Sylvia Rodriguez has been first several times in her life. She was the first bilingual deputy in the Milwaukee County Sheriff’s Department and the first Latina to achieve the rank of captain. She served as translator and developed the Community Policing Unit to build positive relationships.

“I wanted to help people who spoke little English communicate better with law enforcement,” Sylvia said.

But between 1998 and 2013, Sylvia encountered several health problems. In 2013, she added another first to her list. She became part of the first successful in situ split-liver transplant surgery in Wisconsin, a procedure in which surgeons split the liver within the donor’s body and transplant it in multiple recipients, thus saving more lives.

rodriguez-in-situ-split-liver-transplantA Surprise Diagnosis

Sylvia’s journey to transplant started in 1998 when she was diagnosed with hepatitis C. 

“I searched for the best doctor in Wisconsin for hepatitis C, and that’s how I found Dr. Franco,” she said. Jose Franco, MD, specializes in gastroenterology and transplant hepatology and helped Sylvia manage her hepatitis C. He monitored her liver for changes since hepatitis C may cause cirrhosis, or scarring, of the liver.

“Not everyone with hepatitis C gets cancer, but it’s an increased risk because scar tissue provides an environment where cancer may develop,” Dr. Franco said. “In 1998, we treated Sylvia with the best treatments for hepatitis C available at that time; however, there were problems with these older treatments.” Treatments available at that time had low cure rates — only 25 to 35 percent.

Multidisciplinary Team Approach

By 2012, Sylvia’s images showed she had developed tumors on her liver. But Sylvia had an entire team of specialists with her. Each week, experts from diagnostic radiology, transplant, hepatology, vascular and interventional radiology, surgical oncology and radiation oncology meet to discuss how to best treat patients using a multidisciplinary approach.

“Together, we determined Sylvia’s liver could not heal on its own,” Dr. Franco said. “Attempting to perform surgery on the tumors could tip her into liver failure. We needed another option.”

Sylvia’s team determined transplant offered her best chance for survival; however, Sylvia’s tumors made her ineligible for national standards for transplant set by the United Network for Organ Sharing. Sylvia’s team needed to reduce the number and size of the tumors on her liver for her to be eligible for the liver transplant wait list.

Vascular and interventional radiologist Eric Hohenwalter, MD, working together with the hepatology and transplant teams, determined the best course for Sylvia was transcatheter arterial chemoembolization (TACE) to shrink and reduce her tumors. Using TACE, Dr. Hohenwalter targeted chemotherapy drugs directly to Sylvia’s liver by placing a catheter through the artery supplying blood to her tumors. Since the chemotherapeutic drugs are injected directly into the tumor, dosages are 20 to 200 times higher than standard chemotherapy, but most patients do not experience the negative side effects commonly associated with chemotherapy. The procedure worked, and Dr. Hohenwalter’s team stabilized the tumors. Sylvia was placed on the wait list for a new liver.

“I didn’t worry about it,” Sylvia said. “I had done whatever my doctors told me to do, and I trusted them to do everything possible to make me healthy again.”

First In Situ Split-Liver Transplant in the State

On May 21, 2013, Sylvia received news that would save her life. Through an in situ split-liver transplant, Sylvia received a portion of a liver from a deceased donor. Transplant surgeon Johnny C. Hong, MD, director of the Solid Organ Transplant Program, a joint program of the Froedtert & MCW Froedtert Hospital and Children’s Hospital of Wisconsin, performed the surgery. The remaining portion of the liver went to a baby at Children’s Hospital of Wisconsin. Because of the liver’s unique ability to regenerate or regrow itself once it is inside the recipient, two patients received the gift of life from the same donor.

 
“An in situ split-liver transplant is a procedure during which we split the liver within the donor’s body before transplant, so we can avoid rewarming the organ multiple times prior to transplant,” Dr. Hong said. “With split-liver transplant, we can maximize the benefit of each available organ.” Only large medical centers with high levels of expertise are qualified to perform this type of advanced procedure, Dr. Hong said, because the procedure requires quick and precise work, logistical organization, expert care and the right instruments.

“Because of the shortage of organs available for transplant, we cannot miss an opportunity when an organ becomes available,” he said. “In the operating room, everything has to go perfectly; the whole team must work together. ‘Good enough’ is never good enough.”

Excellent Outcomes, Expert Care

The transplant team’s high standards have resulted in positive results, including liver transplant patient survival outcomes that consistently exceed national averages.

Sylvia said the multidisciplinary care approach saved her life. “I’ve been coming here for so long for my care, and I’ve had so many specialists working with me,” she said. “I’ve always felt expertly cared for.”

After her liver transplant, Dr. Franco introduced Sylvia to a new treatment for hepatitis C, a combination pill containing sofosbuvir plus ledipasvir. The medication produces minimal side effects, and the cure rate is more than 90 percent. Sylvia completed the medication cycle, and today, she is cured of hepatitis C. Now, she spends time caring for her six grandchildren and has enough energy to cook her family’s favorite Mexican cuisine.

“My team provided the best treatment I could have received anywhere,” Sylvia said. “They knew what I needed.”

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Michelle
Barnstable
on August 15, 2019 - 4:31 pm

Sylvia I was so happy to hear your story on the radio. Would you be willing to speak with a donor family member? If so I would be grateful for the time. Please respond to my email if you are willing. thank you. mb