UPMC Susquehanna opens liver transplant clinic

With the opening of a liver transplant clinic at UPMC Susquehanna, patients in this region in need of a transplant will be able to receive their initial evaluations at the local hospital rather than travelling to Pittsburgh.

“We just thought for patients in this area and in some of the rural areas, we need to bring our legacy to your backyard and if they’re not able to come to Oakland (a neighborhood in Pittsburgh), we have to bring our center to you,” said Dr. Swaytha Ganesh, medical director, UPMC Living Donor Program at the Thomas E. Starzl Transplantation Institute, Pittsburgh.

“Every patient who needs a liver transplant has to undergo a process called liver transplant evaluation. Once they undergo a liver transplant evaluation they get listed. Once they get listed, the way the organs are allocated to them is based on a score which is assigned to each patient called a MELD (Model For End-Stage Liver Disease) score,” she added.

The MELD score goes from 6 to 40, with the lower scores supposed to be representing patients that are less sick, although Ganesh indicated that isn’t always the case. She estimated that 30 to 35 percent of the patients on the transplant wait list are much sicker than their scores represent.

“Unfortunately 25 percent of the people on the wait list either succumb to their disease or they do not have an opportunity to get a transplant because they are either too sick or they die on the waitlist,” she said.

Ganesh noted that 17,000 people are on the transplant waitlist and around 3,000 transplants are performed each year.

“A very small proportion of patients get transplants,” she said. “For those people the safest, best option is to offer a living donor transplant.”

The liver transplant clinic here will be the only living donor evaluation clinic in the area.

“It’s going to be a unique living donor clinic and not just a liver transplant clinic. We are going to introduce the concept of living donor to every single patient in the clinic,” Ganesh said.

Once it is determined during the evaluation phase that a patient needs a transplant, which usually takes two to three days, the concept of living donor transplants is introduced. Usually by the third session, Ganesh noted, patients already have living donors in mind.

The reason why anyone can donate a liver when they are alive is that the liver has the unique ability to regenerate.

During the process, the surgeon removes 25 to 65 percent of the donor’s healthy liver. The recipient’s unhealthy liver is replaced with a portion of the donor’s healthy liver. Ganesh noted that a donor’s liver takes approximately 10 to 12 weeks to regenerate, but in the recipient, due to their poor health to start, it takes a little longer.

Living donors do not have to be related to the recipient, Ganesh said.

“We have a great program called the living donor champion program, “she said. “We introduce the program because we want to take the burden off the recipient in finding a donor for themselves. We ask the recipient to find a champion in their support system then that champion advocated for the recipient in finding a donor.”

Ganesh said in the last year alone more than 40 percent of the donors who came forward were non-biologically related to the recipient.

“It shows us that people want to help. It’s more gratifying to give than receive,” she said.

Pre-liver transplant evaluation services available at UPMC Susquehanna will be imaging scans, blood tests, radiology, diagnostic testing, consults and exams as well as ongoing education. Patients with chronic liver disease will be managed here by Dr. Puneet Basi, a specialist in gastroenterology and hepatology, and then they will be referred, if needed, to Ganesh’s program. All long-term follow-up care after surgery will be with Basi.

Although there are other living donor transplant centers in the state, the biggest is at UPMC in Pittsburgh, Ganesh noted.

“The only reason we mention it is not to say, ‘oh we are the biggest in the country.’ It’s not at all for that,” she said. “The reason why we say that is that you know as we all know when we do more numbers, we get more experienced. That’s not only the surgeons, we have a phenomenal team, from the surgeons, the hepatologists, the social workers, pharmacy, nutrition, coordinators everyone.”

“When you are experienced at something, you get best at it,” she added.