When Fred Melton, 62, of Sandy Springs, Ga., began experiencing weight fluctuation and leg swelling, he mentioned his symptoms to his primary care physician. He was then referred to a liver specialist, who ran multiple tests.
“He said, ‘You definitely have some liver problems and we can’t handle you here at this particular hospital. You need to go to Piedmont where they have a team of people set up to do this and do a good job at it,’” remembered Melton. “The next thing I know, I’m at Piedmont.”
Oncologists treated Melton’s tumor with localized chemotherapy called chemoembolization.
While the chemotherapy prevented the tumor from spreading, Melton still required a transplant because of the significant cirrhosis in his liver caused by non-alcoholic fatty liver disease.
Waiting for a new liver
Although he endured months of grueling treatments, Melton said the worst part of the experience was waiting for a new liver that matched his blood type.
“Liver allocation is based on severity of disease,” said Dr. Pollinger. “Recipients are given a score called a MELD score. It ranges from seven to 40, 40 being extremely sick with very short life expectancy if not transplanted.”
Melton’s MELD score was high, mainly because he had liver cancer. Patients with cancer are given additional points and moved up the list.
“When you have to wait five or six months, it starts eating at you, particularly when you keep going up and down with the fluid in your stomach,” said Melton.
At first, Melton had fluid buildup removed once a month. As it gradually became more severe, he underwent the procedure once a week. His physicians told him he needed a transplant soon.
A donor liver
Finally, in November 2013, Melton received a phone call that a donor liver matching his blood type was available.
“He’s been waiting on the waiting list for quite some time,” said Dr. Pollinger. “A donor liver became available for him this evening.”
Melton and his family arrived at the hospital and have been waiting patiently for the lifesaving new organ.
“Part of the reason that it takes so long to get a liver is 15,000 people need a liver, but there are only about 8,000 livers available each year,” says Melton.
Just before the surgery, Dr. Pollinger stopped by Melton’s bed to let him know the donor liver looked good and was being transported to Piedmont by Mark Johnson, M.D., program director and chairman.
“When we got the call today, there was some elation in that maybe now I can get back to a normal life and try to heal,” says Melton.
Dr. Pollinger told Melton the surgery would begin around midnight that night and would take six to eight hours.
“Not being biased as a liver transplant surgeon, the liver is the most important solid organ in the human body,” says Dr. Pollinger. “It has thousands of functions, from controlling the thickness of your blood to metabolizing toxins, medicines and nutrients, to making proteins to build muscle, to clearing your bloodstream to make you think clearly. So it’s a real important organ.”
When the liver becomes cirrhotic and scarred, the blood flow through the liver gets congested because it becomes firm and hard. This can lead to:
- Venous hypertension
- Spleen enlargement
- Fluid buildup in the abdomen called ascites, which can be life-threatening
- Increased risk of bleeding
- Varices, which are abnormally dilated veins the abdomen, swallowing tube and esophagus
- Ammonia buildup in the bloodstream, which leads a confused state of mind called encephalopathy
“Oftentimes, people with liver disease succumb to these complications,” says Dr. Pollinger. “That’s why the mortality of someone with cirrhosis is very high.”
Liver transplant operation
“A liver transplant is a fairly big operation with multiple steps,” says Dr. Pollinger. “But when you dissect it down, it’s really not that complex of a surgery.”
The procedure is risky because the patient often has a low platelet count and is coagulopathic, meaning their blood is very thin because their liver is not making the factors that keep the blood thick.
“Transplant is always a happy time for us, but it’s also a sad time and a grieving time for the donor family,” said Dr. Pollinger.
Organ donors are people who typically have either suffered a stroke or sustained a traumatic injury that left them brain dead, meaning they have no chance of survival without life support. While the patient is on life support, their family can either choose to remove life support and have the patient die a cardiac death or, if the patient is a candidate, they can choose for their loved one to be an organ donor.
“Fortunately tonight, that family chose to donate and here we are,” said Dr. Pollinger.
Fred Melton’s new liver
“We work in teams,” said Dr. Pollinger. “There’s always a liver transplant surgeon on for the recipient operation and there’s another surgeon on for the donor operation.”
As Dr. Johnson prepared the donor liver, he noted how healthy it was, with normal vessels and structure.
“It’s really fantastic that the donor donated their organs,” said Dr. Johnson.
Once the donor organ is removed from the donor, it is flushed, preserved with preservation solution and kept on ice until surgeons are ready for it.
The first step in the organ recipient’s surgery is the hepatectomy, which takes 1.5 to 2 hours. During this procedure, the surgeon takes down all of the liver’s attachments and dissects out the blood supply to the liver. The liver is then removed from the patient’s body. For about 30 minutes before the new organ is transplanted, the patient has no liver.
“While I’m working on the recipient, Dr. Johnson will be preparing the [new] liver on the ice bath, getting the blood vessels ready, trimming it of any unnecessary, fatty tissue,” said Dr. Pollinger. “It really takes a team to get this operation done.”
Transplanting the donor liver
Once the old liver is out, the second phase of the operation begins. The new liver is attached to the blood supply that was preserved during the hepatectomy. It takes about 1.5 hours to sew in the new liver.
“From the time the liver is without blood supply on ice to when it’s reperfused, it’s only about 30 minutes,” explained Dr. Pollinger.
Patient safety during surgery
Liver transplantation is a traumatic event for the recipient’s body. When the liver is initially reperfused, cardiac issues can occur. The anesthesia team monitors the patient’s minute-by-minute blood pressure as well as heart and lung function during the surgery. They also check the patient’s blood work every 30 minutes.
Recovery time depends on how sick the patient was before undergoing the transplant.
“For someone like Fred who is sick, but otherwise in pretty good health – he doesn’t have too many other comorbidities – he should stay in the hospital for about seven days and be fully recovered in about three months,” said Dr. Pollinger.
Life after transplant
Melton’s prognosis is good.
“With his new liver, Mr. Melton should no longer suffer from confusion related to liver disease,” said Devina Bhasin, M.D., his transplant hepatologist. “A lot of the fatigue people experience with cirrhosis from liver disease should, over time, get better.”
He will also no longer require the weekly procedures to remove fluid buildup in his abdomen.
“Almost most importantly, he no longer has liver cancer,” she said. “He’s been cured of that.”
Dr. Bhasin told Melton to “take it easy – you’ve got years ahead of you now.”
A second chance a life
With his second chance at life, Melton plans to spend as much time as possible with his beloved grandchildren.
“I missed a summer of doing stuff with the grandkids,” he said.
“Like fishing,” added his grandson. “We always used to do that when I was a young kid – or younger.”
Since 2005, the Piedmont Transplant team has been caring for patients with liver disease and has performed more than 650 liver transplants.
Five days after his transplant, Fred Melton was discharged from Piedmont Atlanta Hospital. He is now making up for lost time with his grandchildren.
Visit Piedmont Transplant Institute to learn more about liver transplantation.