Team Care Propels UMMC’s Liver Transplant Program to National Honor
JACKSON, Mississippi — When Randal Russell was diagnosed with chronic liver disease more than a decade ago, the Madison resident sought treatment at an out-of-state hospital that offered a liver transplant program.
“But then they have a program here,” Sherri, Russell’s wife, said of the University of Mississippi Medical Center, where liver transplants resumed in 2013 after a 20-year hiatus. “We’ve heard a lot of really good things about it and felt comfortable changing it.”
Fast forward to September 27, 2021. His liver paralyzed by primary schlerotic cholangitis, progressive inflammation and scarring of that organ’s bile ducts, Russell had been on a transplant waiting list at UMMC since July 2020 when he received the call: We have a liver for you.
Her transplant took place the next day, but the treatment before and after the surgery has as much to do with survival and recovery as the procedure itself.
This round-the-clock care delivery results in UMMC’s liver transplant program being ranked among the top three in the nation by a federally contracted organization that benchmarks transplant centers nationwide.
This honor clearly demonstrates that the medical center “can aggressively transplant patients and achieve excellent results,” said Dr. Christopher Anderson, James D. Hardy Professor and Chairman of the Department of Surgery.
The Scientific Registry of Transplant Recipients has ranked the medical center above some much larger programs such as the Mayo Clinic hospitals in Jacksonville, Florida, and Phoenix, Barnes-Jewish Hospital in St. Louis and the Ochsner Foundation Hospital in New Orleans.
The registry lists 148 liver transplant centers based on factors such as one-year post-transplant survival rates, survival rates for patients on a liver transplant waiting list, and how quickly a person on the waiting list received a deceased donor transplant. The registry also tracks the number of living and deceased donor liver transplants performed each year.
UMMC scored five out of five for one-year survival and getting a deceased donor transplant quickly. The medical center has received three out of five on survival rates for patients while they are still on the liver transplant waiting list.
The Medical Center’s liver transplant surgery team includes Anderson, its leader; Dr. Mark Earl, professor in the Division of Hepatobiliary Transplantation and Surgery and Surgical Director of Liver Transplantation; Dr. Felicitas Koller, associate professor in the division; and Dr. Praise Matemavi, assistant professor in the division. Dr. James Wynn, a professor in the division, is the lead in kidney transplantation.
“We have a world-class team, and our results reflect that,” Earl said. “During surgery, our anesthesiologists are very good at keeping very seriously ill patients stable, and they can get very sick during the transplant.”
They are joined in the operating room by nurses in addition to surgical and anesthesia technicians. “You know you’re surrounded by experts,” Earl said. “It allows surgeons to focus on their job, and their job alone.”
The team also includes experienced registered nurses assigned as coordinators before and after the abdominal transplant procedure. Anna McGraw, Lacey Dungan, Jodie Kilby and Taylor Tadlock guide and monitor patients, getting to know them well and taking responsibility for the smallest details that could affect their recovery and well-being.
Add to that hepatologists, infectious disease specialists, nurse practitioners, psychologists, social workers, pharmacists, dietitians, primary care physicians, even financial coordinators.
” She is incredible. She’s so responsive,” Russell said of McGraw. “That’s the most important factor for me. She cares. She is caring. If there is a problem, they fix it. Dr Matemavi is texting and checking on me all the time. She was awesome.
When a patient receives a new liver depends largely on their MELD (Model for End Stage Liver Disease) score. It ranges from six, the least ill, to 40, seriously ill. The federal United Network for Organ Sharing uses a formula based on MELD scores to match organs with recipients.
The medical center in 2021 performed 48 liver transplants and since restarting the program in 2013 has performed 333, including several in which two patients shared a single liver.
“We are where we are today thanks to a decade of persistent dedication to that vision. The first of our goals was to be a resource for Mississippi patients who could provide timely and safe liver transplantation,” Anderson said. “At University Transplant, you have a team completely dedicated to the care of liver patients.”
A huge plus is the transplant hepatology team led by Dr. Laura Smart. “Dr. Smart and the transplant coordinators carry the heavy load and complement our surgeons perfectly,” said Dean Henderson, Administrator of Transplant Services.
“That’s a big factor in getting these patients to our clinic and seeing them before they get so sick from liver disease,” said Smart, an assistant professor in the Division of Digestive Diseases. “We keep them as healthy and functioning as possible before they are transplanted.”
She teams up with Assistant Professors Dr. Jan Petrasek and Dr. Joydeep Chakraborty to control pre-transplant issues, including fluid retention due to cirrhosis, bleeding, and issues with diet and exercise.
“Many of them have diabetes, hypertension or other conditions that require ongoing monitoring. We also have mental health providers to offer support for depression due to chronic conditions,” Smart said.
“Getting a transplant is such a gift. Some people struggle with that.
The hepatology team provides exceptional treatment, “preventing some from needing a transplant and caring for others, some of whom are now nine years post-transplant,” Anderson said.
A patient’s surgical team monitors their care for the first month after the transplant. After that, “we see them every week and space them out as they get better,” Smart said.
On January 19, she visited Robert Jacobson, a resident of Theodore, Alabama, who received both a liver and a kidney on November 19, 2021 after being on the waiting list for just over three months. . Liver cirrhosis and kidney failure caused by chronic diabetes made him a candidate for both.
“My team of doctors have been amazing,” Jacobson said. “In intensive care and on the hospital floor, I received good care and great care in rehab.”
Jacobson chose to drive three hours for transplant care “because they said this place had a good turnaround time,” his wife Valerie said. “We stayed here and I’m glad we did.”
At every step of the process, a patient’s transplant coordinator holds their hand – he even calls to tell them that a donor organ is available.
“Our patients are usually transplanted within a year, and for some it’s three or four months,” McGraw said. “It’s really fast, and for a liver transplant it has to be that fast because patients can get very sick.”
Before and after surgery coordinators track patients’ medications and schedule them for appointments and blood work, McGraw said. “We answer their sick calls after hours so that we can take care of their liver as best we can, especially when dealing with other illnesses.”
“Our nurses must be excellent,” Dungan said. “Many of our patients don’t understand the little details that could mean something is wrong.”
“We take care of them for the life of the liver,” McGraw said. “We keep them for life.
“We really have a great squad, with all the players performing at their highest level,” Henderson said. “We have one of the best transplant teams in the country, and now the data is starting to prove that fact.”
About the University of Mississippi Medical Center
UMMC is the only academic medical center in the state. Its education, research, and health missions share the goals of improving the health of the state’s population and eliminating health disparities.
Located in Jackson, UMMC comprises seven schools of health sciences, including medicine, nursing, health professions, dentistry, pharmacy, graduate studies, and population health. The medical center’s health care enterprise includes the only Level I trauma center in the state, the only children’s hospital, and the only organ and bone marrow transplant program. The medical center also houses a Telehealth Center of Excellence, one of two in the country.
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