Saint Louis University Center for Abdominal Transplantation: ‘Show Me’ World Class Care

In this edition of the Missouri Medicine, you will read several articles written by members of the Saint Louis University Center for Abdominal Transplantation. Saint Louis University School of Medicine has a long relationship with transplantation, being the first center west of the Mississippi to perform an orthotopic heart transplant.

For context, currently, there are 111,708 registrants listed with the United Network of Organ Sharing (UNOS) for organ transplantation. Of those patients listed from Missouri, 1,208 are listed for kidney transplants, 216 for liver, 34 for pancreas (25 kidney-pancreas, and seven pancreas alone), and 214 patients for thoracic organs.¹ In Missouri, in the year 2007, there were 6,467 patients vwith chronic kidney disease (CKD) Stage 5. The prevalence was highest in St. Louis County, followed by: Jackson, St. Louis city, Greene, and St. Charles counties. There were 2,079 new cases reported in 2007. In 2006, there were 537 emergency department visits for CKD, and 25.9% of these visits were for end stage renal disease.

Missouri is one of the few states in the nation that has a program to actually assist patients with endstage renal disease and/or kidney transplant - the Missouri Kidney Program (MoKP).

The mission of MoKP is to help meet the medical, educational, and psychosocial needs of eligible Missouri residents who have chronic renal insufficiency or have had a renal transplant. No patient with kidney disease in Missouri should lack for health care, due to financial concerns, including access to transplant services.² Likewise, liver disease in Missouri causes 7% of all deaths as compared to 9% nationwide.

In the United States, nearly 1.8 percent of the population – between 2.7 million and 3.9 million Americans – may be infected with the Hepatitis C Virus (HCV), with 75 percent of those individuals unaware of their condition.³ As of May 2011, there are now new treatments available to treat patients with Hepatitis C⁴, pioneered by Bruce Bacon, MD, head of the Saint Louis University Center for Abdominal Transplantation. In this issue, he will describe how these new therapies work and who is eligible for treatment. We will also discuss the consequences of long term hepatic inflammation in the association of chronic liver disease and hepatocellular carcinoma.

In the current environment of health care reform there are implications regarding the cost of these transplants versus chronic organ support therapies.

Harvey Solomon, MD, longtime medical director of Midwest Transplant Services (MTS) describes the implications of using donors that are not quite “perfect”, but often match the recipients in terms of age and co-morbid disease, so called “expanded criteria donors”. These donors provide patients with end organ failure the opportunity to either avoid dialysis, or be removed from dialysis leading to a longer and higher quality of life.⁵ The financial implications of using these types of organs are described by members of the Saint Louis University Center for Outcomes Research.

When deciding where and how to spend health care dollars, it is important to know the true total cost in terms of the financial expense of medical services and also the costs of life extension as well as the quality of that life. Only then can we make a true informed decision about how our health care dollars are spent. Kevin Martin, MB, describes the current state of the art in dialysis access and how to maintain accessibility while patients await transplantation. The role of the interventional nephrologist is a geographical specialty of the MTC. They provide patients on dialysis access to their true primary care givers.

There are opportunities for Missouri patients with end organ failure due to unique state governmental support, a robust support structure for patients with end organ kidney failure, and access to world class hepatology. It is inscribed on the dome of the Missouri capitol, “Where there is no vision, people perish.” At the Saint Louis University Center for Abdominal Transplantation our vision is world class research and clinical services for patients needing organ support and replacement.

Biography

J.E. (Betsy) Tuttle Newhall, MD, is Professor of Surgery, Division Chief, Abdominal Transplantation, Saint Louis University Center for Abdominal Transplantation.

Contact: jtuttlen@slu.edu