Gerber: You bring up a great point and we talk about this with our patients. Is that because of space, or is that because of how you hook the organ up to blood supply? It’s a procedure now we’ve been doing since the early 1980’s, and roughly 7,000-7,500 patients a year in the United States undergo liver transplantation.įalk: In the world of kidney transplant, the kidneys stay in, but in liver transplant, the liver comes out. It takes several hours-on average, probably six to eight hours. Replacing the organ, something now which is part of our mainstream health care is what we talk about with transplant, it’s just that-it’s removing your entire diseased liver, and replacing it with a healthy liver from either a deceased donor or a living donor, and there are some complexities to both of those. Gerber: Folks with progressive disease of their liver, as he was talking about with cirrhosis, it comes to a point where that organ is no longer going to work functionally for you, and would end up leading to an early mortality or early failure of life. Basics of the Liver Transplant Operationįalk: Both of you have used the rigors of the transplant. In simple words, I say this to the patient, to make sure they can get through the surgical procedure and have a good recovery. Now, to do a transplant means major surgery, so the surgical team comes in to do a surgical evaluation to complement the testing that’s been done. Obviously, Skip and the hepatology team do their job in assessing the patient’s liver function, liver disease and progression, and the early assessment of if they would need a transplant. Gerber: We work very much in tandem in transplant-the medical and surgical colleagues. Gerber, when as the surgeon do you get mixed into the fray? Hayashi has seen this person already, Dr. That’s when transplant certainly needs to be considered.įalk: So, if Dr. Hayashi: Right, and then it creates other problems for the liver and eventually shows signs of failure. So, the liver gets to a point-it does regenerate very well, up to a point, but when it gets to a cirrhotic point it doesn’t do very well anymore.įalk: So, the liver is trying to repair itself, regenerate, try to repair itself, regenerate, and then at some point it just ends up scarring. Hayashi: Not very well anymore, and that’s the problem. It does not necessarily mean that your liver is failing, but I like to say that you’re on the doorstep of failure and you need to be monitored.įalk: If a liver scars, it means it can’t regenerate? Hayashi: It’s just advanced scarring of the liver. Other etiologies would be less common, and they break down to a lot of autoimmune diseases and genetic disorders. People have heard of hepatitis C, hepatitis B, of course there’s alcohol. The more common ones these days-probably the most I see are non-alcoholic fatty liver disease, that’s associated with things like diabetes, high blood pressure, being overweight, and it can affect the liver to the point that they develop cirrhosis. Hayashi: There’s sort of a long list of causes of cirrhosis. We will follow them for quite a while until the transplant, and then we pick them up several months after the transplant.įalk: Why does a liver fail? What causes cirrhosis? Why would you want to do a transplant in the first place? Basically, it comes down to one: Do they need a liver transplant evaluation, now or soon? And two: Are they an appropriate candidate? Not every person can withstand the rigors of a transplant. My job is to meet them, assess them-first of all to make sure they’re stable and get them stabilized, then quickly decide two questions. Hayashi: These often are patients referred to us who have signs of liver failure, often cirrhosis. What do you, Skip, do as a hepatologist, and what do you, David, do as the liver surgeon? How should a patient think of your various roles? Cirrhosis and Transplant Evaluationįalk: Let’s start this conversation with an understanding for a patient what you do. Hayashi.ĭavid Gerber, MD & Skip Hayashi, MD, MPH: Thank you. Skip Hayashi who is an Associate Professor of Medicine in our Division of Gastroenterology and Hepatology, and he is the Medical Director of the Liver Transplant program at UNC. David Gerber who is a Professor of Surgery in the Department of Surgery, and he is the Chief of Abdominal Transplant Surgery. This is our series for patients focused on organ transplant, and today we will talk about liver transplant. Ron Falk: Hello, and welcome to the Chair’s Corner from the Department of Medicine at the University of North Carolina.
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