UC Davis offers liver transplants, quality care close to home

Liver transplantation may be the only treatment option left for patients with end-stage liver disease due to chronic conditions such as cirrhosis or liver cancer.

In the early stages, liver disease may be managed with medical treatments, but eventually patients may reach a point where a transplant is the only life-saving course of action.

The good news for Sacramento area residents who may need a liver transplant is that the UC Davis Transplant Center has been meeting the needs of liver transplant patients throughout Northern California since 1994.

“We have a team of highly trained and experienced physicians, nurses and other health-care professionals who provide a full range of transplant-related care, from initial evaluation to post-surgical follow-up,” said John McVicar, transplant surgeon and director of the Liver Transplant Program.

Center of Excellence

It is a recognized “Center of Excellence” by California’s Medi-Cal program, as well as many other health plans and organizations. It also has been approved by the U.S. Department of Health and Human Services Health Care Finance Administration as a Medicare-approved center for liver transplantation. One of the criteria used for approval is a 77-percent first-year survival rate and a second-year survival rate of at least 60 percent.

“First and second-year survival rates since the program started at UC Davis are 88 and 87 percent respectively, well exceeding the minimum requirements,” McVicar said.

The success of the UC Davis program is due to the individualized and innovative care offered by physician researchers who are leaders in their field. The program offers:

• A multidisciplinary group of surgeons, liver specialists and oncologists that reviews each case of liver cancer to determine the best treatment modality for that patient.
• A combined liver transplant and palliative hospice program to increase end-of-life care. In some cases, the quality of care has resulted in moving patients from hospice back to transplant care.
• A telemedicine program that offers advice and education to primary-care providers treating patients with liver disease, including hepatitis C. The program is offered at 80 satellite locations throughout Northern California. In addition, Sacramento’s ability to provide transplants sooner than other more urban areas is a plus for the UC Davis program.

"We have a team of highly trained and experienced physicians, nurses and other health-care professionals who provide a full range of transplant-related care, from initial evaluation to post-surgical follow-up."
— John McVicar, Liver Transplant Program director

“That’s because Sacramento patients have lower MELD scores at transplant, compared to the San Francisco Bay area, for example,” McVicar said.

MELD point system

When organs become available, the United Network for Organ Sharing, the agency under contract with the federal government to oversee all organ recovery and transplant activities in the United States, will run a match list based on a point system to identify recipients. The point system, called a MELD (Model for End-Stage Liver Disease) score, is the numerical scale used for liver allocation, ranging from six (less ill) to 40 (gravely ill). Patients waiting for a liver transplant are ranked in order of their disease severity. The sickest patients are the highest on the list.

The median MELD score for when transplants occur vary in different regions of the country, due to a variety of factors. The national average MELD score is 22, the same as Sacramento, while the San Francisco Bay area’s median MELD score is 29.

Often, prospective liver-transplant patients can be wait-listed on another liver transplant program as well as the UC Davis program. With the lower MELD score, however, the waiting time for transplants through UC Davis may be shorter, McVicar said.

Patient evaluations

Northern California physicians who would like to have their patients evaluated for a liver transplant can call the UC Davis Transplant Center office toll free at (800) 821-9912 or in Sacramento (916) 734-2111.

The evaluation will include:

• A medical history and physical examination with a transplant doctor to determine if a transplant is a good option for the patient;
• An interview with a social worker to assess the patient’s psychosocial readiness for transplant and to discuss the many changes that will occur after transplant;
• A phone interview with a financial counselor to review the patient’s health insurance needs;
• Extensive medical testing (labs and X-rays) to ensure the patient is healthy enough to have major surgery;
• Education with a transplant nurse coordinator to learn more about the transplant procedure and post transplant care;
• A history and physical exam with a transplant surgeon, where the risks and benefits of the transplant procedure are discussed.

While the UC Davis transplant team continues to support patients with liver transplants, a UC Davis research team also is exploring therapies using regenerative medicine. With the ability to repair damaged tissue and develop into specialized cells and organs, stem cells are expected to have a major impact in medicine and health care. More information about how stem cell research may benefit patients facing transplant surgery is available at www.ucdmc.ucdavis.edu/stemcellresearch.

For more information about liver transplants, contact the UC Davis Transplant Center at (800) 821-9912 or (916) 734-2111, or call the UC Davis Physician Referral Center at (800) 4-UCDAVIS (482-3284).