partnership work?
Dr. Brayman: Well, patients that are either referred to the University of Pittsburgh or patients from Virginia are evaluated for transplantation at the University of Virginia and then are transplanted here at the University of Virginia with organs that are procured locally.
Melanie: So, patients don’t have to go to Pittsburgh to receive their care?
Dr. Brayman: That’s correct. They don’t have to go to Pittsburgh and, for patients that are based in Roanoke and Richmond and in the Tidewater area, that’s a lot easier for them to be closer to their families to have their transplants done in Charlottesville as opposed to having to go to Pittsburgh.
Melanie: Tell us why a child might need a liver transplant. What sorts of conditions come up that would require this?
Dr. Brayman: Well, there are conditions that we’re born with called “congenital liver diseases” such as biliary atresia where the bile ducts are malformed, and that results in progressive fibrosis in the liver, and then liver failure. That is a condition which is not easily treated with anything but liver transplantation. Other conditions would include various types of genetic conditions such as metabolic diseases. There are diseases called “maple syrup urine disease” where there are metabolic conditions that the liver requires replacement. There are other conditions that result in abnormalities of liver resulting in scarring and cirrhosis. So, there are diseases that are peculiar to childhood that have nothing to do with alcohol or hepatitis, which are the primary reasons for adults to receive liver transplants. But, in children, the spectrum of diseases is different but equally life threatening.
Melanie: Tell us about some of the options for liver transplants for children. We hear in adults that a living donor can donate a part of a liver. Is that the same for children?
Dr. Brayman: Yes, it is. Adults can donate part of their liver. Usually, it’s what we call the left lateral segment, to a child. It’s very difficult to size match for liver transplants with children because of the requirement for having a donor that’s about the same size as the recipient. So, if you have very small children, there aren’t that many donors that are in that small size range. So, taking part of an adult liver and transplanting it to a child, is a very effective way of providing a new liver in a more timely fashion. And that, of course, can come from a living donor.
Melanie: Is it very tough to find donors for children’s liver transplants?
Dr. Brayman: Well, it is challenging. I think that’s one of the reasons why Pittsburgh was interested to collaborate with us because we, obviously, have access to a different donor pool than they do up in Pittsburgh. There is a national system for sharing but it’s regionally based and trying to find livers in a timely fashion for patients with rapidly advancing liver diseases is a national problem. So, in an effort to better serve their patients and also the patients of the Commonwealth, we struck up a partnership with them. And, for the University of Virginia and the citizens of the Commonwealth, we have the great fortune of being able to tap into their expertise and 40-year history of experience with liver transplantation. So, it really catapults the status of our liver transplant program for children from being a very small program to being a national player.
Melanie: Do children get priority for livers on a waiting list over adults?
Dr. Brayman: Well, they do get some priority but livers are pretty much distributed on the basis of how ill the patients are. So, there are some factors which will allow children to get some additional points, so to speak. In general, they do compete with adults for transplants.
Melanie: Tell us about your liver transplant care team at UVA.
Dr. Brayman: Well, we have a fabulous liver care team. We have very experienced pediatric hepatologists and gastroenterologists that are integrated with our local transplant surgeons as well as a variety of different nurse practitioners. The surgeons and the anesthesiologists from Pittsburgh will be coming down to the University of Virginia to participate in the actual surgeries themselves. There are nurses that are coming down to participate in the post-operative care of the patients that receive liver transplants here. University of Virginia has done a number of pediatric liver transplants successfully but having the collaboration with Pittsburgh is really wonderful because it will increase the volume and the complexity of the patients that we can take on as liver recipients.
Melanie: Doctor, what’s life like for a child that’s received a liver transplant? What happens afterwards as far as growth factors and nutritionally? What happens for a child?
Dr. Brayman: Well, it’s amazing. The patients that receive liver transplants, they will resume, essentially, a normal existence. Their liver, if they receive a segment, will grow in size to take up the area in their right-upper abdomen where the liver is situated. They will have normal clearance of toxins, normal production of bile, normal clearance of drugs, and they will grow and develop normally. There are many patients now that have received liver transplants in childhood since the mid-1980s that have gone on to grow up and have normal adulthoods, normal families, normal offspring. It’s remarkable. It basically takes individuals who have very little medical options and completely restores and rehabilitates them with the goal of achieving and living a long, normal life.
Melanie: Because you’re dealing with parents who, we all know, can worry about the smallest thing--and this not the smallest thing--what do you tell parents every single day about the hope for their child to live this nice, long, normal life?
Dr. Brayman: Well, it’s very challenging to have individuals that are in the hospital or as outpatients with families that are waiting for that very special call with the message that, “We have an organ for you--a gift of life.” So, we do our best to try to support families both that are here locally within the hospital and long distance, by being available to them and keeping them up to date as to the likelihood of receiving a transplant. We work very closely with the families and families appreciate the availability of our coordinators and our physicians. We offer a very satisfying experience for patients that do require a liver transplant.
Melanie: In just the last few minutes, Dr. Brayman, how do patients and families benefit from this partnership? Wrap it up for us. And, why should they come to UVA for their transplant care?
Dr. Brayman: Well, University of Virginia is the only comprehensive transplant program in the State of Virginia meaning that we offer all transplants: heart, lung, liver, kidney, pancreas, adult, pediatric. We offer a very high quality liver transplant and transplant experience. We have a very experienced team of physicians, surgeons and nurses. Our hospital is a premier institution which is very patient-centric. It takes the tension and minimizes it as best as possible, creates a very healthy environment for individuals to undergo a very stressful experience, which is to obtain a transplant. I think that it’s not just about the operation itself, it’s about the whole process--from the evaluation to the support from social workers, financial coordinators, to the ability to arrange for local housing and transportation. The excellent care and surgery that they get, obviously, is important, also; but it really is a very supportive environment to receive complex care.
Melanie: Thank you so much. What great and such important information. Dr. Brayman. Thank you so much for being with us. You're listening to UVA Healthy Systems Radio. For more information on the new partnership between UVA and Children’s Hospital of Pittsburgh, you can go to UVAhealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
New Partnership Expands Access to Pediatric Liver Transplants
Melanie Cole (Host): If your child needs a liver transplant, you’ll have a team of specialists at UVA. This team approach ensures that your child receives the best therapy during this highly complex process. How will the new partnership between UVA and Children’s Hospital of Pittsburgh expand access to pediatric liver transplants in Virginia? My guest today is Dr. Kenneth Brayman. He’s a board certified surgeon and the Division Chief of Transplant Surgery at UVA. Welcome to the show. Dr. Brayman, tell us why did UVA and Children’s Hospital of Pittsburgh establish this partnership?
Dr. Kenneth Brayman (Guest): The partnership was established in an effort to improve access to high quality liver transplantation for pediatric age patients in the Commonwealth of Virginia that require liver replacement. Arguably, the University of Pittsburgh has the premier pediatric liver transplant program in the United States and, in fact, in the world. They have a large number of patients that come to their center seeking liver transplantation. For us in Virginia, we don’t have that high concentration of patients but we have some and we were able to create a win-win situation with the group at Pittsburgh in an effort to increase access to care and quality of care for pediatric age patients that require liver transplantation.
Melanie: So, how does this partnership work?
Dr. Brayman: Well, patients that are either referred to the University of Pittsburgh or patients from Virginia are evaluated for transplantation at the University of Virginia and then are transplanted here at the University of Virginia with organs that are procured locally.
Melanie: So, patients don’t have to go to Pittsburgh to receive their care?
Dr. Brayman: That’s correct. They don’t have to go to Pittsburgh and, for patients that are based in Roanoke and Richmond and in the Tidewater area, that’s a lot easier for them to be closer to their families to have their transplants done in Charlottesville as opposed to having to go to Pittsburgh.
Melanie: Tell us why a child might need a liver transplant. What sorts of conditions come up that would require this?
Dr. Brayman: Well, there are conditions that we’re born with called “congenital liver diseases” such as biliary atresia where the bile ducts are malformed, and that results in progressive fibrosis in the liver, and then liver failure. That is a condition which is not easily treated with anything but liver transplantation. Other conditions would include various types of genetic conditions such as metabolic diseases. There are diseases called “maple syrup urine disease” where there are metabolic conditions that the liver requires replacement. There are other conditions that result in abnormalities of liver resulting in scarring and cirrhosis. So, there are diseases that are peculiar to childhood that have nothing to do with alcohol or hepatitis, which are the primary reasons for adults to receive liver transplants. But, in children, the spectrum of diseases is different but equally life threatening.
Melanie: Tell us about some of the options for liver transplants for children. We hear in adults that a living donor can donate a part of a liver. Is that the same for children?
Dr. Brayman: Yes, it is. Adults can donate part of their liver. Usually, it’s what we call the left lateral segment, to a child. It’s very difficult to size match for liver transplants with children because of the requirement for having a donor that’s about the same size as the recipient. So, if you have very small children, there aren’t that many donors that are in that small size range. So, taking part of an adult liver and transplanting it to a child, is a very effective way of providing a new liver in a more timely fashion. And that, of course, can come from a living donor.
Melanie: Is it very tough to find donors for children’s liver transplants?
Dr. Brayman: Well, it is challenging. I think that’s one of the reasons why Pittsburgh was interested to collaborate with us because we, obviously, have access to a different donor pool than they do up in Pittsburgh. There is a national system for sharing but it’s regionally based and trying to find livers in a timely fashion for patients with rapidly advancing liver diseases is a national problem. So, in an effort to better serve their patients and also the patients of the Commonwealth, we struck up a partnership with them. And, for the University of Virginia and the citizens of the Commonwealth, we have the great fortune of being able to tap into their expertise and 40-year history of experience with liver transplantation. So, it really catapults the status of our liver transplant program for children from being a very small program to being a national player.
Melanie: Do children get priority for livers on a waiting list over adults?
Dr. Brayman: Well, they do get some priority but livers are pretty much distributed on the basis of how ill the patients are. So, there are some factors which will allow children to get some additional points, so to speak. In general, they do compete with adults for transplants.
Melanie: Tell us about your liver transplant care team at UVA.
Dr. Brayman: Well, we have a fabulous liver care team. We have very experienced pediatric hepatologists and gastroenterologists that are integrated with our local transplant surgeons as well as a variety of different nurse practitioners. The surgeons and the anesthesiologists from Pittsburgh will be coming down to the University of Virginia to participate in the actual surgeries themselves. There are nurses that are coming down to participate in the post-operative care of the patients that receive liver transplants here. University of Virginia has done a number of pediatric liver transplants successfully but having the collaboration with Pittsburgh is really wonderful because it will increase the volume and the complexity of the patients that we can take on as liver recipients.
Melanie: Doctor, what’s life like for a child that’s received a liver transplant? What happens afterwards as far as growth factors and nutritionally? What happens for a child?
Dr. Brayman: Well, it’s amazing. The patients that receive liver transplants, they will resume, essentially, a normal existence. Their liver, if they receive a segment, will grow in size to take up the area in their right-upper abdomen where the liver is situated. They will have normal clearance of toxins, normal production of bile, normal clearance of drugs, and they will grow and develop normally. There are many patients now that have received liver transplants in childhood since the mid-1980s that have gone on to grow up and have normal adulthoods, normal families, normal offspring. It’s remarkable. It basically takes individuals who have very little medical options and completely restores and rehabilitates them with the goal of achieving and living a long, normal life.
Melanie: Because you’re dealing with parents who, we all know, can worry about the smallest thing--and this not the smallest thing--what do you tell parents every single day about the hope for their child to live this nice, long, normal life?
Dr. Brayman: Well, it’s very challenging to have individuals that are in the hospital or as outpatients with families that are waiting for that very special call with the message that, “We have an organ for you--a gift of life.” So, we do our best to try to support families both that are here locally within the hospital and long distance, by being available to them and keeping them up to date as to the likelihood of receiving a transplant. We work very closely with the families and families appreciate the availability of our coordinators and our physicians. We offer a very satisfying experience for patients that do require a liver transplant.
Melanie: In just the last few minutes, Dr. Brayman, how do patients and families benefit from this partnership? Wrap it up for us. And, why should they come to UVA for their transplant care?
Dr. Brayman: Well, University of Virginia is the only comprehensive transplant program in the State of Virginia meaning that we offer all transplants: heart, lung, liver, kidney, pancreas, adult, pediatric. We offer a very high quality liver transplant and transplant experience. We have a very experienced team of physicians, surgeons and nurses. Our hospital is a premier institution which is very patient-centric. It takes the tension and minimizes it as best as possible, creates a very healthy environment for individuals to undergo a very stressful experience, which is to obtain a transplant. I think that it’s not just about the operation itself, it’s about the whole process--from the evaluation to the support from social workers, financial coordinators, to the ability to arrange for local housing and transportation. The excellent care and surgery that they get, obviously, is important, also; but it really is a very supportive environment to receive complex care.
Melanie: Thank you so much. What great and such important information. Dr. Brayman. Thank you so much for being with us. You're listening to UVA Healthy Systems Radio. For more information on the new partnership between UVA and Children’s Hospital of Pittsburgh, you can go to UVAhealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.