Tuesday, June 27, 2023

400 Liver Transplants & Counting

 Patrice Guilfoyle authored the following essay for UMMC. 

When Dr. Christopher Anderson performed the University of Mississippi Medical Center’s 389th liver transplant, his focus was on his patient, not what day it was. 

March 4, however, was the 10th anniversary of the day in 2013 when UMMC emerged from its 22-year liver transplantation hiatus by giving Jackson resident Karen Battle a life-saving organ. Her surgery began late March 4 and concluded in the wee hours of March 5. 

“I’d had a conversation with a couple of people a week or so earlier. Dr. (Mark) Earl said, ‘You realize what’s coming up,’ and I said, ‘Yes, of course I do,’” remembered Anderson, the James D. Hardy professor and chair of the Department of Surgery and chief of the Division of Transplant and Hepatobiliary Surgery. 

“That Monday morning, I woke up and put two and two together, but the day we did the surgery, I didn’t even think about it.” 

A decade after Battle’s surgery – she’s healthy and doing well today – the Medical Center performed its 400th liver transplant May 28. It’s the latest milestone in abdominal transplant at the state’s sole academic medical center. 

They include: 

Anderson was recruited in 2011 to jump-start a liver program that had gone by the wayside after faculty and supporting providers dwindled. He built a stellar team for the Division of Abdominal Transplant and Hepatobiliary Surgery, beginning in late 2012 with the hiring of Earl, now professor and surgical director of liver transplantation. 

When he accepted the job, Anderson knew access to liver care in his home state was all but non-existent. “But I’m not sure I fully appreciated the degree of it. That hits you in the face when you get here,” he said. 

“There were all these patients showing up with late-stage liver disease, late-stage liver cancer, complex liver issues. Their local doctors were doing the best they could do. 

“In those first few years, I would describe to colleagues around the country some of these very complex patients that we were seeing and how we handled them, and they said, ‘We’ve never seen this,’ or ‘We’ve only read about that.’ I would say, ‘This is just Monday in Mississippi.’ 

“Today, we are the only place in the state that offers transplant, and if this program wasn’t here, not only is there no access to liver transplant care, but there’s no access to liver care,” Anderson said. 

Waiting at UMMC for Anderson was Dr. Ashley Seawright, a nurse practitioner recruited in 2007 to help with the kidney transplant program. Her passion would prove invaluable in the revitalization of the abdominal transplant program. 

“I helped him build the hepatobiliary program and start the first conference to review cancers in surgical cases,” Seawright said. “From that, we grew the liver program.” 

“Ashley is the master of operationalizing things and ideas,” Earl said. “I don’t know if we could have done it without her.” 

“I don’t think a single one of us went into this thinking that we were here to be a rock star,” Seawright said. “We did it to provide the services that people need. The patient is the rock star.” 

The abdominal transplant team expanded to include Dr. James Wynn (2014), professor of transplant surgery; Dr. Felicitas Koller (2017), associate professor of transplant surgery; and Dr. Praise Matemavi (2020), assistant professor of transplant surgery. 

The state’s only hepatologist was recruited in 2012 in order to start the program. But a huge boost came in 2020 with the recruitment of Dr. Laura Smart and Dr. Joydeep Chakraborty, both assistant professors in the Division of Digestive Diseases, with Smart leading the hepatology team. 

The hiring of Smart and Chakraborty “has been the biggest game-changer for how easily people can access care in our system, and a byproduct of that is more transplants,” Anderson said. “Part of their job is to prevent some patients from progressing to transplant, and delay progression in others.” 

The Medical Center in 2020 recruited its first dedicated transplant infectious diseases team. Dr. Prakhar Vijayvargiya and Dr. Zerelda Esquer Garrigos work with the transplant team to manage the care of that infection-prone population, including patients with HIV. 

The program grew its liver transplant patient coordinators, who include registered nurses Lacey Dungan, Anna McGraw, Taylor Tadlock and Sam Book. Dungan and McGraw hold transplant coordinator certification through the American Board for Transplant Certification. 

Today, abdominal transplant clinics are held in Jackson, Hattiesburg and Grenada, allowing pre- and post-transplant patients to receive a substantial part of their care closer to their home. 

“You can’t really talk about the successes of our program without roping in the clinics,” said Dean Henderson, the administrator of transplant services. He was hired in 2013 to provide structure and help grow liver transplant. 

“We get attention for the surgery, but it’s those other groups of people who take care of the patients,” Koller said. “It’s an entirely different thing to have a comprehensive liver program, and it’s become much more sophisticated.” 

The liver transplant reboot saw 17 more transplants in 2013, growing to 23 in 2014. Last year, it was 50, and so far this year, 24 as of June 21. 

The night of Battle’s transplant, she was in the ICU and extremely ill with acute liver and kidney failure, making her very frail and high risk for surgery. 

“I vividly remember Dr. Anderson and I standing in the hall in the transplant office, looking at each other,” Earl remembered. “We thought, ‘She is so sick.’ I said, ‘Are we open for business, or are we open for business?’ And he said, ‘Let’s do it.’ 

“I took off on a plane that evening, brought the donor liver back, and it was a tremendous outcome. It sends chills up my spine.” 

More milestones followed, including UMMC’s first liver-kidney transplant in 2014; 100th liver transplant in 2016; first split liver transplant in 2017, in which two women shared a donor liver; first heart-liver transplant in 2018; 200th liver transplant in 2019; and 300th liver transplant in 2021. 

One of the early patients was Alenda Carmichael. In the weeks before her September 2014 transplant, she had no idea that her liver was going downhill fast. 

“A coworker said I didn’t look good, and suggested I go see a doctor,” said Carmichael, a Madison County resident who at the time was a paralegal. 

She went to her family doctor, who told her he wanted her to see a gastrointestinal diseases specialist. Carmichael scheduled a morning appointment. 

The specialist’s office called her that afternoon. “They said not to panic or rush, but that I needed to go to UMMC now, and they are expecting you. By the time I got to the hospital, my eyes were yellow.” 

She went from a regular floor bed to intensive care. “On a Thursday afternoon, the doctors and my liver transplant coordinator told me I was good to go for being on a transplant list,” Carmichael said. 

“They had a liver for me in four hours. I had the surgery the next day.” 

UMMC’s vast multidisciplinary liver care has been nationally recognized, with the transplant program’s outcomes in 2022 being listed in the top three by the Scientific Registry of Transplant Recipients, a federally controlled organization that compares 148 transplant centers nationwide. 

The program received acclaim when Seawright in 2018 was recognized by the American Society of Transplant Surgeons with its Advanced Transplant Provider Award. 

The state’s need for liver care is only increasing. “The rates of death in Mississippi from liver disease are not insignificant. The rates of death from liver cancer are not insignificant,” Anderson said. “Having a robust liver transplant program lends itself to an institution having expertise in liver cancer and other complex hepatobiliary cancers.” 

To expand UMMC’s program, “we need people. We need physicians. We need staff,” Earl said. “We need more managed care contracts with payors,” meaning more insurance companies making transplant at UMMC in-network for coverage. 

More providers and more transplants would at some point require more space on the Medical Center campus. “If this program were to go away, it would be a big public health issue for Mississippi,” Anderson said.  

“It’s not just about the surgery. It’s creating an ecosystem that these patients can thrive in,” Koller said. “We are developing a much more comprehensive care model, and we are getting people back to health and well-being.” 

Carmichael is grateful for the transplant team who surrounded her then and now. “God made me stronger for the last few months of my husband’s life,” she said of her spouse Mark, who died in 2015. 

“I absolutely adore him,” Carmichael said of Earl, her surgeon. “I always said when he entered my room, ‘I must be your favorite person.’ That’s how he treated me.” 

“We’ve built over the years an incredible team, from pre-transplant and post-transplant hepatology to pharmacy to nursing to social workers and more,” Earl said. 

“I don’t know if we are the best in the country, but I’d sure nominate us.” 


5 comments:

Anonymous said...

Great article. Good news. Fine team.

Kingfish said...

Don't know what a comment about covid vaccines has to do with this post so I'm not approving the comment.

Anonymous said...

Great for UMMC and the State.

Anonymous said...

This team is the best, infact, top 3 in the nation for liver transplants if memory serves me correctly. Right here in Mississippi. They and the unknown Donor saved my Dad's life in 2019 with his liver transplant. They are the most caring and empathetic team, which is exactly what my family needed. Liver disease is prevalent in Mississippi, and it is often NOT a result of alcohol consumption. My dad never had a drink in his life and found out he had cirrhosis in 2016 and then quickly went downhill and nearly died before his 2019 transplant. Even I, in my 30s have fatty liver and I do not drink, nor am I overweight. I say all this to tell you to keep a check on your liver and take care of it! I never want to see any of you go through what my Dad had to endure leading up to his transplant. God bless UMMC and that wonderful team that they have assembled.

Anonymous said...

My older brother lived in Jackson and had liver failure in 1992 after contracting Hepatitis C. He had to go to Baylor in Dallas for a liver transplant. There were ups and downs after that, but he was able to live long enough to raise his daughter, twelve years. Happy that Mississippi folks in his situation can be treated at UMMC.


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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).


Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.


In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.


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Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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