One Liver, One Life
Our Transplant Team's Mission is Making Every Liver Count

The Longest Wait

Liver transplantation is a life-saving procedure. In New York State, where organ shortage is severe, patients spend years on a waiting list, depending, unfortunately, on the death of a donor. For those who have the good fortune to obtain a liver, however, the transplant operation marks only the mid-way point in the patient's odyssey.

"At the time of the transplant, most of our patients have already undergone lengthy hospitalizations, because their conditions have deteriorated due to the long wait for a liver," says Dr. Lewis Teperman, director of NYU Medical Center's Liver Transplant Program, who - along with attending surgeons Thomas Diflo, Glyn Morgan, and Devon John - performs the transplant procedures. Dr. Teperman continues, "In an organ poor state like New York, patients usually have to be so sick that they need hospitalization in order to receive a transplant. Following the operation, patients take immunosuppressants to keep their bodies from rejecting the new liver, which to the immune system is a foreign invader. They also have to live with side-effects like reduced kidney function."

The members of NYU Medical Center's Liver Transplant Program are working at every stage of this process to increase patients' chances of survival and to improve their quality of life. Survival rates of NYUMC's liver transplant patients - 90% after one year, and 83% after three years - attest to the program's excellence, but only partly tell the story of its life-saving work. The transplant team is increasing the number of lives saved, using pioneering treatments and meticulous attention to detail at every moment.

Too Few Livers

"Our biggest challenge," says Dr. Teperman, "is that there aren't enough livers. We lose people who are waiting for transplants." Nearly 12,000 people are now on liver organ waiting lists in the US; on average, 3 people die every day because the donor liver they needed did not become available. On NYU Medical Center's waiting list alone, there are 250 patients waiting for livers that can save their lives.

These figures underscore NYU's innovations. The hospital's transplant team has pioneered the use of older livers for transplants, thereby increasing the pool of donor organs, and has developed the technique of plasma exchange, which helps to regenerate transplanted organs that otherwise might need to be replaced. "We used to use no organs older than 40 years, then 50 years, then 60 - now we're using 70 or 80-year-old livers for transplants," Dr. Teperman says.

Plasma exchange is one treatment that has helped make this possible. Says Dr. Teperman: "If a transplanted organ isn't working, you can remove it and get another, which increases mortality and cost, or try to salvage the organ with plasma exchange, which washes the blood, and takes the toxins out. It helps to regenerate the organ, while 'letting the organ sleep.' We do this process several times, and, for the majority of patients, we salvage the organ." Plasma exchange is also sometimes used prior to the operation, as a bridge to keep critically ill patients alive until a donor liver is available. It is particularly effective in the case of patients with sudden and complete liver failure, such as those who contact Hepatitis A from contaminated food.

Because liver transplantation is a life-saving procedure, any increase in the precious resource of donor livers adds to the number of patients whose lives are saved. When a patient needs a second transplant, for example, another patient is likely to die because that liver did not become available. By maintaining a very low rate of retransplantation - 4% compared to a national rate of 10% - NYUMC's Liver Transplant Program is making more livers available to patients, and helping to save more lives. Many patients are also saved from the ordeal of having to go through the process a second time.

Patients with hepatomas, or liver tumors, have special difficulty in maintaining healthy transplanted livers, because tumors often reappear in the new organ. A new procedure called chemoembolization, developed and now under study at NYU, has been shown to greatly reduce the chance of tumors reappearing. Says Dr. Teperman: "Many of our patients have tumors when they come to us. With chemoembolization, we not only perform chemotherapy on the patient's original liver, but also cut off the blood flow to the tumor. This helps eradicate the tumor. We do this several times, because tumors are smart, and can come back."