Dr. Lynt Johnson: Liver Transplant and the Living Donor Program - [Video Transcription]
- How did the transplant program at GUH start?
The program at Georgetown began in 1998. The interesting thing about Georgetown is that Washington D.C. was really the only major city in the country that didn't have a major transplant program. Most major cities had one and sometimes two or three to serve the needs of the population. Washington D.C. was the last big city that didn't have one. We looked at this as an opportunity to come down and provide a needed service to the residents of the metropolitan area. We did so in 1998. We started with a very small contingent of folks. With the commitment from the hospital, the university, and MedStar we began. We have grown into one of the largest programs on the East Coast and the biggest program in the Mid-Atlantic area.
- In addition to being the only liver transplant program in DC, you also have a living donor program. How did that come about?
Currently, we perform well over 500 transplants. We are close to 550 transplants over the past 10 years. There have been a lot of exciting changes in the field. The biggest obstacle that we face is with all our organs is that we don't have enough donors. The largest pool of donors for livers come from deceased donors. Therefore in 2000, we began a living donor program. We were one of the first on the eastern seaboard to do so. We were the first in this immediate area to do so. We now utilize that as a means to help patients who are on a list who otherwise would have ordinarily probably died on the list if not for a living donor.
- What usually causes a person to need a liver transplant?
In the United States, the most common cause of end stage liver disease resulting in transplantation is hepatitis C. In 1990, there was not a test for hepatitis C. So, many patients contracted the virus from a number different of reasons. It included things like transfusion during surgery or during injury. Also, through contact with other individuals that may have had hepatitis C. Prior to 1990, there was not a way of testing it. So, many patients contracted it without knowing. It is an indolent disease. It takes about 20 years for the disease to progress to cirrhosis. Well over half of our patients require transplantation on that basis. We have other causes such as some autoimmune disease, primary biliary cirrhosis, primary sclerosis cholangitis, and hepatitis B can also be a cause for liver transplantation. As well, the more garden variety of patients that have alcohol as the cause of their end stage liver disease.
- If I am a patient in need of a transplant, what should I look for in a liver transplant program?
I think that first and foremost you have to have a core group of transplant surgeons who are well versed and experienced in liver resections alone setting this program up. We are fortunate to have four trained surgeons who are quite capable. In any given case, we will have two surgeons working on the donor side and two surgeons working in the recipient side. In addition, I was very much involved in setting up and standardizing how living donor operations are to take place across the country a few years ago. We have been able to utilize some of that information that was gathered at that time to how we structure our system here. Not only is the technical aspect worked out, but we also have an independent donor committee that is designed to evaluate and decide whether or not a donor is suitable or not to move ahead independent of the physicians involved in the transplant program.
- What is it about the transplant program at Georgetown that makes it different from other centers?
I think that the one thing that we do that is perhaps is different from a lot of transplant centers is that we have a patient centric program in the sense that all the individuals that participate in the transplant program do so under the umbrella of the transplant institute. We are all housed together. We are all under the same administrator structure. I think that this allows us to function more cohesively as a team which results in better care for the patients. We have surgeons, transplant hepatologists, critical care personnel, and anesthesia all under the same roof. I think that this allows us to be able to focus and concentrate on the patient as opposed to some programs where the individuals have different administrative responsibilities in different departments and don't really see the patient under one umbrella. I think that is what separates us.
- After my liver transplant, what kind of a recovery can I expect?
The first year after the transplant is usually the toughest. Patients can come in and out of the hospital with either infections or rejections. That is really the balance of the immunosuppressant medication that we give. We have to fine tune between not giving them so much that they have infections and not giving them too little that they end up with rejection. Usually after the first year, things really level out quite nicely. Most patients are down to one medication. Most patients can live a normal healthy lifestyle without any real true precautions and are physically able of doing really anything they are able to do prior to them becoming ill. The amount of time it takes for recovery depends upon how sick the patient is prior to the transplant. Patients that come in from home to receive a transplant typically stay in the hospital for about ten days. It is usually two to three months before they feel back to normal.
- If I am planning to become a living liver donor is there anything new to make my surgery easier?
Over time what became apparent is that if we could help to minimize the incision and the discomfort associated with this, we could benefit the donors. We have now been involved in a process where part of the operation is done laparscopically through small tiny incisions while watching the television monitors. The end of the operation is done through an open incision. The open incision is only about 4 to 6 inches in length. It doesn't divide any of the muscles that are attached to the ribs which is the biggest cause of pain and discomfort after the surgery.
- You did your 500th liver transplant back in September 2007. What does that milestone mean for the patient?
Over time what became apparent is that if we could help to minimize the incision and the discomfort associated with this, we could benefit the donors. We have now been involved in a process where part of the operation is done laparscopically through small tiny incisions while watching the television monitors. The end of the operation is done through an open incision. The open incision is only about 4 to 6 inches in length. It doesn't divide any of the muscles that are attached to the ribs which is the biggest cause of pain and discomfort after the surgery. One of the things that we know is that the more experienced the team is and the higher number of transplants that they have performed together improves outcomes. The milestone of reaching 500 transplants with the same core group of individuals really means that we are able to offer our patients a much more comprehensive and better outcome than centers that are doing fewer transplant a year or fewer over time. I think that certainly that is quite a feat to accomplish that in a fairly short period of time.
