60% to 70% Chance of Surviving a Year : Long Recovery for Liver Transplant Recipient

Although UC San Diego Medical Center’s first liver transplant has been hailed as a success, the surgeons said Monday that the woman has only a 60% to 70% chance of surviving more than a year and her treatment over the next six months may prove the most trying part of the case.

Speaking publicly for the first time since the operation eight days ago, doctors Oscar Bronsther and Nicholas Halasz noted that the woman will spend the rest of her life on drugs aimed at preventing her body’s immune system from rejecting the new liver.

“You don’t get transplants for free,” said Bronsther. “What you’re really doing, quite honestly, is trading one disease for another. You’re trading your kidney disease, your heart disease, your liver disease for a chronic immunodeficiency disease.”

Bronsther said his patient will be taking anti-rejection drugs for the rest of her life. The potential complications associated with that treatment include the possibility of infections, tumors and facial hair growth, he said.

“However, given that as background, there are very few limitations . . . on the lives of successful transplant recipients,” Bronsther said.

The UCSD patient, a San Diego woman in her mid-40s whose name has been withheld, received the new liver in a 10-hour operation. She had been suffering from primary biliary cirrhosis, a disease caused by obstruction of the bile ducts, which was expected to eventually kill her.

On Monday, she had her first “rejection episode,” a condition experienced by nearly all transplant patients. To counteract it, the surgeons were to begin treating her Monday afternoon with a monoclonal antibody treatment that has been available for just six to eight months.

“Obviously, it has to be tuned very finely, because if we over-attack these defense mechanisms, then we make the patient very susceptible to infection and, to a lesser extent, we also make them more susceptible to tumors,” Halasz said. “So nothing is really free in this business.”

The operation and post-operative care are expected to cost about $125,000--a price UCSD Medical Center intends to pay because the patient cannot afford it. Asked at the press conference whether liver transplantation is worth the price, Bronsther said he has no doubt that it is.

“It’s very expensive, interestingly enough, to die of liver disease in America,” he said. “It’s been estimated that terminal liver patients consume 75,000 health care dollars in the last six months of his or her life. That’s to die; with no hope of survival.”

Comparing that $75,000 cost to the cost of a transplant, Bronsther concluded, “So for $50,000 to $75,000, you have the opportunity to restore these people to life. . . . We’re returning them to meaningful, productive, economically viable existence. If you want to do a cost-benefit analysis, it’s probably cost-effective to do transplants.”

Since the first successful liver transplant in the late 1960s, more than 1,000 have been done in the United States and Europe. But until the introduction of cyclosporine in the early 1980s, only 20% to 40% of all recipients survived even one year.

Authorities say that use of the drug, combined with improved patient selection and operative techniques, now results in an overall one-year survival rate of 60% to 80%. The rate is higher in children than in adults, Halasz said.

Bronsther and Halasz said epidemiological studies suggest that 10 to 20 people per every one million population will need a liver transplant in a given year. The only other liver transplant programs in the Western United States are in Los Angeles and Phoenix, creating a great need for the San Diego center, the surgeons said.