UW Hospital Surgeons Perform Rare Domino Organ Transplant

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Doctors in surgery; UW Hospital surgeons perform first "domino" organ transplant in WisconsinMADISON - Eino Ahlgren was told he only had a few months to live. Joe Stoikes couldn't understand why he was having heart problems when he felt fine.

On Sunday night, transplant surgeons at University of Wisconsin Hospital and Clinics saved them both, performing a rare "domino" organ transplant, the first in Wisconsin history.

Both patients are doing well and recovering at UW Hospital and Clinics.
Anthony D'Alessandro, MD, director of UW's liver transplant program, took
a deceased-donor liver and placed it into Stoikes, a Madison patient who suffers from Familial Amyloid Polyneuropathy (FAP), a rare condition in which amyloid protein deposits build up in the liver and damage nerves, the gastrointestinal tract and the heart.
Stoikes' liver was then transplanted into Eino Ahlgren of Waukesha, who was dying of complications caused by a decades-old case of hepatitis-C.
Three transplant teams were needed to pull the domino sequence off: Luis Fernandez, MD, handled Stoikes' transplant and Joshua Mezrich, MD, handled Ahlgren's surgery. The entire sequence took more than 12 hours.

The surgeries resulted in some unusual developments—neither patient required any blood transfusions during surgery—as well as a few unusual challenges.

"From a technical perspective, a transplant like this is very different than a standard liver transplant," explains Dr. D'Alessandro. "You really have to focus on preserving the FAP liver. Normally, we don't worry about preserving blood vessels in the liver, but in a case like this we absolutely do."

Domino transplants are quite rare in the United States, representing only .1 to .2 percent of liver transplants done each year. According to the United Network for Organ Sharing (UNOS), there have been only 10 done in 2009 and only 100 since 1996. This is the first time one has been performed in Wisconsin.

Ahlgren, 58, is a retired pipefitter from Waukesha who'd had several brushes with death as a result of the hepatitis C infection he caught while serving overseas in the military. On two separate occasions, his esophagus began to bleed and had to be surgically repaired. At the time of his transplant, Ahlgren was bordering on liver failure.

"We knew this kind of transplant was rare," Ahlgren says of his unusual transplant. "We just didn't know how rare. It boggles my mind how lucky we were to have this happen." Two days after his procedure, his wife Beth was looking forward to watching him enjoying his first cheeseburger.

Because of the genetic abnormality in Stoikes' liver, there's a small chance that Ahlgren may develop FAP himself in 20-30 years, but compared with the alternative, Ahlgren was more than willing to take the risk.

Stoikes, meanwhile, seemed perfectly healthy when some abnormal readings on a routine physical suggested something was wrong with his heart. Five confusing months of appointments later, doctors finally reached a diagnosis: FAP, a condition that can only be treated through liver transplant.

"I was devastated," recalls Stoikes, a Madison cabinet-maker whose company manufactured the cabinets in the patient rooms at UW Hospital and Clinics. "And at first, I had no idea what it meant."

Now Stoikes understands that the liver transplant he got has halted the progression of a disease which would have eventually killed him. When the transplant team asked him if he'd like to donate his liver, he didn't hesitate.

"Mr. Stoikes' symptoms were mild, so this was a good time to do the transplant," says Dr. D'Alessandro. "If we hadn't done the transplant now, his symptoms would have worsened, and a liver transplant would have been less effective in stabilizing him."

Like Ahlgren, Stoikes is looking forward to recovering and resuming a healthy life, spending time with his wife, Toni, his son, Adam and his daughter Jess…and maybe getting in a little bow-hunting this winter.

Date Published: 09/24/2009

News tag(s):  luis a fernandezanthony m dalessandrotransplantjoshua d mezrich

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