Living-donor. Liver Transplantation Living Doner Updated_rev15 hires.indd 2 1/7/10 9:46:34 AM

Transcription

1 Henry Ford Transplant Institute Living-donor Liver Transplantation Living Doner Updated_rev15 hires.indd 2 1/7/10 9:46:34 AM

2 Living-donor Liver Transplantation A recognized leader in cutting-edge liver treatment, the Henry Ford Transplant Institute is advancing a life-saving alternative for people in need of a new liver: adult living-donor liver transplantation. As the gap between the need for liver transplantation and available deceased-donor organs continues to widen, more patients are critically ill when they receive a transplant and experience poor outcomes after transplantation. Living-donor liver transplantation is an innovative solution to this growing challenge. The living-donor transplant provides an opportunity for improved survival with a better recovery and minimal rejection. Recipients no longer have to wait for a liver to become available. They can choose the time for their transplant and even select the donor. And, with the development of laparoscopic-assisted liver donation, donors recover faster and experience less postoperative pain. Only a select number of centers across the country have the experience to perform this specialized surgery. Henry Ford Hospital s Liver Transplant team conducted Michigan s first living-donor, adult-to-adult liver transplant in 2000, and the state s first laparoscopic-assisted adult living-donor liver transplant donation in Our team is UNOS certified for living-donor liver transplantations Living Doner Updated_rev15 hires.indd 3 1/7/10 9:46:34 AM

3 Living-donor Liver Transplant Patient Survival** ONE YEAR; LIVING DONOR* HENRY FORD NATIONAL Henry Ford Hospital 100% 89.88% THREE YEAR; LIVING DONOR + HENRY FORD NATIONAL 100% 88.89% 88.89% 82.92% % * For adult patients receiving their first transplant 7/1/ /31/ For adult patients receiving their first transplant 1/1/2003-6/30/2005. ** Single-organ transplants only. Source: Scientific Registry of Transplant Recipients Transplant Program and OPO- specific Data Reports, released 1/13/2009. The living-donor approach provides an opportunity for improved survival with a faster recovery and minimal rejection. In 2000, Ela Bullock of Detroit received a section of her daughter Lea s healthy liver when surgeons at Henry Ford Hospital performed Michigan s first living-donor, adult-to-adult liver transplant. Today, both mother and daughter are doing very well Living Doner Updated_rev15 hires.indd 4 1/7/10 9:46:45 AM

4 Advantages Because the liver has the ability to regenerate, a portion of the liver from a living donor can be removed and transplanted into a recipient. Both the remaining liver masses of the donor and the donated part will grow to almost normal size within about two months. Advantages over deceased-donor transplantation include: Adult living-donor liver transplantation eliminates a long wait. The average wait for a liver transplant in the United States has increased from one month in 1988 to more than 3 1/2 years. The transplanted liver is in better condition because it is outside the body for a very short time. This surgery is elective, so the transplant is performed before the patient becomes critically ill, giving a more favorable prognosis. The donor is chosen because she or he is healthy, therefore providing a better liver. Possible Risks The main reason for our extensive donor evaluation process is to reduce any possible risks. From our experience with this procedure, there is little long-term impact on the donors. However, risks can include: Bile leak and infection Pain from the incision Wound infection Bleeding that would require blood transfusions Death to the donor, which is rare but possible Living Doner Updated_rev15 hires.indd 5 1/7/10 9:46:45 AM

5 Who is a Candidate for Liver Transplantation? Karen Stewart donated a section of her healthy liver to her sister Valerie Stewart. Potential candidates for living-donor transplants are carefully evaluated by the Henry Ford transplant team for eligibility on an individual basis. Primary Diagnosis: Postnecrotic cirrhosis (hepatitis B or hepatitis C) Primary biliary cirrhosis Primary sclerosing cholangitis Autoimmune chronic active hepatitis Alpha-1 antitrypsin deficiency Hemochromatosis Wilson s disease Steatohepatitis Select patients with alcoholic liver disease, hepatocellular carcinoma, benign hepatic tumors, polycystic liver disease or inborn errors of metabolism Indications: Specific indicators of severity of illness are used to determine timing of referral, evaluation and listing. Variceal bleeding Refractory ascites Spontaneous bacterial peritonitis Encephalopathy Progressive fatigue Refractory pruritus Muscle wasting Development of stage 1 or 2 hepatocellular cancer in the setting of cirrhosis Contraindications: Sepsis outside the liver Malignancy outside the liver Severe hypoxemia due to rightto-left shunts Advanced cardiopulmonary disease Active alcohol or substance abuse Poor support system or unsuitable psychological profile Irreversible brain damage Noncompliance with transplant requirements HIV positivity Living Doner Updated_rev15 hires.indd 6 1/7/10 9:46:46 AM

6 Dedicated and highly experienced members of the Henry Ford Liver Transplant team ensure patients receive an exceptional level of support and coordinated care. Who is a Potential Living Liver Donor? Our priority is to ensure good health and minimal risk to the donor. We emphasize that the donor has the right to change his or her mind at any time. The Ideal Candidate Is: Between the ages of 18 and 55 A friend or a family member such as a spouse, parent, sibling, child, nephew or niece Similar size or larger than the recipient The same or compatible blood type as the recipient In excellent medical and psychological health Highly motivated Contraindications: Previous liver surgery HIV infection Viral hepatitis History of cancer Heart and lung disease Diabetes Active alcoholism Living Doner Updated_rev15 hires.indd 7 1/7/10 9:46:47 AM

7 Laparoscopic-assisted Liver Donation Always striving to provide patients with the most advanced medical treatment, Henry Ford Transplant Institute surgeons were the first in Michigan to perform laparoscopic-assisted liver donation in Shortening recovery times and lowering risks for the donor, laparoscopicassisted liver donation provides a much-improved surgical option for living-donor transplant. Using cameras and specialized tools, the surgeon can see the entire surgical theater through three small incisions. Through an additional small (5 inch) incision, the donated portion of the liver is removed without the need to make a larger incision, which is usually required during open abdominal surgery. The traditional method requires an incision of 20 to 25 inches on the abdomen to reach the liver and perform the procedure. This typically results in pain over the incision and puts the patient at risk for hernia formation. With the laparoscopic-assisted option, living donors recover quickly and are back on their feet and driving a car shortly after they leave the hospital. Scarring is minimal roughly one-third the size of the open abdominal procedure, and the risk of infection is very low. Comparison Chart Incision site Incision size hospital stay recovery time discomfort level TRADITIONAL Along the rib cage to the sternum 20 to 25 inches Five to seven days Four to six weeks Moderate to severe laparoscopic Along the abdomen 3 keyhole incisions, plus one 5 inch incision to remove the donated portion of the liver Three to five days Two to three weeks Minimal Living Doner Updated_rev15 hires.indd 8 1/7/10 9:46:49 AM

8 The Living Liver Donor Evaluation The evaluation process is extensive because even though we are trying to provide the recipient with a good liver, our primary concern is the safety of the donor. If at any point we feel the donor s health is at risk, the workup will not be completed. Potential donors undergo an intense, four-step screening process. TIME FRAME: Workup is paced to the comfort and schedule of the potential donors, but can be completed within two to three weeks if necessary. STEP I Medical history and physical exam Blood tests to rule out liver disease Meeting with transplant team physicians and support staff Psychiatric and social work evaluations EKG, chest X-ray and blood work STEP II MRI or CT scan to assess the size of the donor s liver and reconstruct vasculature Consultation with hematologist for assessment and blood clot prophylaxis Consultation with physician patient advocate Possible hepatic angiogram to assess liver arterial blood flow Possible liver biopsy STEP III Final visit and scheduling of surgery Consents for surgery signed Donors may store their own blood for possible transfusions during surgery Living Doner Updated_rev15 hires.indd 9 1/7/10 9:46:50 AM

9 Helping to Give a Second Chance at Life Receiving a second chance at life, Henry Ford Transplant Institute patient Mark Otto returned to an active lifestyle after undergoing a living-donor transplant. About the Henry Ford Transplant Institute Henry Ford has long been committed to providing organ transplantation. The Henry Ford Transplant Institute has grown to become one of the nation s busiest and highest-regarded transplant centers. We are one of only two multiorgan transplantation centers in Michigan with transplant programs for: Liver Lungs Kidney Heart Pancreas Bone marrow The Institute is responsible for many of the state s first-ever transplantation procedures, including performing the first heart transplantation in Detroit. Aside from being first and foremost, the Henry Ford Transplant Institute can boast survival rates that are the best in the state as well as significantly above the national average. The Henry Ford Transplant Institute s dedicated and experienced team ensures patients receive an exceptional level of support and coordinated care before, during and following transplantation. Together, the team is united in one cause: to offer patients the rare opportunity of a second chance at life Living Doner Updated_rev15 hires.indd 10 1/7/10 9:46:52 AM

10 Henry Ford Transplant Team Members of the Henry Ford Liver Transplant team are nationally recognized for cutting-edge liver treatments. We welcome the opportunity to discuss living-donor liver transplantation and answer any questions you have about the procedure and the evaluation process. To speak to a transplant team member, please call (313) Marwan Abouljoud, M.D. Director, Henry Ford Transplant Institute; Chief, Division of Transplant and Hepatobiliary Surgery Atsushi Yoshida, M.D. Associate Director of Operations, Division of Transplant and Hepatobiliary Surgery; Surgical Director, Liver Transplant Dean Kim, M.D. Surgical Director, Kidney and Pancreas Transplant Jason Denny, M.D. Senior Staff Transplant Surgeon Marwan Kazimi, M.D. Senior Staff Transplant Surgeon Lauren Malinzak, M.D. Senior Staff Transplant Surgeon Robert Slater, M.D. Senior Staff Transplant Surgeon Kimberly Brown, M.D. Chief, Division of Gastroenterology and Hepatology Dilip Moonka, M.D. Medical Director, Liver Transplant Stuart Gordon, M.D. Section Chief, Hepatology; Director of Hepatology Research Layla Hajjafar, M.D. Senior Staff Physician Mary Ann Huang, M.D. Senior Staff Physician Surinder Batra, M.D. Living-donor Patient Advocate Arlene Helms, R.N. Pre-liver Transplant Coordinator Carol Rembor, R.N. Pre-liver Transplant Coordinator Jo Ann Choinski, R.N. Pre-liver Transplant Coordinator The Henry Ford Transplant Institute is a major transplant center approved by most major payers in Michigan Living Doner Updated_rev15 hires.indd 11 1/7/10 9:46:54 AM

11 See a digital hologram of our living-donor liver-splitting process come to life in your hands. 1 3 GO TO HENRYFORD.COM/SPLITLIVERAR TURN ON YOUR COMPUTER S SOUND AND WEBCAM. CLICK ALLOW IF YOU ARE PROMPTED. THIS WILL ALLOW ACCESS TO YOUR WEBCAM. HOLD YOUR PRINTED PATTERN SO IT FACES YOUR COMPUTER S WEBCAM. IT MAY TAKE A FEW SECONDS TO BEGIN. 2 Henry Ford Transplant Institute Henry Ford Hospital, K W. Grand Blvd. Detroit, MI henryford.com (313) Living Doner Updated_rev15 hires.indd 12 1/7/10 9:46:55 AM

12 Henry Ford Transplant Institute Henry Ford Hospital, CFP West Grand Blvd. Detroit, MI Look inside to view a digital hologram of our liver-splitting process Living Doner Updated_rev15 hires.indd 1 1/7/10 9:46:55 AM