When Avera was given the green light last year to perform liver transplants, surgeon Jeffery Steers described the feeling in one word.
“It was hard knowing there was a patient we could help, but couldn’t yet do the transplant here in Sioux Falls,” said Steers, MD, FACS. “For many people in this situation, a liver transplant is all they need to go on to live a healthy, happy life.”
Avera Transplant Institute recently completed South Dakota’s first liver transplant after earning active program status with the United Network for Organ Sharing (UNOS). Avera’s liver transplant program is in addition to an already robust transplant program at the Avera Transplant Institute, which for years has performed kidney, pancreas and bone marrow transplantation, totaling more than 1,250 transplants.
While working toward UNOS approval, liver specialists worked with patients locally to provide pre- and post-transplant care coordination, with referral for transplant surgery hundreds of miles away. For those on the wait list, the call for a transplant can come any time and a transplant requires several days of hospital and outpatient care. “The benefits of adding liver transplant here in Sioux Falls are clear. The farther you are from the transplant center, the more difficulties patients have,” Steers said.
In South Dakota, 30-40 patients a year are put on the list waiting for a liver transplant, Steers said. That doesn’t include Wyoming, North Dakota and other nearby states that don’t have a liver transplant program.
Prior to Avera’s liver disease program, only a fraction of South Dakota residents needing a liver transplant were placed on any transplant waiting list.
In the more than 20 years Steers has been doing liver transplants, the success rate has continued to improve. Today, liver transplant patients have 80-90 percent survival rate one year after transplant compared to 60 percent in the 1990s.
Steers, who came to Avera in 2012, helped build a team that could meet federal requirements and successfully handle the rigor and demands of a 24/7-transplant operation. The process was made simpler by the infrastructure Avera Transplant Institute already had in place for kidney and pancreas transplantation as well as specialized liver disease care.
“We need to be able to do everything we can do at two in the afternoon at 2 a.m.,” Steers said. Also doing liver transplant surgery at Avera is Christopher Auvenshine, DO. As is common with abdominal transplant surgery practices, these surgeons are looked to for specialized skills applicable in liver and pancreas tumor resections, as well as dialysis access surgery.
It’s not the first time Steers has helped launch such a project — he helped start a liver transplant program in Jacksonville, Fla., for the Mayo Clinic before rejuvenating a program in Milwaukee, Wis.
“A lot of things we do in medicine have an impact that is less dramatic. With transplant I feel, without a shadow of a doubt, that I have changed someone’s life and given them hope,” he said.
When a liver is available, there’s a rigorous testing process to ensure the organ is a good match. The decision-making process is delicate balance — you don’t want to take a chance on a liver that won’t successfully transplant but you don’t want to pass up an opportunity for a patient on the organ waiting list, either.
“You can’t afford to take chances on whether a liver will work — it has to work because there isn’t any other way,” Steers said.
He has completed more than a thousand transplants over the years leaving him with many memories — a young woman he transplanted as an infant or the gentleman who told Steers his goal was to see his grandchildren grow up.
Unlike kidney disease patients who can receive dialysis while waiting for a transplant, there is no alternative treatment for end-stage liver disease. Steers remembers one patient who looked and felt miserable for five years leading up to his transplant, and like others he was transformed back to health. “Months later, when he was back for a checkup, I walked right past him in the hallway — I didn’t even recognize him because he looked so different.”