Living-donor transplants target of study

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Gary Reilly and his brother-in-law, Paul Davis, have a special interest in a University of Pittsburgh Medical Center study of the surgical complications of living-donor liver transplants.

A year ago, Mr. Davis, of Nazareth, donated part of his liver to Mr. Reilly during companion surgeries at UPMC Montefiore.

Though grateful for the life-saving surgery, Mr. Reilly, of Beltzhoover says he hasn't bounced back as expected. Unable to work, he says he is frequently tired and nauseated, has trouble gaining weight and has had excess fluid drained from his chest. He'd like to know how many other recipients have had similar problems.

Mr. Davis, the donor, hopes the study will shed light on any long-term health effects he might expect from the surgery.

He said he currently has a hernia at the incision site and no feeling from his midsection to his groin. He wonders if the operation has affected his stamina, which "is not what it used to be."

UPMC disclosed the existence of the study following the surprise resignation last week of its transplantation chief, Dr. Amadeo Marcos, an expert in those transplants. UPMC officials emphasized that his decision to step down was unrelated to clinical or patient care issues.

Dr. Marcos, who was asked by UPMC to resign after violating the health system's code-of-conduct policy, reportedly plans to stay at UPMC until June. He has been unavailable for comment.

No interim successor has been named, said UPMC spokesman Paul Wood, who gave no details about a search for a permanent successor.

Mr. Wood also has given little information about the reasons for the study, except to say that enough living-donor transplants have been completed "to analyze in a meaningful way." The investigators, he said, include experts within and outside of UPMC.

Mr. Wood, who suggested the findings would "reaffirm the excellence of the program," gave no specifics about when the study began, whether it will address both recipients and donors, or when it might be finished. He said the medical center will not disclose the findings until they are published or released by a medical journal.

Living donors, often family members, can donate a portion of the liver, which can regenerate. Mr. Davis said he provided about 60 percent of his liver to his brother-in-law.

UPMC's 19 living-donor liver transplants were the third-highest among U.S. centers last year, not counting 14 at UPMC-owned Children's Hospital. In 2006, UPMC ranked first nationally in the donations with 36, with 10 occurring at Children's.

Nationwide, just 265 living-donor liver transplants occurred in 2007, compared to more than 6,200 involving deceased donors, according to the Organ Procurement and Transplantation Network.

Some centers have backed away from living-donor liver transplants, in part because of their complexity and the need for two surgical teams, said Dr. A. Joseph Tector, chief of transplantation at the Indiana University School of Medicine in Indianapolis.

Adult-to-child living-donor transplants pose less risk, he said, because a smaller portion of the donor's liver is required.

Dr. Byers Shaw, chairman of surgery at the University of Nebraska, said risks of adult-to-adult living-donor liver transplants may have been understated early on, "out of the typical band-wagon enthusiasm that attends the introduction of a new procedure."

To provide more information, a group of centers has conducted the Adult to Adult Living Donor Liver Transplantation Study, known as A2All. Findings published in 2005 in the Annals of Surgery indicated that 81 percent of the transplanted live-donor livers were still functioning at one year, which is comparable to the success rates for deceased-donor livers.

The most common causes of liver failure following live donor transplants were clots in the artery that supplies blood and oxygen to the transplanted liver, severe infection and failure of the liver for unknown reasons -- complications also seen in whole liver transplants from deceased donors.

In living-donor liver transplants, recipients are more likely than donors to have serious complications because they generally are in poorer health, said Dr. William Payne, surgical director of the liver transplant program at the University of Minnesota Medical Center, Fairview. Many complications are typical of major surgeries, he said, such as hernias, problems in wound healing, infection or fluid accumulation in the abdomen or chest.

Mr. Reilly, 56, said he felt the first signs of liver trouble in late 2006, when he thought he had a bad case of the flu. He went to UPMC South Side, then UPMC Montefiore, where doctors told him his liver "was really shot." Without a transplant, he was told, he didn't have long to live.

Mr. Davis, 50, said he had never heard of living-donor liver transplants until his brother-in-law fell ill. He was evaluated as a donor and was accepted.

Dr. Marcos was his surgeon, he said; Mr. Reilly said the transplant chief provided him with follow-up care.

After the March 7, 2007 surgery, Mr. Davis said he was in intensive care for five days and felt like he'd "been in a car wreck." But he was discharged from the hospital two days later. Two weeks after the surgery, the staples and drains were removed, and he was back at work in mid-April.

"It's not perfect and Gary has problems, but he's still alive a year later," Mr. Davis said.


Joe Fahy can be reached at jfahy@post-gazette.com or 412-263-1722.


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