Issue No. 1
An Aggressive Tradition
Date: March 1, 2010
In some ways, the Johns Hopkins Liver Transplant Program might seem similar to the handful of other such programs across the country: the majority of their patients present with hepatitis C, they perform one of the most surgically challenging of any transplant procedures and their patients are often gravely ill.
But, launched in the late 1980s as the first such program in the Mid-Atlantic, the Johns Hopkins liver center has remained one of the most aggressive and successful teams in the area.
“In many ways, we are a traditional program,” says surgical director Andrew Cameron. “But we’re also forward-looking, evidence-based and striving toward innovation.”
With a team that includes surgeons, hepatologists, anesthesiologists, critical care physicians, pharmacologists, nurse practitioners and dietitians, the program emphasizes a holistic approach. In 2009, Hopkins surgeons performed 63 adult liver transplants—more than any other year in hospital history.
“Our outcomes are superior to the national average, which reflects the multidisciplinary efforts that we’re so proud of,” Cameron says. “We’ve had some of the best results we’ve ever gotten.”
The center now aims for even more progress with its living donor program.
While most transplantable livers come from deceased organ donors, there are circumstances, says Cameron, in which live donors can give a portion of their own livers to patients in need. “The downside is that the living donor does face some significant risk,” he says. “Obviously we proceed with great caution and only allow the healthiest people to donate.”
The transplant program is also endeavoring to become a regional referral center for acute liver failure cases, regardless of whether those patients qualify for or need a transplant.
“In an emergency room somewhere, there may be a doctor who’s having a tough time placing a patient in the appropriate care setting. Either there isn’t bed availability, there are insurance problems, or they doubt whether the patient is a good transplant candidate,” Cameron explains. “We are interested in all of those patients, no questions asked. If they ultimately don’t need a transplant, that’s good news. If they do, we can provide that.”
Of course, with livers in short supply and patients who are acutely ill, determining who is and isn’t eligible for transplant is a complicated process. A strict set of criteria must be met, says medical director Ahmet Gurakar, and an organ must become available.
“The sicker the patient, the higher they are on the waiting list,” he says. “How quickly they can get a liver depends on a lot of factors, such as blood type, but the sickest patients may receive a liver within a month or two.”