UC Department of Surgery

Multidisciplinary Liver Treatment Center

The success of the Pancreatic Disease Center prompted the development of a partner program in hepatobiliary disease launched in September 2002. This multidisciplinary program incorporates the disciplines of surgical oncology, transplant surgery, gastrointestinal surgery, interventional radiology, hepatology, advanced therapeutic endoscopy, and radiation oncology. This calls on the combined talents of Drs. Syed Ahmad, Jeffrey Sussman, and Steven Rudich within the Department of Surgery and many colleagues in the Departments of Internal Medicine and Radiology.

Utilizing the aforementioned range of expertise brings unique insight into the management of benign and malignant tumors and other disorders of the liver and biliary tree. During the last calendar year the program performed over 300 advanced hepatobiliary surgical procedures, evaluating and treating patients from as far away as Texas, Milwaukee and New Jersey. State-of-the-art surgical techniques available through this program include ex vivo (out of body) and laparoscopic liver surgery.

Among the conditions within the expertise of the program include primary and metastatic liver tumors and benign and malignant obstruction of the bile ducts. The hepatobiliary program has emphasized the management of benign and malignant disease with minimally invasive surgical techniques. This allows patients to undergo major hepatic surgery with a 36-hour hospitalization. The program also prides itself on the ability to manage those advanced malignancies referred out by other major institutions, including large hepatocellular carcinomas (liver cancers), hilar cholangio-carcinomas (bile duct cancers in the middle of the liver) and vena cava tumors (tumors of the major blood vessel). New technologies have also been introduced and refined at the University of Cincinnati. These include the introduction of radiofrequency ablation of tumors (burning of unresectable cancers) and isolated hepatic perfusions. This is a surgical procedure that allows treatment of unresectable liver cancer with hyperthermic (heated) chemotherapy at superhuman doses. This group was the first to treat such patients in the United States outside of the National Institutes of Health and has seen an increased survival rate of six months to two years and a cure rate of 25% in three years.

UC Liver Transplant Program

The University of Cincinnati Liver Transplant Program has been revitalized, with more adult liver transplants performed in Cincinnati over a six-month period during the past year than in the other four Ohio liver transplant programs. As a result, many more patients have been removed from the waiting list and returned to a normal life. Both allograft and patient survival have been excellent, exceeding national averages.

This increase in transplant activity has occurred largely due to the more aggressive recruitment of local and statewide organ donors through the widespread use of "extended criteria donors." Whereas organ donors with advanced age, certain types of infections, containing high degrees of fat, among other factors, were previously not considered for liver donation, the new approach has enabled the acceptance of these organ donors by minimizing the time the donor is without blood flow as well as manipulating post-transplant immunosuppression drugs.

Within the next few months, the UC Liver Transplant Program will begin to perform adult-to-adult live-donor liver transplants. In this case, a relative (usually) who is exceptionally healthy has about 60% of his/her liver removed, which is then given to the recipient. The liver regenerates in both the donor and recipient. UC Surgeons were the first in Ohio to offer live-donor transplants to patients with liver disease.

In addition, more widespread use of donation after cardiac death (DCD) organ donors will be realized through the use of extracorporeal membrane oxygenation (ECMO), a technique that allows reoxygenation and revitalization of organs after death. UC Surgeons are one of only two groups in the world to use ECMO technology to prepare livers from DCD organ donors for transplantation.

The Division has developed a Therapeutic Drug Monitoring (TDM) Program with the TDM group at Children’s Hospital Medical Center. This collaborative effort has provided a new assay for sirolimus, which will replace the need to send samples to Mayo Clinic (72 hour turnaround) with an on-campus assay with a 24 hour turnaround, thus benefiting all transplant programs in the Medical Center.

During the oncoming academic year, plans include exploration of the surgical applications of laparoscopic and particularly robotic surgery. Robotic surgery holds the potential of the future, allowing highly complex pancreatic, biliary and liver surgeries to be performed with precision.

For more information, please call (513) 475 8787.