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Inside Tract - Live-Donor Liver Transplants: Back in Business
Inside Tract Spring 2015
Live-Donor Liver Transplants: Back in Business
Date: May 18, 2015
Nabil Dagher and Ahmet Gurakar are helping to reinvigorate the Johns Hopkins live-donor liver transplant program.
When high-profile adverse events, including donor death, put the brakes on live-donor livere transplant in the U.S., it left people with poor liver function at a loss for alternatives.
Despite an overall increase in organ donation in the U.S., whole livers remain scarce and are used only in patients who won’t survive more than a few months without a transplant. Patients with low Model for End-Stage Liver Disease (MELD) scores have a harder time getting a cadaveric liver.
Today, hepatologists and transplant surgeons at Johns Hopkins are getting a live-donor transplant program back on track.
“The number of live-donor transplants we’re doing is increasing,” says Nabil Dagher, director of living donor transplantation at Johns Hopkins. “We expect this year that we’ll continue to increase.”
Johns Hopkins hepatologist Ahmet Gurakar says the live-donor transplant surgery improves lives.
“The population with lower MELD scores are not going to get cadaveric offers for a long time but are suffering from chronic fatigue, encephalopathy or ascites,” says Gurakar.
Dagher says many transplant centers across the United States shied away from live-donor liver transplants, and the number of surgeries nationwide is half of what it was in 2000. Despite the drop, Dagher is confident in the procedure and encourages Johns Hopkins liver patients to consider it.
“We know a lot more than we used to about donor risk, and we have excellent results,” he says. “We do a rigorous workup of our living donors, not only with laboratory tests, but with imaging and biopsies.”
He and the transplant team, which includes Ben Philosophe, clinical chief of the Division of Transplantation, and Andrew Cameron, surgical director of liver transplantation, use the donor workup and the recipient’s condition to map out a strategy. “We decide where we’re going to split the liver in a way that keeps the donor safe and ensures an excellent outcome for donor and recipeint.”
Donor safety, says Dagher, is a top priority. “It’s a complex surgery, and if it’s not done right, there can be some serious complications,” he says. “That’s why a lot of centers stopped doing it.”
Asian nations have a high rate of liver disease but, for cultural reasons, generally reject the practice of cadaveric transplants. Dagher says that prohibition led to the rise of live-donor transplants in Japan, Korea and other Asian countries.
“They have a very high volume,” says Dagher, who trained on the procedure in Hong Kong and Istanbul. “They don’t have deceased donors, so this is all they do.”
Dagher also looks forward this year to expanding the live-donor liver transplant program to include transplants for people who are ABO incompatible with their donors.
“We do that for kidneys already,” he says. “Now we’re going to start setting up protocols for ABO-incompatible live-donor liver transplants. So if people want to donate and they’re the wrong blood type but are otherwise good donors, they could still potentially donate with extra antibody-decreasing treatment of the recipient. Same thing we do for kidneys, only for the liver.”