Medical Advances
Transplant Immunology Research
Emory is at the forefront of transplant immunology research. Our physicians are investigating new drugs that can establish true immune tolerance with fewer toxic side effects (high blood pressure, high cholesterol, kidney toxicity and diabetes) than traditional immunosuppressants.
Other new, exciting developments in liver transplantation include improved post-transplant treatment strategies for patients with hepatitis B and successful liver transplantation across blood groups. Traditionally, crossing blood groups increased the risk of infection in liver tranpslant recipients. Emory researchers have shown that patients in need of emergent transplants can receive an organ from a donor of another blood type and that, with proper medical care, crossing blood groups in transplantation can work with great outcomes.
Liver Transplant and Cholangiocarcinoma
Emory Transplant Center is one of just a handful of centers across the U.S. offering a groundbreaking treatment protocol for bile duct cancer (cholangiocarcinoma). Bile duct cancer is an aggressive and often lethal disease. The traditional treatment is resection (surgical removal of the tumor), but often the cancer continues to spread around the bile duct. In the past, patients with inoperable bile duct cancer had little chance of survival.
The new protocol combines chemotherapy and radiation with a liver transplant. Replacing the patient's entire liver greatly improves the chances that the entire tumor will be removed. Chemotherapy and radiation treat and sterilize the tumor bed, but using these options alone may eventually cause liver failure and thus the need for a liver transplant.
Until recent years, patients diagnosed with cholangiocarcinoma had few treatment options and little chance of survival. This new protocol offers hope to patients with this difficult disease.
Domino Liver Transplant
In July 2009, transplant surgeons at Emory University Hospital were the first in the state of Georgia to perform a very rare domino liver transplant. The procedure saved two lives: It cured a rare disease (Maple Syrup Urine Disease, or MSUD) in one patient and dramatically improved the quality of life in the other patient, who has suffered a lifetime battle with hemophilia, and more recently hepatitis C.
In a domino liver transplant, a liver from a deceased donor is transplanted into the first recipient, and the first recipient's liver is then transplanted into a second recipient. To date, fewer than 100 domino liver transplants have been performed in the U.S.
According to Stuart Knechtle, MD, director of Emory's liver transplant program, domino transplants are a rare but effective way of overcoming the national shortage of organs available for transplant. "Domino transplants are still quite rare because, in part, there are few illnesses that may impact one liver, but if that organ were to be given to another donor, would fail to negatively impact the health or quality of life in the recipient. In the case here at Emory, one patient suffered from a rare disease called Maple Syrup Urine Disease, and it happens to be one particular challenge that would not impact the recipient," says Knechtle.
The MSUD that so badly impacted the donor will not be passed along to the patient receiving the donated liver, Knechtle says. And because MSUD does not exclusively affect the liver (the disease is caused by a missing enzyme in all cells of the body) the second patient will not acquire the disease since his cells make the enzyme.
"Both patients are now, in effect, living with new, perfectly functioning livers," he says.
