{"id":73,"date":"2015-09-28T19:38:15","date_gmt":"2015-09-28T19:38:15","guid":{"rendered":"http:\/\/emu.edu\/now\/ma-biomedicine\/?p=73"},"modified":"2015-09-28T19:38:15","modified_gmt":"2015-09-28T19:38:15","slug":"suter-science-seminar-a-liver-transplant-journey","status":"publish","type":"post","link":"https:\/\/emu.edu\/now\/ma-biomedicine\/2015\/09\/28\/suter-science-seminar-a-liver-transplant-journey\/","title":{"rendered":"Suter Science Seminar: A Liver Transplant Journey"},"content":{"rendered":"

EMU had the pleasure of hosting a Suter Science Seminar by Dr.Scott Matherly<\/a> on September 11,2015. \u00a0He is a transplant Hepatologist\u00a0as well as an Assistant Professor of Medicine in Internal Medicine \u00a0in the Gastroenterology department\u00a0at Virginia Commonwealth University in Richmond,VA. Dr.Matherly completed his residency in Internal Medicine at Johns Hopkins University.<\/p>\n

Before beginning the journey, Dr.Matherly pointed out that he is not a surgeon but instead he is the physician who keeps a patient alive pre and post transplantation.<\/p>\n

The journey begins with a 29 year old female who has Glycogen Storage Disease Type 3. \u00a0She was later diagnosed with cirrhosis of the liver as well as\u00a0ascites. \u00a0 Due to the stage of her cirrhosis, she was recommended to undergo a liver transplant. \u00a0Dr.Matherly defines cirrhosis as “the liver accumulated so much scar tissue and no longer functions.” \u00a0 He showed us anatomical and pathological slides of this disease. \u00a0In the slides, one can see an increase in lymphocytes, which is a telltale sign of inflammation. \u00a0 In cirrhosis patients, the inflammation becomes scar tissue.<\/p>\n

The second part of the journey involved the etiology and consequences of cirrhosis. \u00a0 Dr.Matherly discussed eight factors that cause cirrhosis. \u00a0He states that 36% of cases are due to Hepatitis C, 15% of cases are due to Hepatitis and Alcohol consumption, Alcohol consumption causes 14%, Fatty Acid disease contributes to 9% of cases, Cryptogenesis is 9% of cases, Primary Biliary Cirrhosis(PBC)\/Primary Sclerosing Cholangitis(PSC) causes 8% of cases, while Autoimmunity causes 5% of cases and Hepatitis B causes 4% of cases. \u00a0He states that alcohol consumption, Hepatitis, and autoimmunity stimulate cirrhosis. These percentages are from the year 2005. \u00a0However, present day, the percentages of cases due to Hepatitis C and B as well as PBC\/PSC has decreased due to medications. \u00a0 The percentage due to Fatty Acid disease continues to increase due to obesity. \u00a0Cirrhosis affects the brain, lungs, heart, vascular system, gut, kidneys, endocrine system, immune system, skin, as well as the musculoskeletal systems.<\/p>\n

The next part of the journey involved the transplant process. \u00a0 Dr.Matherly pointed out a very interesting point. \u00a0When a person has a defected heart or lungs or kidneys, they can be placed on a pacemaker, ventilator, or dialysis before transplantation even becomes an option. However, there is no biomedical device for a liver. Therefore, with no liver transplant, death is the outcome. \u00a0 Matherly then talked about the MELD score<\/a>, which determines a patient’s chance of survival with a transplant; this method has been in use since 2002. \u00a0This score is based on three lab values: Bilirubin, Creatine, and INR. \u00a0Normal patients have a MELD score of 6, and the worse score obtained is a 40. \u00a0To be placed on the transplant list, a patient needs a score of at least 15.<\/p>\n

Matherly also talked about the consequences of not undergoing a transplant. \u00a0A patient can have recurrent hepatic encephalopathy, recurrent ascites, recurrent hepatic hydrothorax(for which a patient can undergo TIPS<\/a>,but can cause liver and mutliorgan failure), weight loss\/malnutrition, and hospitalization. \u00a0The patient whose journey Dr.Matherly was discussing was admitted to the hospital a total of 10 times over a course of 1 month. \u00a0The following month, the patient underwent a deceased donor liver transplant. \u00a0Mayo Clinic calculated her MELD score and this score was given to UNOS<\/a>. \u00a0UNOS has a geographical order of offers from first to last: regional acute liver failure (1a)–>local candidates with MELD score of greater than 35–>regional candidates with MELD score of greater than 35–>local candidates with a score of greater than 15–>regional candidates with a score greater than 15–>national candidates with acute liver failure–>national candidates with a score greater than 15. \u00a0The patient also underwent organ matching+blood type match.<\/p>\n

Next in the journey is the evaluation process. \u00a0The patient has to be evaluated by several different professionals before getting the “green light.” \u00a0 The path, stated by Matherly, starts off like this: \u00a0“hepatologist–>lab work–>cardiac clearance–>pulmonary clearance–>liver imaging–>preventative health–>dental exam–>other case by case exams–>financial screening–>psychology consultation–>social worker consultation–>transplant coordinator–>nutritionist–>pharmacist–>transplant surgeon.”<\/p>\n

Post transplantation was the second to last part of the journey. After her transplantation, the patient weighed 88 pounds and had to stay in the hospital for 6 weeks. \u00a0 Dr.Matherly discussed survival rates as well as acute cellular rejection and side effects post transplantation. \u00a0The survival rate one year after surgery is 86.3%, 78.7% after three years, and 72.6% after five years. \u00a0 Acute cellular rejection occurs approximately one year after transplantation. \u00a0 This is due to the fact that “the liver is a weak immunogenic organ.” \u00a0The rate is around 15-25% of all cases. \u00a0Dr.Matherly states that “the transplant of a liver with a second\u00a0organ decreases the rejection of the second organ.” \u00a0To prevent the rejection, treatment includes calcineurin inhibitors, mTOR inhibitors, anti-metabolites, and\/or steroids. \u00a0He also states that calcineurin inhibitors can cause kidney toxicity, which becomes an “acute and long term injury.” \u00a0Other possible consequences of taking immunosuppressants include: cancer( “de novo malignancy is the second cause of death”), kidney failure, infection, Hepatitis B\/C, and metabolic syndromes. Dr.Matherly states there is a 95% chance of Hepatitis C reoccurring post transplantation. Metabolic syndromes are obesity, diabetes, high blood pressure, and high cholesterol. \u00a0\u00a0 Cardiac disease is the first cause of death and this occurs in 58% of post-transplantation patients.<\/p>\n

The journey concluded with an update of the 29 year old female patient. \u00a0Today, she is alive and well. \u00a0 Three and half years post transplantation, she gave birth to a healthy baby boy followed by giving birth to a healthy baby girl three years later. \u00a0Currently, she is on a low dose of one\u00a0immunosuppressant.<\/p>\n

Overall, Dr.Matherly points out that a liver transplant is needed to increase a person’s quality of life as well as increasing the function of the liver.<\/p>\n

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EMU had the pleasure of hosting a Suter Science Seminar by Dr.Scott Matherly on September 11,2015. \u00a0He is a transplant Hepatologist\u00a0as well as an Assistant Professor of Medicine in Internal Medicine \u00a0in the Gastroenterology department\u00a0at Virginia Commonwealth University in Richmond,VA. Dr.Matherly completed his residency in Internal Medicine at Johns Hopkins University. Before beginning the journey,....<\/p>

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