Novel Strategies Increased the Number of Usable Donor Livers for Transplant, Helping to Save More Patients’ Lives
In March 2022, the NYU Langone Transplant Institute welcomed three new physicians to its liver transplant program: transplant surgeons Karim J. Halazun, MD, and Adam Griesemer, MD, and medical director Patrick G. Northup, MD. The trio’s overriding goal is to help as many patients as possible receive lifesaving liver transplants.
Nationally, some 14,000 patients are on the waitlist for a liver transplant, and while 9,000 will ultimately receive one, that still leaves a sizable gap. To help close it, NYU Langone has redoubled efforts to move as many patients as possible off the waitlist. In 2022, the team performed 100 liver transplants, a record for the program since its inception in 1998 and nearly double its 2021 total of 54. This growth reflects a program on the rise. Along with the increase in volume, it has a perfect 1-year patient survival rate of 100 percent. What’s more, its 1-year functioning graft survival rate is 97 percent, well above the national average of 92 percent.
“We’ve changed the infrastructure and the mindset,” said Dr. Northup, who is also a professor in the Departments of Medicine and Surgery at NYU Grossman School of Medicine. “A new approach has enabled us to move patients off the waitlist faster and increase the number of people we can help.”
Among the new strategies is an effort to increase the number of donor livers accepted for transplant: the number accepted is now 128 percent higher than it was in 2021. As with kidneys, a liver suitable for a transplant can come from either a deceased or a living donor. But while living donor liver transplants tend to have fewer complications and better outcomes, they account for only 5 percent of liver transplants nationwide.
Dr. Griesemer, the new surgical director of the Living Donor Liver Program and Pediatric Liver Transplant Program, is working to expand the use of living donor organs at NYU Langone. “Getting patients who have a living donor off the waitlist allows us to transplant other patients with organs from deceased donors,” said Dr. Griesemer, who is also a member of the Department of Surgery. “It’s a win–win.”
Reflecting a guiding principle of the Transplant Institute, the liver transplant team now considers a broader range of donor organs, including those that other centers routinely reject. “To quote a fellow transplant surgeon who was one of the leaders in adopting this approach, there are no bad livers, only good livers with bad stories,” said Dr. Halazun, who is surgical director of the Adult Liver Transplant Program and a member of the Department of Surgery. “We look at every liver, irrespective of its size, age, and the donor’s medical history, and determine whether we can use it.”
The thorough evaluation process means NYU Langone clinicians will travel anywhere in the United States to procure organs, often on short notice, as the liver from a deceased donor must be transplanted within a day to maximize success. The team has now accepted organs from as far away as Texas and Puerto Rico. “New York State has a dearth of donor organs, so this is vital in order to help as many of our patients as possible,” explained Dr. Halazun.
Equally as important as broadening the criteria for donor organs is growing the care team. Previously, transplant surgeons took the lead in seeing patients for follow-up visits during the first year after surgery. Now, patients are joined by hepatologists throughout their care, from evaluation to postoperative care. “It’s a team approach,” explained Danielle Fox, NP, who joined the program earlier this year as the lead administrator. “All the providers are familiar with every patient. That way, if an issue arises, anyone can respond.”
The program has added an outreach coordinator and a nurse practitioner charged with coordinating evaluations and managing candidates on the waitlist. These new hires have helped improve efficiency, avoid bottlenecks, and ultimately increase the number of transplants, said Fox.
The program is poised for further growth in 2023—including the launch of pediatric liver transplants. “We’re incredibly proud of what our entire team has been able to accomplish in a short amount of time,” said Dr. Halazun. “And we’re just getting started.”