March 17. 2014 2:00AM

Medical College doctor makes major strides in liver transplant medicine

By Dan Shafer

  
Under the leadership of Dr. Johnny Hong, great strides are being made in the field of solid organ transplants at the Medical College of Wisconsin.
Dr. Johnny Hong, director of the Solid Organ Transplantation Joint Program

He serves as director of the Solid Organ Transplantation Joint Program, a collaborative effort among Froedtert Health System, the Medical College of Wisconsin, Children's Hospital of Wisconsin and the BloodCenter of Wisconsin, all located at the Milwaukee Regional Medical Center in Wauwatosa.

Transplant center visits at the Milwaukee Regional Medical Center have nearly tripled over the past decade, and because of this growth, the center will be moving into the new, 480,000-square-foot building currently under construction at the medical centerand set to be completed in 2015. Arlene Wilson, chair of the Medical College of Wisconsin's We Care Fund for Innovation and Research, said surgery has driven the need for the new facility.
Froedtert & The Medical College's new building, currently under construction, will be home to the Transplant Center when it is completed in 2015.

Hong also serves as associate professor of surgery and holds the inaugural Mark B. Adams Chair in Surgery at the Medical College of Wisconsin. He joined MCW in 2012 after seven years at the University of California Los Angeles and now works as an administrator, teacher, and surgeon at MCW.

Hong will be overseeing the transition to the new Transplant Center as it moves into its new location and continues to grow.
Skeleton Liver Xray

"Our goal is to become a premier transplant center in the United States," Hong said.

Meg Bilicki, director of development, surgery, said Hong is among Milwaukee's "hidden treasures."

The Solid Organ Transplantation Joint Program, formed in 2012, is consolidating its adult and pediatric transplant practices and forging ahead in new research and education.

Liver transplants are among the areas in which advancements are taking place under Hong's leadership. Hong said MCW's liver transplant program became the first in Wisconsin to be accredited to do live donor transplants last December. Of the 6,000 transplants that take place across the country every year, Hong said, half are with a live donor. The Medical College of Wisconsin is one of the only places in the U.S. to offer this option.

While great strides have been made in the research, education, and clinical transplantation of the liver since the practice became standard 60 years ago, many challenges remain.

For all organ transplants, one of these major challenges involves the waiting list. The number of people on the waiting list for a liver is increasing, Hong said.

There is a huge gap of roughly 90,000 people who need an organ, but won't get one, every year. About 17,000 people are on the waiting list for a liver, with an estimated 6,000 available. Every year, 3,000 people die waiting for a liver, Hong said.

Another rising challenge of the liver transplant waiting list is that there are "fewer ideal donors because of alcohol and obesity," he said.

Outreach is currently taking place, along with the Blood Center of Wisconsin, to spread the word about the need for more organ donation to prevent further shortages. Hong noted that in Spain, all citizens are organ donors.

On the Blood Center of Wisconsin's YouTube channel, there is a video titled "Laura's Gift of Life" that shares the powerful story of a life saved by a liver transplant.

Liver transplants differ from other solid organ transplants. With kidney transplants or heart transplants, there are certain procedures – dialysis, for example – that can be used to treat a patient before an organ is available. That is not the case with liver transplants.

Subsequently, the waiting list for a liver transplant is different, as well. Whereas the wait for a kidney transplant is currently three to four years for each patient, a donated liver is allocated based on medical urgency, Hong said.

Another differentiation of liver transplants is the "unique ability of the liver to regenerate," he said.

Transplants can be done with a whole organ from a deceased donor and from a partial organ from a living donor. Whole and partial donor recipients have a similar survival rate.

This allows for different types of transplants to take place and presents a different set of challenges and opportunities in transplantation advancement.

Hong performed the first split organ transplant in Wisconsin last May, where half of the donated organ went to an adult woman, and the other half went to a child.

Transplant patient care "takes a village," Hong said, with a huge amount of people involved in the recovery process for years after a transplant takes place.

One of the big challenges for any transplant program, he said, is that they are constantly evaluated on outcomes under federal oversight, and programs can be closed if outcomes aren't optimal.

In addition to transplant surgeries, MCW also does a great deal of transplant education and research under Hong's leadership. Currently, the research goal is to find a way for smoother blood flow back to an organ, he said.

Injuries and complications can stem from the interruption of blood flow and depletion of nutrients that occurs in the period between donor organ procurement, preservation and transplantation into the recipient.

Hong's system uses a mix of blood and nutrients to replenish the organ before transplantation. The system has shown encouraging results in studies at MCW's "state of the art" animal testing facility, Hong said, and is currently under patient review. Further studies are examining whether this system could be effective for lung and kidney transplants.

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