Cedars-Sinai Posts Top Liver Transplant Survival Rates in California
Post-Surgery Care is Key to Good Outcomes, Say Transplant Experts
When 66-year-old Donna Terrell from Compton began suffering from aches and pains in the spring of 2005, she attributed it to stress from working long hours in the banking industry. But when she started vomiting blood, she realized something was seriously wrong.
The diagnosis, however, took her by surprise. Terrell had cryptogenic cirrhosis, an irreversible liver disease not related to any definable cause, such as alcoholism or hepatitis. A non-drinker who has never taken drugs or been tattooed, Terrell did not have any of the risk factors that could increase her risk of cirrhosis, or severe scarring of the liver.
Nevertheless, in June 2006, she found herself at Cedars-Sinai preparing for a liver transplant. On June 14, after an eight-hour surgery, "I woke up in the ICU and could hear the 'beep-beep-beep' of the machines," said Terrell. "I looked up at the night sky through the window and knew I was going to be OK."
She is not the only one. According to a recently released national report compiled by the Scientific Registry of Transplant Recipients (SRTR), the Cedars-Sinai Comprehensive Transplant Center's Liver Transplant Program had the best one-year survival outcome of all hospitals in California, with 96 percent of patients surviving beyond the one-year milestone. Kidney transplant and heart transplant patients also had excellent outcomes, with 97 percent of patients surviving past the one-year benchmark.
"These outcomes place Cedars-Sinai among the nation's best transplant programs," said Andrew Klein, MD, the Esther and Mark Schumann Chair in Surgery and Transplantation Medicine and director of the Cedars-Sinai Transplant Center. "Our ability to successfully transplant complex cases of severe liver disease is due, in large measure, to the multidisciplinary integrated care provided by experienced, technically excellent surgeons and anesthesiologists working with a comprehensive post-transplant team. Patient care does not end after the surgery; it is only beginning."
Our ability to successfully transplant complex cases of severe liver disease is due, in large measure, to the multidisciplinary integrated care provided by experienced, technically excellent surgeons and anesthesiologists working with a comprehensive post-transplant team. Patient care does not end after the surgery; it is only beginning.
The program's success is especially notable given the number of very ill patients undergoing transplants at Cedars-Sinai said Nicholas Nissen, MD, surgical director of liver transplantation at Cedars-Sinai.
"One of the most important aspects of our growth and success has been the constant focus on improving the management of patients with severe liver failure who have only a few weeks to live. Most of these patients are in the intensive care unit and will not leave the hospital alive unless they get a transplant,” Nissen said. “We have worked hard to create a system that patients, family members and referring doctors can trust, from the point of referral until they have a new liver and are safely home.”
When a patient receives an organ from someone else during transplant surgery, the patient’s immune system may recognize the organ as foreign and attempt to harm it. Even years later, this can lead to transplant rejection, which is one of the reasons why aftercare is so important.
At Cedars-Sinai, liver transplant patients benefit from specialized treatment teams, such as a multidisciplinary surgical intensive care team focused on liver disease and dedicated transplant social workers who follow patients from their initial referral through transplant hospitalization and for the rest of their lives. Other key teams include the Transfer Center, Advanced Practice Nursing, and the operating room support teams.
Also offered are in-patient and out-patient support groups and a buddy program, which pairs newly transplanted patients with others who have been through a similar experience and can help with guidance and reassurance.
To date in 2018, the team has completed 103 liver transplants, an increase in volume of almost 100 percent over the last three years. According the Nissen, a major factor in this growth has been efforts of a world-class team of hepatologists that have become known both regionally and nationally as problem solvers and fierce patient advocates.
Looking to the future, Nissen said projects underway include expanded efforts to reach out to underserved communities and increased efforts to meet the national donor organ shortage by salvaging livers that previously had been discarded. Studies have shown that healthy organs from deceased donors with HIV or hepatitis C could save lives of patients who could die waiting for a perfect organ. The team is also furthering research and developing new treatments for a wide range of liver diseases, including fatty liver disease, alcoholic liver disease and liver cancer.
The SRTR performs its assessments by analyzing the outcomes of patients who underwent transplant surgery during the preceding two-and-a-half years. This data is updated on the SRTR website every six months. The most recent SRTR data include outcomes for 144 patients who underwent liver transplants at Cedars-Sinai between January 1, 2015 to June 30, 2017, showing 96 percent one-year survival..
For Terrell, who has not been readmitted to Cedars-Sinai since the transplant 12 years ago, the support she received has been essential to her recovery, she said. Terrell still has blood work done every six months and a full check-up once a year to ensure the transplant continues to work well.
"I am where I am today because of the care and support I received from the Cedars-Sinai team," said Terrell. "My nurses and doctors became my family. They explained everything to me and they treated me like a person; not just a transplant recipient. If I needed to cry, they let me cry. Even today, before I take any medication, I contact the team to make sure it doesn't interact with my anti-rejection medicine. I trust them with my life."