Lehigh Valley Institute for Surgical Excellence at Lehigh Valley Health Network, part of Jefferson Health, has added liver transplant services to its already successful kidney and pancreas transplant program.

LVHN has recruited top surgeons, transplant hepatologists and gastroenterologists to lead the new program, including surgeon George Rofaiel, MD, Chief, Surgical Transplantation, and hepatologist Shahid Malik, MD, Medical Director, Transplant Hepatology, both with LVPG Transplant Surgery.

The first of its kind in the region, the program will offer transplantation to patients with end-stage liver disease, acute liver failure and liver tumors. The program is bolstered by Jefferson’s resources, including access to necessary tools and services and cross-training with Jefferson’s liver transplant experts.

“This is a major development for the Lehigh Valley. It takes a large organization to build and sustain a liver transplant program and the support from Jefferson has helped make this possible,” says Michael Pasquale, MD, Physician in Chief, Lehigh Valley Institute for Surgical Excellence and System Chief, Jefferson Health Perioperative Services.

“There is a strong need for dedicated liver transplant services in this population. Our existing transplant program has doubled in just the last year and a half, and we continue to expand. We’re offering more services and are transplanting more patients, so they have the chance to go on to thrive.”

The liver transplant program has been almost 10 years in the making and comprises “hundreds of people hours.” It has required the skills and coordination of professionals from all levels of LVHN, as well as extensive education and training on the part of the nursing and administrative staff.

The program will use livers from deceased donors, which make up 85-90 percent of liver donations nationwide. According to Dr. Rofaiel, the team will not be performing liver transplants from live donors at this time.

Eligible candidates for the surgery will undergo extensive testing from multiple specialties including social work and psychology.

This is necessary to make sure patients are medically and physically fit to undergo the lengthy transplant procedure and have the support system necessary for recovery afterward.

“I always say it takes 500 people to do a transplant,” says Dr. Rofaiel, who notes the operation takes a lot of patience and a lot of skill. “It is a major disruption of the body, even affecting circulation to the heart and brain. We have about a dozen people at every operation, including two surgeons performing the transplant, along with anesthesiologists, perfusionists, dialysis nurses and cardiologists.

Afterward, there are pharmacists, dietitians, social workers, rehabilitation specialists and coordinators involved. Liver transplant doesn’t just take a village, it takes a sizable village.”

Patients are considered for a liver transplant after referral from a hepatologist or through self-referral.

They may also be accepted through emergency departments and hospitals in the region if the situation calls for emergent evaluation. Mostly, transplants are only discussed when the patient has a very high risk of succumbing to their illness in six months to a year.

If the patient is a candidate, tests are taken for blood type and a myriad of laboratory testing and imaging will be performed. These tests result in a Model for End-Stage Liver Disease score that estimates each patient’s chances of surviving their disease during the next three months. Organ allocation is determined by the Organ Procurement and Transplantation Network. Livers from deceased donors are allocated first to the sickest patients (those with the highest MELD score).

One of the challenges of liver transplantation long has been the availability of healthy livers and keeping them viable long enough to be useful.

“The number of patients diagnosed with liver disease keeps growing while the number of donors has flatlined,” says Dr. Malik. “We are also selective. Once we have a healthy one, it’s a race against time since livers are only viable between six to 12 hours.”

LVHN is preparing to add normothermic machine perfusion as a tool in the preservation of livers before transplantation. NMP, or “liver pump,” refers to the technique of preserving organs during the transplantation process with circulating perfusate that mimics blood flow. This technology can extend the life of a liver by many more hours, which means the program would be able to accept livers from farther away, increasing the donor pool.

Once patients have had a liver transplant operation, they continue to be monitored for their lifetime by Dr. Malik and his team. In many cases, people go on to live healthy, productive lives with a liver lasting as long as 25 years.

“Liver transplant is truly one of the miracles of medicine,” Dr. Malik says. “Many of these patients are on death’s door. With a transplant, they get a new lease on life.”