Feb. 1986: Mayo Clinic’s Year-Old Liver Transplant Program
In 1986, Mayo Clinic's year-old liver transplant program was growing to be one of the largest in the world. Take a step back to 1986 by reading this article from the February issue of Mayovox:
In less than a year, Mayo’s liver transplant program has become one of the largest in the world. The reasons for success are quite basic, says the surgeon who heads it. When Dr. Ruud Krom considers the impressive track record amassed by Mayo’s 11-month-old liver transplant program, he is well-pleased, but not surprised.
With characteristic bluntness, the Dutch-born surgeon who joined Mayo in 1985 to head the program says: “It couldn’t fail . . . . We had all the right stuff to make the program fly.”
The “right stuff,” according to Dr. Krom, is Mayo’s vast patient population base from which to select suitable transplant candidates and the institution’s “tremendous medical resources and support capabilities.”
As of mid-January, 31 liver transplants had been performed at Mayo on 28 patients, the first operation being performed in March of last year. Mayo is now considered one of the largest referral centers for chronic liver disease in the world.
The 31-transplant total is about 16 more than expected from the program when it was begun. (Three operations were re-transplants, and there were two deaths.)
Other notable facts about the program:
- The median time of hospitalization for Mayo transplant patients is 25 days.
- Short-term survival rate is more than 85%, one of the highest reported in the country.
- Blood loss during surgery averages seven liters, considerably less than most. About a third of blood loss is salvaged by special equipment (developed by the Mayo Blood Bank) in the operating room and returned to the patient by autotransfusion.
- Operating time ranges from six to seven hours.
- Patient age range for the 31 transplants was from 8 years to 54 years.
- Transplant patients were suffering from either chronic bile duct diseases or chronic active hepatitis.
The year 1986 promises to be even busier for the program, according to Dr. Krom. More than 50 liver transplants are expected to be performed at Mayo during the next 11 months, he says. Steps have already been taken to handle the anticipated increase in surgery: Dr. James Perkins, a former fellow in liver transplantation who trained under Dr. Krom at Mayo, was recently added as the second full-time surgeon to the transplant team. Up to this time, Dr. Krom handled the majority of the cases.
Two other surgeons—Drs. Sylvester Sterioff and David Nagorney—are available part-time for transplant operations. And soon, four surgeons on the team will handle organ procurement.
More than 50 liver transplants are expected to be performed at Mayo in 1986. To meet the demand, the transplant team has expanded, adding another full-time surgeon.
Says Dr. Krom: “By doing this many liver transplants in 11 months, we have been able to provide the necessary specialist team training to distribute the workload. The team must grow with the need.”
A need also exists, he says, to provide a 24-hour, 7-day-per-week outpatient facility for liver transplant patients to better centralize the continuity of care.
Since coming to Mayo from Chirurgische Kliniek, Groningen, the Netherlands (where he headed the liver transplant team and performed 36 such transplants since 1979), Dr. Krom has remained a firm believer in the team approach to medicine.
“Surgery, especially transplant surgery, is no one-man show,” he says emphatically. “Sure, the surgeon does the operation, but it can’t be done alone.”
Every liver transplant is indeed a study in teamwork. At Mayo, 4 surgeons, 5 hepatologists, 4 anesthesiologists, 2 intensive care unit physicians, a cadre of nurses and technicians, and the skills of Social Services and others are involved in the preoperative and postoperative care of liver transplant patients.
“That’s what I like about Mayo—there’s such an integration of high-quality professionals under one umbrella. With a team like that, the patient comes out ahead, and so do we.”
- The first liver transplant was performed by Dr. Thomas Starzl, now at the University of Pittsburgh, in 1963. Since then, more than 1,000 have been done worldwide.
- Since the early 1980s, liver transplant survival rates have improved to 60% after the first year. This rate is continuing to improve. Five-year survival rates are about 50% in certain programs.
- Use of the anti-rejection drug cyclosporine has contributed to these improved survival rates.
- Number of U.S. medical centers doing liver transplants is about 35. Closest to Rochester: University of Minnesota, Iowa City, Madison, and Chicago.
- Preservation time for donor liver after removal is 8 to 10 hours.
- Liver disease is fourth-leading cause of death in U.S. from birth to age 65.
- Total costs of the disease, including medical expenses and loss of wages, are greater than those for cancer.
- More than 100 different types of liver diseases, many without an effective form of medical therapy.
- Liver is largest organ in the body, weighing about three pounds.
- Liver is the body’s major metabolic organ. Converts food into essential chemicals. Removes toxic substances from the blood. Chemically modifies medicine so that it can be effective.
- Effects of chronic (end-stage) liver disease: severe exhaustion, weight loss, intractable itching, bleeding complications, and serious bone fracturing.