Featured Physician

Mitchell Faddis, MD, PhD, was drawn to his specialty of cardiac electrophysiology by the demanding atmosphere of the cardiac intensive care unit.

See All Featured Physicians

Accepted Insurance

Top Stories

Text Size: S M L

International Health - Centers of Excellence: Living Donor Liver Transplantation

Overview

In the United States, just 5 percent of deceased donor transplants are available for international patients. That is why the new procedure of living related and living unrelated donor liver transplants performed in the U.S. may be ideal for international patients who need a liver transplant. Now from 10-20% of all liver transplants performed at Barnes-Jewish Hospital use living donors or are split-liver transplants.

Washington University transplant surgeons have been innovators of newer surgical techniques, including living-related segmental transplants and split-liver transplants that enable reduction hepatectomy of adult liver donor organs to be placed in even very small infants. The first lobar transplant in the U.S. from an adult to an adult was performed at Barnes Jewish Hospital in 1996.

Number of Procedures

More than 750 liver transplants have been performed at the Barnes-Jewish Hospital transplant program. The transplant program is part of a larger system. It is a full-service transplant program for both adults and children.

Barnes-Jewish Hospital's solid organ transplant programs have among the best outcomes of any center in the United States, according to the United Network for Organ Sharing (UNOS). Expertise in transplant candidate selection and management of the patient's illness during the wait for organs are additional factors in the transplant program's success.

Pediatric liver transplants, performed under the direction of Jeffrey Lowell, MD, have been performed at St. Louis Children's Hospital since 1985. More than 100 children ranging in age from 3 months to 15 years with all forms of end-stage liver diseases have successfully undergone liver transplantation at St. Louis Children's Hospital, including infants as small as 3 kg (9 lbs.).

Today the St. Louis Children's Hospital's liver transplant program is among the most successful in the United States, with survival rates of 95 percent at one, three and five years. The hospital's success has resulted in part from refinements in candidate selection and surgical techniques, which have led to a 45 percent reduction in length of stay over the last five years. The development of anti-rejection medications that can be used when traditional drugs are not effective has contributed to the programs overall success as well.

Specialized Services

In an adult-to-adult living donor liver transplant, surgeons take the right portion of the donor's liver (about 60 percent of the total liver volume) and transplant it into the recipient, after their diseased liver is removed. In about 12 weeks, the liver regenerates in the both donor and recipient. Most patients are in the hospital for about a week.

Living donor transplantation allows a child to receive a portion of a healthy adult relative's liver. This procedure has revolutionized transplantation, allowing children to survive in circumstances that would have been fatal not long ago.

Key Physicians

William Chapman, M.D., an accomplished and expert surgeon, directs the Transplant Program at Barnes-Jewish Hospital. The transplant team at Barnes-Jewish Hospital has the longest history of doing living donor liver transplants in the country.

Jeffrey Lowell, M.D.
Maurico Lisker-Melman, M.D.
Kevin Korenblat, M.D.
Jeffrey Crippin, M.D.
Will Chapman, M.D.
Surendra Shenoy, M.D.

Best Candidates

Candidates for living related and unrelated donor transplant include those with end-stage liver disease. At least half of pediatric liver transplants at Washington University are from living donors. There is no advantage of tissue typing for living related or unrelated donors. An unrelated living donor transplant has the same success rates as a related living donor transplant. The risk to the donor is minimal.

Donor criteria:
• Age 18 or older
• Can be a relative or unrelated
• Good physical and mental health
• Blood group compatible
• Successful screening tests

Advantages

Living donor transplants have several advantages over cadaver donor transplants. First, the surgery can be scheduled and done when the recipient is healthier. In addition, the donor is known to be healthy and the team knows the donor's complete medical history. Ischemia time is also much shorter with a living donor transplant.

How to Proceed

The process of arranging for a possible living donor liver transplant is not difficult. Patients do not need to come to St. Louis for an initial evaluation. Instead, a transplant coordinator gathers all necessary information and medical records. Physicians perform a streamlined evaluation through the patients' medical records first.

International Referrals

International Health - Centers of Excellence: Aneurysms