Liver Transplant: Making More Possible

Liver transplants are challenging procedures. For Renae Field, of Omro, who received a new liver after a six-year wait, the process was even more complex because liver cancer, Crohn’s disease, diabetes and other conditions complicated her life. 

Thankfully, skilled physicians using advanced technology at Froedtert Hospital, the academic medical center of the Froedtert & the Medical College of Wisconsin health network, helped Renae get the liver transplant she needed. 

Renae’s trek to better health began in 2017 when she was diagnosed with a form of liver cirrhosis known as non-alcohol-related steatohepatitis, or NASH. A subsequent biopsy revealed liver cancer, which often stems from cirrhosis. 

“I went home, told my dad and then broke down crying,” Renae said. “I was very upset.” 

Going forward, physicians worked to keep Renae healthy enough to remain eligible for a new liver. “With small tumors in the liver, the best treatment is a liver transplant,” said Kia Saeian, MD, hepatologist and MCW faculty member. 

“Surgically removing tumors usually isn’t feasible because of elevated pressures in the blood vessels in the abdomen, which can lead to complications.” 

Nontraditional Chemotherapy  

William Rilling, MD, vascular and interventional radiologist and MCW faculty member, treated Renae’s cancer with transarterial chemoembolization, also called TACE. It differs from other chemotherapy treatments in two ways. First, patients receive an “on-demand” dose of a drug mixture instead of a scheduled series of doses, followed by an imaging test a month later to judge the results. Second, the drugs are injected directly into an artery that supplies blood to the tumor, not into a patient’s blood system. 

“We seal the blood flow into the vessels going into the tumor, which traps the drugs inside the liver,” Dr. Rilling said. “Sometimes we’re able to shrink a tumor and get a complete response, meaning there are no live tumor cells left.

“The main objective is to keep the patient within the criteria for the size and number of tumors allowed for a transplant. Livers are scarce, so to be fair, we have to be sure each patient has the same chance for surviving a transplant as a patient without liver cancer.” 

Long Wait Rewarded

Renae said that during her wait for a new liver, she was notified several times that she was either a backup transplant candidate or an outright candidate. But, in some instances, she was taking antibiotics, which disqualified her.

“It was trying,” she said. “I thought the day would never come.”

That changed in May 2023, when Renae finally received a new liver. Raj Prasad, MD, hepatobiliary and liver transplant surgeon and MCW faculty member, led the complex surgery. To ensure the donor liver was sufficiently functional prior to transplant, it was perfused, which filled it with nutrient-enriched and oxygenated blood.

“Even if a liver worked normally for a donor, that doesn’t guarantee it will work after it is removed, especially if it is suboptimal,” Dr. Prasad said. “Perfusion technology helps give us confidence a liver will work.

“Donor livers traditionally had to be kept cold to preserve function and be transplanted within a fairly short period of time. Perfusion technology enables livers to remain viable without cold storage and for longer periods of time, which makes more livers available for transplant.” 

A Positive Outcome After Liver Transplant

Renae went home six days after the surgery, and while she still has some fatigue, she said she feels much better overall. She is amazed at how her care team navigated all of her health challenges.

“They were absolutely amazing,” she said. “I thank God for them every day.”

The health network’s collaborative approach to patient care played an important role in Renae’s outcome.

“This approach helps us better manage care for a complex patient with multiple issues to address before and after the transplant,” Dr. Saeian said. “We have an outstanding program,” Dr. Prasad said, noting that the Froedtert & MCW Liver Transplant Program is one of only three in Wisconsin.

“We know the best ways to care for patients as they await a transplant, and we have the ability to accept livers that some programs may not be able to use. “Renae’s liver wasn’t a top match, but by utilizing perfusion technology and my experience working in the United Kingdom, where there’s also an organ shortage, we can take what might be called marginal organs and use them successfully.”