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Jorge Marrero, M.D. Answers Questions On Liver Transplants

Jorge Marrero, M.D. Answers Questions On: Liver Transplants

How do you determine if patients with liver cancer will be eligible for a transplant?

If we detect a tumor on an MRI or CT scan that is under a certain size and it has not spread to other organs, then those patients would benefit from liver transplantation.

We don’t have a liver for every patient who is waiting for a transplant. The problem is about 17,000 people are actively waiting for transplant in the United States. And transplant surgeons perform only about 6,400 transplants a year.

Despite our desire to offer transplants to all patients who need them, some patients will have more aggressive tumors than others, and we will not be able to perform a transplant on them. Transplant for liver cancer (hepatocellular carcinoma) is limited to patients with a single tumor less than 6 centimeters in diameter, or three tumors each less than 3 centimeters.

How do patients qualify for a liver transplant?

During a transplant evaluation at UT Southwestern, patients see a multidisciplinary team that includes a transplant surgeon, transplant hepatologist, social worker, dietitian, nutritionist, and a pharmacist. The patients go through a class in which they learn about the way the organ allocation process works, what to expect while they wait for a transplant, what happens when we call them for a transplant, and what happens afterward.

We also do a lot of testing to make sure the other organs are functioning and that the patient would survive this operation. That includes cardiac testing, lung testing, and blood work to rule out certain infections. It’s quite involved, and it takes time to do an evaluation.

If the multidisciplinary committee determines that we can put a patient on the organ wait list, the waiting begins for a liver to become available. Livers are allocated for liver transplantation based on severity of illness. We determine severity of illness with a score called the MELD – the model for end-stage liver disease. The higher a patient’s MELD score, the greater probability that the patient will die from liver failure in three months. So people with the highest MELD scores go higher on the wait list.

How long does it usually take to recover from a liver transplant?

In general, patients are in the hospital seven to 10 days. Most patients feel immediately better. They say it’s kind of like a cloud lifting over their entire body. But the full recovery from the transplant can take up to three months or longer.

There are several phases to the recovery. Most of it is physical because these patients are sick and they need to get their strength and their nutrition back.

Patients also need to just adjust to having an organ transplantation. They don’t need to take certain medications anymore, but they need to get blood work and take the anti-rejection medications on a specific time schedule. They need to learn what those medications do and especially understand interactions with other medications.

What advances in liver disease are exciting to you?

We’re seeing the biggest advancements right now in treating hepatitis C, which is the most common indication requiring transplantation. It’s an infection that’s still pretty hard to treat and cure; however, there are new agents being developed – currently in human trials – that will revolutionize hepatitis C care. And if more people get cured of hepatitis C, then fewer people will need an organ transplantation.

What is the benefit to patients in having liver intensive care specialists on hand?

Because of the organ shortage, patients are much sicker at the time they receive a transplant than 10 years ago. So it’s critical to have a group that specializes in the liver to care for these patients when they’re critically ill.

Our liver intensive care specialists see patients before and after transplant. It’s a huge advantage to have a team dedicated to getting our patients through, preparing them for transplant, and then seeing them after transplant.

To my knowledge, this doesn’t exist anywhere else in Texas and probably in very few centers in the United States.