Liver Transplant Programs - Adult

Since its inception in 1985, more than 1,610 patients have undergone liver transplantation at the University of Michigan Hospital. During calendar year 2008, a total of 92 liver transplants were performed involving 90 adult and 2 pediatric recipients. Patients transplanted at the University of Michigan are jointly managed by dedicated Transplant Surgeons and Medical Liver Specialists that are referred to as "Transplant Hepatologists" in conjunction with their support staff. All members of the team including nurses, coordinators, clerks, and social workers have advanced training and expertise in liver disease and liver transplantation. Liver transplant candidates and recipients are assigned to an individual nurse-physician team who oversee the medical care provided in our outpatient clinics. The Transplant team interacts daily with physicians and staff members in Pathology, Radiology, Cardiology, and other subspecialty services to provide expert, timely, and coordinated care for each of our patients.

Our center offers many unique treatment options for patients with liver disease. We have performed adult to child living donor liver transplantation since 1996 and reduced size liver transplantation ("splits") since 1988. We currently consider living donor liver transplantation for children and small adults that are too ill to wait for a deceased donor graft. We also offer an artificial liver therapy that is available at only a few hospitals in the world. This treatment, called albumin dialysis wherein circulating toxins are removed from the body using a dialysis machine is currently reserved for patients with severe liver failure that may have only a few days to live. For patients with liver cancer, both percutaneous and intraoperative radiofrequency ablation (RFA) treatment modalities are available as well as chemoembolization and surgical resection. For patients with complications of cirrhosis including internal bleeding or ascites, a Transjugular Intrahepatic Portosystemic Shunt (TIPS) device can be placed to treat the immediate problem and serve as a bridge to transplantation.

The liver transplant program at the University of Michigan includes an inpatient Medical Hepatology and an inpatient Transplant Surgery service. The inpatient Medical Hepatology service consists of medical residents, students, fellows, and physician assistants who provide high quality care to patients with varying forms of liver disease both pre and post-transplant under the supervision of a Transplant Hepatologist. Many inpatients are evaluated for possible transplantation or undergo treatment for complications of liver failure. The inpatient Transplant Surgery service includes a team of physician assistants, medical students, residents, and fellow trainees under the supervision of a Transplant Surgeon. All surgical procedures and immediate post-operative care is provided by this team in specialized surgical wards either in the main University Hospital for adults or in Mott's Children Hospital for pediatric patients. A Transplant pharmacist with expertise in immunosuppressive drugs is also available to provide consultative services for all inpatients.

A dedicated team of nurse coordinators, physician assistants, social workers, and dieticians work in conjunction with the Transplant Hepatologists and Surgeons to provide high quality and patient centered care to all of our liver transplant candidates and recipients. Currently, adult liver transplant clinics are held every Monday and Friday morning in the Taubman Center. Liver transplant candidates and patients awaiting transplantation are principally cared for by the Transplant Hepatologists in these clinics. Once a diagnosis and treatment plan has been devised, these patients are seen back on a regular basis to optimize their liver disease and medical status pre-transplant. Recent liver transplant recipients are seen for post-operative care by the Transplant Surgeons for 3 to 6 months. When stable, liver transplant recipients return to the care of their previous Transplant Hepatologist for long-term management. Educational, financial, and psychological support services are available to all of our patients in the clinic as well as in the hospital. Pediatric liver transplant candidates and recipients are seen in a separate clinic located in the outpatient area of Mott that is staffed by a smaller group of nurses, social workers, and physicians once a week.

The TACU was opened on the 5B ward of the University Hospital in 1996 to meet the growing and unique ambulatory care needs of our transplant candidates and recipients. The TACU is an 8 bed outpatient facility wherein medications and blood products can be infused and minor outpatient procedures can be performed. The unit is staffed 7 days a week by experienced nursing staff and provides a pleasant setting for various outpatient treatments.

In addition to their busy clinical practices, the Transplant Surgeons and Hepatologists are also involved in various research initiatives. In fact, the liver transplant program faculty are regional, national, and international leaders in their various fields of endeavor. Currently there are active research protocols for patients with Hepatitis B and Hepatitis C infection both before and after liver transplantation. In addition, our center continues to be involved in a variety of immunosuppressive and antibiotic studies and protocols. These studies are completely optional and voluntary - patients will receive the same level of care regardless of whether they enroll in scientific studies. However, in many cases these studies offer patients the opportunity to receive "tomorrow's treatments today", so quite a few of our patients take advantage of this opportunity.

We are currently involved in a study sponsored by the National Institutes of Health aiming to produce "immunological tolerance" in liver transplant recipients. Currently all patients that receive transplants must take drugs that suppress their immune system to prevent rejection of the transplanted organ. Immunological tolerance would mean that chronic immune suppression may not be necessary. While tolerance can now be routinely induced in laboratory animals, spontaneous tolerance is rare in humans. The entire Transplant community anxiously awaits the results of this trial as immunosuppressive drugs are not only costly, but cause numerous side effects as well as increased susceptibility to infection.