Programs and Services

Liver Transplant Program

Froedtert & the Medical College of Wisconsin’s Liver Transplant Program began in 1983 when we performed Wisconsin’s first liver transplant. Since then, we have performed more than 500 liver transplants. Currently, we perform about 30 to 40 liver transplants each year. With more than two decades of experience, we provide superior care for liver transplant patients.

Our program has a strong multidisciplinary approach, relying on the expertise of physicians in a wide range of specialties. Patients with liver failure often have other underlying conditions, such as diabetes, hypertension, lipid disorders, osteoporosis and more. We are able to care for the whole patient because of the breadth of specialties and resources available at Froedtert & the Medical College of Wisconsin.

FAQ

See our FAQ for more informations about our program.

One-year survival rates for our Liver Transplant Program are higher than the national average, and we believe that is due to our multidisciplinary approach and high level of expertise. To compare survival rates of liver transplants across the country, go to the Web site for the Scientific Registry of Transplant Recipients.

Because we are a leading academic medical center, Froedtert & the Medical College of Wisconsin hepatologists and other physicians are better able to recognize and treat complications of cirrhosis and other liver diseases, which means patients undergo transplant surgery in overall better health. We currently have four hepatologists on staff to care for patients with end-stage liver disease (cirrhosis) and liver transplants.

Froedtert & the Medical College of Wisconsin also offer a strong team of dedicated support professionals. Our hepatologists and transplant surgeons are assisted by experienced transplant nurses, social workers, psychologists, dietitians and more.

Our success is also linked to the excellent work of the Wisconsin Donor Network (WDN), based at Froedtert & the Medical College of Wisconsin. The WDN recovers the liver from a high percentage of organ donors, which means shorter waiting times for transplant candidates in eastern Wisconsin.

In fact, we have much shorter waiting times than the national average for liver transplants. We also have a low mortality rate for people on our waiting list, meaning patients are less likely to die while waiting for a donated liver to become available.

From the patient’s perspective, it all adds up. Shorter waiting times plus aggressive multidisciplinary care means patients are healthier going into a transplant. That can mean fewer complications and a shorter hospital stay. Surgical advances result in fewer complications, and advances in immunosuppression medications lead to fewer episodes of organ rejection and fewer medication-related complications.

End-Stage Liver Disease Program

Our End-Stage Liver Disease Program, together with our Transplant Program, is led by nationally recognized physicians, many of who have been named to the “Best Doctors in America®” list. Our dedicated support staff, including nurses and physicians assistants, specializes in caring for patients with end-stage liver disease and in transplant programs.

Excellent end-stage care is vital to a successful transplant program. By offering the best care for end-stage liver disease patients, we can help some avoid transplantation while ensuring that those who need a transplant are in the best possible health at the time of transplant.

Dedicated Clinic and Follow-up Care

Because transplant patients need to take anti-rejection medications for the rest of their lives, we have a dedicated Transplant Clinic that provides a central place for questions, check-ups and other resources. Surgeons, hepatologists, endocrinologists, infectious disease experts and others are available to give our patients the best care that meets the diversity of needs they may face.

We also have post-transplant coordinators who work with our patients to coordinate every aspect of their follow-up care. By drawing on the strengths of physicians in a variety of fields, we can take care of little problems early before they become big problems. Having a dedicated clinic with an experienced staff and a central location gives patients a familiar place where their unique needs are well understood. Clinic hours accommodate patients’ schedules, and patients may come to the clinic without an appointment if they’re not feeling well.

Living-Donor Transplants

While some centers perform living-donor liver transplants, whereby a piece of the donor’s liver is transplanted into the recipient, we are not currently performing them here. The need for living-donor liver transplants is driven primarily by long waiting times at transplant center. In contrast to kidney transplants, the outcomes for living-donor liver transplants are not better than deceased donor transplants. Furthermore, the risk to the donor is substantially higher than for a kidney donor. If special circumstances dictate the need for a living-donor liver transplant, we would refer you to a center that performs this procedure. If a donated liver does not become available in a reasonable amount of time, some centers may suggest a living-donor transplant.

Fortunately, at Froedtert & the Medical College of Wisconsin, we have had very generous donation rates and have not yet had to resort to living-donor liver transplants. That’s due to the work of the Wisconsin Donor Network, which has put tremendous effort into promoting awareness of organ donation.

Causes of Liver Failure

There are many causes of liver disease that can lead to liver failure and the need for a transplant. The most common causes that we see at Froedtert & the Medical College of Wisconsin are:

Hepatitis C — Its progression is slow, often taking decades to cause damage. There was no test for Hepatitis C until 1992, and many people receiving transplants today were infected in the 1970s. It’s estimated that almost 2 percent of the general population has Hepatitis C, and most don’t know it yet. It’s important to note that not everyone with Hepatitis C will require a liver transplant.
Excessive use of alcohol leading to cirrhosis of the liver — All patients, as part of our effort to care for the whole patient, undergo a psychological exam to make sure they understand the ramifications of their disease and the risks of transplantation. To be a candidate for transplantation, patients undergo a very careful psychosocial evaluation and are required to abstain from alcohol for at least six months.
Non-alcoholic fatty liver disease — This disease causes damage similar to that caused by alcohol abuse, but it occurs in patients who don’t drink to excess. It is by far the most prevalent liver disease in the United States, but only a small percentage of people with this condition progress to the most severe form where they need a transplant. Risk factors include obesity, diabetes and lipid disorders.
Bile duct diseases — These affect the “plumbing” of your liver. Bile ducts carry bile, which aids in digestion, from the liver to the gallbladder and then to the small intestine. Some bile duct diseases can cause severe liver damage (examples include primary biliary cirrhosis and primary sclerosing cholangitis).
Acute liver failure — The first four conditions above are all chronic diseases. Acute liver failure comes on quickly and without warning. Several things can cause acute liver failure including all viral infections and certain medications (most notably, acetaminophen). Patients with acute liver failure will typically either recover completely or require a transplant within a week or two. These patients will go to the top of the transplant list because of the severity of their condition. Many of our acute liver failure patients have been referred to us from other hospitals in the region. Because of our multidisciplinary approach and our extensive experience with liver disease, we are able to help many of these patients recover without a transplant. We do everything possible to support these patients through their condition. At the same time, we are able to determine when their only option is a liver transplant.

Research

At Froedtert & the Medical College of Wisconsin, much of our research is aimed at trying to halt or prevent diseases that lead to the need for a transplant. That’s why our major focus now is on Hepatitis C, the leading cause of liver failure nationwide. Through our own studies and participation in national and international research, we’re actively looking for ways to prevent patients with Hepatitis C from deteriorating to the point where they need a transplant. We are proud to be one of just 10 centers nationwide recently chosen to study the next class of drugs to treat Hepatitis C.

We also study the immunosuppressive drugs used by patients for the rest of their lives after a transplant. We’re always looking for the best combination of drugs and the right doses with the fewest side effects. In the past 10 years, Froedtert & the Medical College of Wisconsin have been involved in testing, under FDA supervision, of virtually every major new medication developed for either immonusuppression or for treating Hepatitis C.

Another research focus involves the work of Samer Gawrieh, MD, Medical College of Wisconsin Hepatologist. Dr. Gawrieh’s research centers on non-alcoholic fatty liver disease (NAFLD), the most common liver problem in the country, affecting millions of Americans. Fatty liver disease, in its most severe form known as nonalcoholic steatohepatitis (NASH), may lead to liver failure and the need for a transplant. Fatty liver may also make a donor liver unusable.

There are different forms of fatty liver disease and it can be caused by a number of factors. The most common are being overweight and obesity. Dr. Gawrieh’s research focuses on identifying genes that may cause NAFLD and NASH or protect against the conditions. Identifying the genes associated with these diseases would make it possible to design better treatments. His research may also make it possible to more easily and accurately determine which patients have which form of the disease, since the two forms require very different courses of treatment. Dr. Gawrieh is also studying the problems encountered with interpretation of liver biopsies by pathologists and finding solutions to improve the accuracy of diagnosing the different forms of NAFLD.

Author: Joan Cotter Pike

Date: May 18, 2007