UNMC Surgeons Perform First Adult Living-Related Liver
Transplant in Nebraska
University of Nebraska Medical Center surgeons recently performed the
first adult-to-adult living donor liver transplant in Nebraska. The procedure
is a potentially a life-saving alternative to patients on the national
United Network for Organ Sharing (UNOS) liver transplant waiting list.
On Feb. 28, Tim Seitz, a 33-year-old Westminster, Colo., man donated
a portion of his liver to his mother, Kathleen Seitz of Phillips, Neb.
The surgery was done in Nebraska Health Systems University Hospital, located
on the UNMC campus in Omaha.
Normally, patients with liver disease wait months to years for a cadaveric
liver to become available. If an organ does not become available in time,
the patient will die from progressive liver failure. In 1998, the number
of deaths in potential recipients on the liver transplant waiting list
in the United States reached an all time high of 1,319 an increase of nearly
20 percent over the previous year.
With a living donor, surgeons can choose the time of transplantation
so that the recipient is in optimal condition, said UNMC Transplant Surgeon
Debra Sudan, M.D.
Its amazing, Kathleen Seitz said. I gave him life, and now he has
given it back to me.
Kathleen had been on the waiting list since April 1999 as a status 2B,
which is the highest category of those not in critical condition. Kathleen
has primary biliary cirrhosis, a liver disorder that results in damage
to the liver and the bile ducts. Its cause is unknown.
Last year I was getting sicker and more tired and wondered how sick
I would get before I got the transplant, she said.
Her children told her about the possibility of a living donor. They
believed it was the right thing to do and approached UNMC physicians.
Physicians found that two of Kathleen and Tony Seitz four sons and
one of Kathleens sisters had matching blood types, which made them possible
donor candidates. Dr. Sudan determined that Tim was the best candidate
based on the size of his liver. She said the surgery was important for
many reasons.
Kathleens liver disease had advanced rapidly over the three to six
months prior to her transplant and she was expected to have an additional
waiting time of nine to 18 months, Dr. Sudan said. By performing a living
donor transplant Kathleen was spared from waiting for a cadaveric liver
and the inevitable further decline in her health during those months or
years while she waited.
About 200 to 300 living related liver transplant procedures have been
performed in adult recipients worldwide, she said. In the United States,
surgeons began trying the procedure about two years ago. Since the early
1990s about 3,000 transplants have been done worldwide where an adult
shares their liver with a child.
Many of the transplants have been done in Asia where culturally, and
in some cases legally, cadaveric organ transplantation was not an option.
Due to the availability of cadaveric liver transplantation, only about
70 living-donor operations on pediatric recipients have been performed
each year since UNOS began collecting data in 1990. UNMC surgeons have
performed approximately 45 of these procedures.
During the procedure, surgeons divided the right side of Tims liver
from the left while blood was flowing through both segments. Once the tissue
was divided, the vessels were clamped and the right side was removed and
placed on ice.
This is a large operation being performed on a person who does not
personally benefit in terms of his own health status, Dr. Sudan said.
That makes it a large burden for surgeons who must choose donors who have
a low risk of complications from the operation.
For Kathleen, the surgery lasted about six hours. Her liver was removed
completely, and Tims liver was put in place.
Were very thankful to Dr. Sudan and the team. After being with the
team, they inspired a lot of confidence in us. These people are some of
the best in the nation, said Tim, a lawyer from the Denver area who specializes
in international tax, merges and acquisitions. He and his wife, Jodi, have
four children. Tim is the oldest of Kathleens eight children, four sons
and four daughters.
The liver is an organ that regenerates itself and it grows back rapidly.
In a short period of time, anywhere from seven days to six weeks, the donor
and recipient livers will increase to approximately the full normal size
of the whole liver prior to surgery, Dr. Sudan said.
For the recipient the risks are not very different than transplantation
with a whole cadaveric liver, Dr. Sudan said. The availability of living
donors can increase the number of recipients who are able to be transplanted.
Hopefully we can offer it to other families, especially those whove waited
a long time on the list.
The introduction of living donor liver transplantation for adult recipients
is expected to have an even greater impact on liver transplantation than
in children. Children only make up five to 10 percent of the patients waiting
for transplant and more than 13,000 of the 14,722 individuals currently
on the waiting list are adults. The current number of recipients on the
waiting list is more than three times the total number of liver transplants
done in the United States last year.
UNMC is the only public academic health science center in the state.
Through its commitment to research, education, outreach and patient care,
UNMC has established itself as one of the countrys leading centers for
cancer research and treatment, solid organ transplantation and arthritis.
During the past year, nearly $31 million in research grants and contracts
were awarded to UNMC scientists, and UNMCs funding from the National Institutes
of Health increased by 28 percent, going from $16.2 million to $20.7 million.
UNMCs educational programs are responsible for training more health professionals
practicing in Nebraska than any other institution.