Health information, patient stories, and research updates for the Columbia University Department of Surgery.
In an unexpected twist of fate, the death of a star athlete saves the life of his former baseball coach. Read the full story of how a young man’s tragedy provided life-saving organs not only for his coach but 50 organ recipients at NewYork-Presbyterian/Columbia.
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The December 2011 edition of the Manhattan Times featured two CLDT patients, Jeff Isaacs and Tony Herrera, in Celebrating the Gift of Life, One Transplant at a Time. Both had been severely ill with end-stage liver disease, but went on to receive liver transplants at NYP/Columbia: Isaacs received a deceased donor organ, and Herrera received a living donor liver from his son. Read the inspiring story of how transplantation not only treated their diseases, but completely transformed their lives.
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Organ transplantation may be the most intense journey that a family ever experiences, complete with daunting challenges and the joys of triumph. On the Facebook site of the Center for Liver Disease and Transplantation, many organ donors and recipients have shared the stories of their struggles so that others will know what to expect and that they are not alone.
One such story is that of Kevin Martinsen, who received a living donor liver from his brother Daniel. Read how Kevin and Daniel share their moving stories in their own words.
So Many Roads, Ease My Soul: A Story of Living-Liver Transplantation
Kevin Martinsen
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NewYork-Presbyterian Hospital has a distinguished track record for liver transplantation and features a team of world renowned leaders in the field. The Center for Liver Disease and Transplantation offers a seamless integration of medical, surgical, radiological, and support services — using both deceased and living donor liver tissue, and minimally invasive laparoscopic techniques whenever possible.
Founded in 1998, the Center for Liver Disease and Transplantation at NewYork-Presbyterian Hospital/Columbia University Medical Center is one of the first liver programs built from its inception as a multidisciplinary unit. As of July 2011, the Center had performed more than 1,400 liver transplants, including over 200 living donor transplants. NewYork-Presbyterian Hospital/Weill Cornell Medical Center’s strong hepatobiliary program was bolstered by the addition of adult liver transplantation to its services in 2010.
Together these programs provide compassionate, individualized care to a wide variety of patients, combining exceptional care with the most innovative approaches for expanding access to liver transplantation to reduce the mortality of patients on the waiting list.
Alyson Fox, MD, NewYork-Presbyterian/ Weill Cornell Medical Center
Alyson Fox, MD
Dr. Alyson Fox earned her BA in Public Health at the Johns Hopkins University prior to attending the Mount Sinai School of Medicine. She completed her residency in Internal Medicine at NY Presbyterian Weill Cornell Medical Center, where she served as assistant chief resident. She completed her Gastroenterology fellowship at the University of Pennsylvania. While at Penn, she completed a Masters in Clinical Epidemiology and served as chief fellow. She completed her advanced fellowship training in Advanced Transplant Hepatology at the University of California, San Francisco and was named clinical fellow of the year by the department of medicine.
Dr. Fox’s clinical practice is focused on the management of patients with a variety of liver diseases including viral hepatitis, alcoholic and non alcoholic fatty liver diseases, inherited liver diseases and liver cancers. As a transplant hepatologist, she has advanced training in the management of end stage liver disease and caring for patients both pre and post liver transplantation. Her research area is focused on issues related to organ allocation and complications of portal hypertension.
Elizabeth Verna, MD, NewYork-Presbyterian/ Columbia University Medical Center
Elizabeth Verna, MD
Dr. Elizabeth Verna, Assistant Professor of Medicine, earned her BA in Biology at the University of Virginia prior to attending the Columbia University College of Physicians and Surgeons for medical school. She completed her Internal Medicine residency at Columbia Presbyterian Hospital and then served as a Chief Resident before remaining at Columbia for Gastroenterology and Advanced/Transplant Hepatology fellowships.
While in fellowship, she also completed a Masters in Biostatistics at the Columbia University Mailman School of Public Health.
Dr. Verna’s clinical practice includes the management of patients with a variety of liver diseases with a focus on viral hepatitis and liver transplantation as well as the new emerging therapies for hepatitis C. She treats patients with liver cancer, alcoholic and non-alcoholic fatty liver disease and metabolic liver diseases and has expertise in the management of end stage liver disease. She has an active research program with grant support for the study of hepatitis C in liver transplant recipients and will be actively involved in clinical trials for the treatment of hepatitis C in both the transplant and non-transplant settings.
Julia Wattacheril, MD, NewYork-Presbyterian/ Columbia University Medical Center
Julia Wattacheril, MD
Dr. Julia Wattacheril graduated magna cum laude from Brandeis University in Waltham, Massachusetts, obtained her MD with high honors from Baylor College of Medicine, did her internal medicine training at the Baylor College of Medicine in Houston, Texas and pursued her fellowship in gastroenterology, hepatology and nutrition as well as her Masters in Public Health at Vanderbilt University School of Medicine. She joined us last year for her training in transplant hepatology while maintaining an adjunct faculty appointment at Vanderbilt.
Her clinical interests include all aspects of transplant hepatology, general hepatology and gastroenterology with emphasis on metabolic liver disease and obesity. She specializes in nonalcoholic fatty liver disease as well as all forms of hepatitis, chronic liver disease, and liver cancer in addition to liver transplantation. Her research interests focus on hepatic steatosis, insulin resistance and metabolic liver disease in adults. Her current grant concentrates on the proteins and lipids that signal the transition from steatosis to steatohepatitis.
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When Brad Shwidock needed a liver transplant due to primary sclerosing cholangitis, his wife, Carol, was not only eager to donate, but was a good match. The successful living donor transplantation took place at NewYork-Presbyterian/Columbia September 13, 2011.
Living donor liver transplantation is considered one of the most important advances in the treatment of severe liver disease. By improving access to transplantation, living donor transplantation significantly reduces patients’ risk of dying while on the organ donation waitlist. At the Living Donor Liver Transplant program at New York Presbyterian Hospital, which is one of the largest living donor liver programs in North America, approximately 15-20% of the center’s transplant patients currently receive a liver from a living donor.
Read the Shwidock’s story as reported by the couple’s local paper, The Hour Online.
Learn more about living donor liver transplantation at livermd.org or by calling 1.877.LIVERMD (1.877.548.3763).
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Robert S. Brown, Jr., MD, MPH
In this editorial, Dr. Brown addresses the difficult questions surrounding how to fairly allocate donor organs, which are in far shorter supply than their demand. In the case of patients with alcoholic hepatitis, current guidelines exclude such patients from the liver transplant waiting list unless they have successfully abstained from alcohol for at least six months. Yet as Dr. Brown points out, many die before this required, albeit arbitrary, window elapses. And a new study indicates that if they are permitted to receive liver transplants, such patients may do at least as as well as, if not better than, some other patients who receive transplants far more often.
As Dr. Brown explains in this editorial, the typical recidivism rate among alcoholics is approximately 30%. Yet organs are regularly allocated to patients with hepatitis C, who have a 100% disease recurrence rate, and a much higher rate of graft failure than those with alcoholic hepatitis, at five years. A study by Mathurin et al in this issue found that carefully selected patients with alcoholic hepatitis experienced a 77% survival rate after liver transplantation at six months, and a recidivism rate of 11.5%. Based on these encouraging results, Dr. Brown writes, “…this study highlights the need to rethink our approach to transplantation for alcoholic liver disease, including applying better rules for selecting patients who are at low risk for recidivism that can be applied in a uniform and fair way.”
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When Megan Ellerd and Steven Ferretti met seven years ago, it was “instant love,” she says. Not long after, the young couple found out that Steven had autoimmune hepatitis — but they didn’t worry too much about it, hoping that it wouldn’t affect them until much later in life. In 2008, however, the two were happily engaged when Steven’s condition suddenly took a turn for the worse. His liver was failing, and he needed a transplant.
Although Steven had severe liver disease and was experiencing painful symptoms such as ascites (fluid buildup in the abdomen), he would have had to become deathly ill in order to qualify for a donor organ from the transplant waiting list. For a couple with a wedding to plan and a bright future ahead, the prospect of Steven spending many months, if not years, in progressively worsening health was just not an option. For Megan, the choice was clear. She had known from the beginning that she would donate part of her liver to him if she could — and when testing confirmed she was a good match, that’s exactly what she did.
Steven Ferretti and Megan Ellerd
On January 6, 2011, the team at the NewYork-Presbyterian/Columbia Liver Transplant Program transplanted Megan’s left lobe to Steven, an operation that not only saved his life, but spared him the ordeal of becoming even sicker while waiting for a liver from the organ donor waitlist. Benjamin Samstein, MD, Surgical Director of the Liver Transplant Program, and Lorna Dove, MD, MPH, Medical Director of Adult Liver Transplantation, are happy to report that the transplantation was a success, and that Steven and Megan have both made excellent recoveries.
Both Steven and Megan have been transformed by the experience; they speak of their gratitude for the support they received from their loving families, and of a newfound appreciation for life. Thanks to the team at Columbia, and to each other, they’re now thinking of having kids and possibly starting a new business. Whatever they decide, they’re fortunate to be able to do it in good health, and together.
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American Transplant Congress
Presentation 1: Excellent Outcomes of Machine Preservation of “Orphan” Extended Criteria Liver Allografts: Interim Results of a Phase 2 Trial;.
James V. Guarrera, Benjamin Samstein, Scot D. Henry, Claudia Musat, Charlotte Fisher, Theresa Lukose, Tomoaki Kato, Jean C. Emond. Division of Abdominal Organ Transplantation.
Between the time a liver is retrieved from a donor and transplanted into the recipient, it must be very carefully preserved in order to maintain optimal function. An approach known as cold storage (CS), essentially keeping the organ on ice during transport, has been the standard practice in liver transplant for 20 years. Now there is new evidence that a technique called hypothermic machine perfusion (HMP) outperforms standard preservation, according to the first-ever study comparing the impact of the two techniques on transplant outcomes. The phase I study was carried out by Dr. James Guarrera and his colleagues at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Unlike cold storage, which Dr. Guarrera describes as a static technique, HMP dynamically simulates “aliveness” by providing a continuous flow of oxygen and key nutrients to the liver while diluting and removing toxins and waste products. In his presentation to the American Transplant Congress in May 2011, Dr. Guarrera reported that HMP reduced injury to donor organs effectively enough that organs declined elsewhere for transplantation could be preserved well enough to function successfully after transplantation. Of 15 ‘extended criteria’ livers preserved using HMP in this study, all had good function after transplantation. Fourteen patients were alive and well at the time of presentation, and one patient had died due to multidrug resistant Klebsiella sepsis.
Watch for ATS Presentations 2 and 3 later this month at columbiasurgery.net.
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New York Times article highlights transplant donor and recipients at New York-Presbyterian Hospital
UK NHS Organ Donation Checkbox
As organ transplantation has advanced and improved in recent decades, more and more patients’ lives are saved every year. But the most pressing problem in organ transplantation has yet to be solved: the shortage of donor organs available to the thousands of people waiting on lists for a new kidney, liver, lung, heart, or other organ. People who intend to donate may not indicate their wishes to family members before their death, or families are reluctant to make that decision in the midst of profound grief and loss. For others, donating an organ was just never something they knew much about or even considered.
When they do choose to donate a loved one’s organs, families usually remain anonymous, as do those whose lives they save. Perhaps that is why articles like the one in the New York Times on May 16, 2011, touch and inspire readers so deeply. This version of an increasingly common story captures the essential soul-searching, as well as the profound gratitude, hope, and solace, that marked the meeting of Mirtala Garcia and the people who received her husband’s organs.
After his sudden death by a brain hemorrhage, transplant surgeons at NewYork-Presbyterian Hospital transplanted Julio Garcia’s heart, both kidneys, pancreas, liver (divided to save one adult and one child), one lung, and his corneas — saving seven lives and restoring sight to another.
Read the full story: One Death Provides New Life for Many.
NewYork-Presbyterian Hospital/Columbia University Medical Center is one of the nation’s foremost centers for transplantation of the heart, lung, kidney, pancreas, liver, and abdominal organs. For information, visit www.columbiasurgery.org and see Surgical Specialties.
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NYP/Columbia and NYP/Weill Cornell Outreach Program Educates New York Immigrants about Hepatitis B
Hepatitis B is one of the world’s most serious healthcare issues. This chronic infection can cause cirrhosis of the liver and liver cancer. Common in Asia, eastern Europe, Africa, and the Caribbean, hepatitis B infection is most prevalent in Asia. With a large immigrant population from Asia now residing in the U.S., hepatitis B has become a significant health issue in the U.S. as well. At this time, over 10% of New York City’s population is Asian.
When treated properly, the prognosis of people with chronic hepatitis B is generally good. Even patients who develop cirrhosis or liver cancer along with hepatitis B can expect to fare well in the long-term when the infection is detected and treated early. However, if the disease is diagnosed too late or left untreated, patients may die at a young age. The Center for Liver Disease and Transplantation (CLDT) treats many people with chronic hepatitis B infection, some of whom were previously unaware they had hepatitis B or who had been misinformed by other healthcare providers about the disease.
Prevalence of chronic infection with hepatitis B virus, 2006. (CDC)
To raise awareness about hepatitis B and encourage Asian immigrants to seek treatment, liver surgeons at CLDT are conducting outreach events with high school students as part of a program called Health and Education for Asian Livers, or H+EAL. According to Tomoaki Kato, MD, Chief, Division of Abdominal Organ Transplant, and Surgical Director, Liver and Gastrointestinal Transplantation, who initiated the outreach effort, “Because of language and cultural barriers, it is very difficult to reach first-generation immigrants to teach them about health issues such as hepatitis B. But their children tend to be well-educated and, of course, fluent in English. We believe that targeting the offspring generation is the best way to reach the first generation immigrant. If high school students are told they can be a life-saver for their family, they will tell their family about it.”
Together with medical students at NewYork-Presbyterian Hospital, Dr. Kato has developed educational presentations and has spoken at Hunter College High School, Bronx Science High School, and others in the New York metropolitan area. Other leaders of the outreach program include Arlene Loh, patient advocate, and Maya Gambarin, MD, hepatologist at NewYork-Presbyterian/Weill Cornell.
For information about hepatitis B and the CLDT, please visit livermd.org.
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