Transplant Success
UVA's Transplant Survival Rates Exceed National Averages
Liver transplant patients at the University of Virginia Health System are enjoying high survival and graft survival rates thanks to leading-edge care provided by a multidisciplinary team - as shown by the latest statistics from the Scientific Registry of Transplant Recipients.
For the period between July 1, 2001 and Dec. 31, 2003 - the most recent timeframe for which statistics are available - UVA's three-year patient survival rate (82.09 percent) and three-year graft survival rate (75.68 percent) for adults were the highest in Virginia and exceeded the national average. UVA's treatment team expects to perform 80 to 90 liver transplants this year, and earlier this year began offering intestinal transplants.
Team Approach
UVA's transplant team includes surgeons, hepatologists, transplant nurses, social workers and anesthesiologists. Depending on a patient's co-morbidities, other UVA specialists are routinely consulted to assist in the transplant process.
Hepatologists serve as the initial point of contact in the treatment process and play a leading role in assessing patients for a potential transplant, says hepatologist Carl Berg, M.D. Factors include whether patients are physically able to handle a transplant, whether they have the psychosocial support for a transplant and whether their liver disease would be best treated with a transplant.
Once a patient is approved for transplant, he or she is seen by different members of the treatment team depending on the patient's individual needs. For instance, some patients need pretransplant hernia surgery, while others may need medical treatment for hepatitis. During all surgical procedures, surgeons work closely with anesthesiologists who are experienced in tailoring their work to patients with impaired liver function, says transplant surgeon Timothy Pruett, M.D.
"We meet as a team to discuss patients, and everyone looks at patients in a different light to make sure none of the small details get overlooked," says transplant surgeon Timothy Schmitt, M.D.
Fast, Aggressive Care
UVA's transplant volumes are increasing, Schmitt says, because the program's speed in liver transplantation - an average of about three hours - allows physicians to access a wider pool of liver donors and introduce a higher-quality transplant liver, reducing the chances for complications. UVA is also aggressively seeking usable donor livers from neighboring states, Berg says. That means patients receive transplants while they have a lower MELD score - which measures disease severity - reducing a patient's pain and discomfort prior to transplant.
Leading-Edge Treatments
Following their groundbreaking work in the early 1990s to make liver transplants feasible for Hepatitis B patients, UVA hepatologists are working to make transplants successful for Hepatitis C patients, Berg says. For instance, UVA physicians have found that providing Hepatitis C patients with as little as 12 weeks of medical treatment for Hepatitis C - compared with the standard one year of medical treatment - prior to transplant has been successful at preventing the recurrence of Hepatitis C.
UVA is also working to expand the availability of liver transplants, Pruett says, performing transplants in HIV patients through a clinical trial in conjunction with University of California-San Francisco. UVA is also performing live liver transplants as part of a multicenter clinical trial analyzing outcomes from live transplants.
Intestinal Transplants
Continuing its leading-edge care, UVA earlier this year became the first hospital in Virginia to perform an intestinal transplant, which involves transplanting an entire small bowel to allow patients to sustain nutrition. UVA's first patient - a 24-year-old female with a tumor blocking the gastrointestinal tract - continues to do well, Schmitt says.
To refer a patient for a liver or intestinal transplant, call UVA Physician Direct at 800-552-3723.