Tag: liver disease
Super-Cooled Livers Could Bring New Flexibility To Organ Transplants

Super-Cooled Livers Could Bring New Flexibility To Organ Transplants

By Alan Zarembo, Los Angeles Times

In liver transplantation, the biggest inequity is geographic. When organs become available, they are generally offered first to patients nearby. A big part of the reason is that once a liver is harvested from a cadaver, it remains viable for no more than 12 hours.

As a result, waiting times vary dramatically across the country depending on supply and demand. Liver patients in Los Angeles, for example, typically wait years longer — and become far sicker prior to surgery — than those in northern Florida.

Now a group of Harvard University researchers has come up with a preservation technique that could one day allow livers to be shared more easily around the world.

In a paper published this week in the journal Nature Medicine, the scientists describe an experiment in rats in which livers were preserved for up to four days before transplantation.
Of the 12 rats that received four-day-old livers, seven survived for at least three months. Transplantation after three days worked perfectly: All six rats in that group survived.

In comparison, no rats survived after receiving three- and four-day-old livers preserved in the standard ice-cold solution — a breakthrough in transplantation when it was invented at the University of Wisconsin in 1980.

The new method relies on super-cooling. Livers were stored at minus 6 degrees Celsius in a chemical bath that prevented them from freezing. Freezing destroys delicate cell membranes.
The livers were slowly warmed before surgery.

The experiment marks the first time that a liver has been successfully transplanted after four days of storage — in any species.

But will the technique work in people? The scientists wrote that preserving human livers could require changes to the chemical solution or the protocol of cooling and warming.

One challenge is that human livers are more vulnerable to freezing than rat livers because of their size. There are other differences in liver biology as well.

But if the researchers can make it work, extending preservation time could have profound effects on the transplant system. Livers could be flown around the country or the world where they are needed most, equalizing waiting times and reducing organ shortages in the places with the highest demand and the lowest supply.

More than 15,700 people in the United States are waiting for liver transplants.

Photo: Rusty Clark via Flickr

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A Form Of Liver Disease Has Quickly Emerged As A Public Health Threat

A Form Of Liver Disease Has Quickly Emerged As A Public Health Threat

By Joe Smydo, Pittsburgh Post-Gazette

PITTSBURGH — Renee Terney, who traveled to Erie, Pa., earlier this month to ride the slides at Splash Lagoon, has come a long way in the 2.5 years since she was struck by a form of liver disease that has quickly emerged as a public health threat and a challenge to transplant programs.

Blood work and other tests revealed that the Sheraden resident had non-alcoholic fatty liver disease, an accumulation of fat in liver cells associated with poor diet, a sedentary lifestyle, and obesity. The damage to Terney’s liver was so extensive that she was near death at the time of her May 2013 transplant at Allegheny General Hospital.

Terney, now 48, lost 85 pounds during the ordeal. “My goal is not to put it back on,” she said.

Like other chronic conditions and other liver ailments, non-alcoholic fatty liver disease can be a silent killer, with some patients experiencing no symptoms for years or longer.

Jose Oliva, medical director of Allegheny Health Network’s liver transplantation program, said it’s often discovered when routine blood work ordered by a primary care physician reveals elevated levels of liver enzymes. He said follow-up tests, such as a CT scan or ultrasound, are used to confirm the diagnosis.

If caught early, exercise and improved diet can slow or reverse the disease. “It’s behavior modification,” Oliva said.

However, there are no medications to assist with treatment, and in the most severe and advanced cases, known as non-alcoholic steatohepatitis, or NASH, scarring of the liver is identical to the damage caused by alcoholism.

Some of these patients — who eventually experience symptoms such as belly pain, jaundice, and swelling of the legs, as Terney did — must pin their hope for survival on a transplant.

But livers are in short supply. “There aren’t enough now as it is,” and a rising tide of non-alcoholic fatty liver disease will make matters worse, said Vinod Rustgi, medical director of liver transplantation for UPMC.

Of about 17,000 people on waiting lists nationwide, Oliva said, only about 6,500 receive transplants each year. Rustgi said 15 percent die before receiving an organ.

According to the American Liver Foundation, non-alcoholic fatty liver disease already is “the most common liver disease in most of the Western world.” It affects 30 million Americans, and the numbers are growing.

“We are particularly concerned about the high prevalence of fatty liver disease in children. It is setting them up on a path to liver failure and puts them at significant health risk,” foundation Chairman Tom Nealon said in a statement.

Obesity is believed to be the chief culprit.

As obesity has soared in recent decades, so have the diseases associated with it. People depositing fat in their livers are also depositing it in other organs, increasing their risk of cardiovascular disease and other problems. The situation worsens when patients develop type 2 diabetes, Rustgi said.

“I think it’s very, very important that people recognize that obesity can shorten life expectancy, and, conversely, longevity has been associated with thinness,” he said.

Unlike heart disease, hypertension, and type 2 diabetes — long the subject of public awareness and education campaigns — non-alcoholic fatty liver disease remains little known and little understood among the U.S. population. When told they have liver disease, Oliva, some patients are perplexed.

“The first thing they say is, ‘I don’t drink,’ ” he said.

More than a year after her transplant, Terney says she feels great. She credited her partner, Nancy Burns, with supporting her fight, and said her five adopted children were an inspiration.

“I wanted to keep going for them,” she said.

Photo: kbrookes via Flickr

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