When 66-year-old Donna Terrell began suffering from aches and pains in spring 2005, she attributed it to stress from working long hours in the banking industry. But when she started vomiting blood, she realized something was seriously wrong.

Liver surgeons Dr. Nicholas Nissen and Dr. Andrew Klein lead a medical team dedicated to improving the outcomes of organ transplant patients at Cedars-Sinai Medical Center. (photo courtesy of Cedars-Sinai Medical Center)

The diagnosis, however, took her by surprise. Terrell had cryptogenic cirrhosis, an irreversible liver disease not related to any definable cause, such as alcoholism or hepatitis. A nondrinker who has never taken drugs or gotten a tattoo, Terrell did not have any of the risk factors that could increase her risk of cirrhosis, or severe scarring of the liver.

Nevertheless, in June 2006, she found herself at Cedars-Sinai Medical Center preparing for a liver transplant.

“I woke up in the ICU and could hear the ‘beep, beep, beep’ of the machines,” said Terrell, who underwent an eight-hour transplant surgery on June 14, 2006. “I looked up at the night sky through the window and knew I was going to be OK.”

According to a recently released national report by the Scientific Registry of Transplant Recipients, the Cedars-Sinai Comprehensive Transplant Center’s Liver Transplant Program had the best one-year survival outcome of all hospitals in California, with 96 percent of patients surviving beyond the one year. Kidney transplant and heart transplant patients also had excellent outcomes, with 97 percent of patients surviving past the one-year benchmark.

“These outcomes place Cedars-Sinai among the nation’s best transplant programs,” said Dr. Andrew Klein, the Esther and Mark Schumann Chair in Surgery and Transplantation Medicine and director of the Cedars-Sinai Transplant Center. “Our ability to successfully transplant complex cases of severe liver disease is due, in large measure, to the multidisciplinary integrated care provided by experienced, technically excellent surgeons and anesthesiologists working with a comprehensive post-transplant team. Patient care does not end after the surgery; it is only beginning.”

The program’s success is especially notable given the number of very ill patients undergoing transplants at Cedars-Sinai, said Dr. Nicholas Nissen, surgical director of liver transplantation at Cedars-Sinai. “One of the most important aspects of our growth and success has been the constant focus on improving the management of patients with severe liver failure who have only a few weeks to live. Most of these patients are in the intensive care unit and will not leave the hospital alive unless they get a transplant. We have worked hard to create a system that patients, family members and referring doctors can trust, from the point of referral until they have a new liver and are safely home.”

When a patient receives an organ from someone else during transplant surgery, the patient’s immune system may recognize the organ as foreign and attempt to reject it. Even years later, this can lead to transplant rejection, which is one of the reasons why aftercare is so important.

At Cedars-Sinai, liver transplant patients benefit from specialized treatment teams, such as a multidisciplinary surgical intensive care team focused on liver disease and dedicated transplant social workers who follow patients from their initial referral through transplant hospitalization and for the rest of their lives. Other key teams include those from the Transfer Center and Advanced Practice Nursing, as well as operating room support teams.

The hospital also offers in-patient and out-patient support groups and a buddy program pairing newly transplanted patients with others who have been through a similar experience and can help with guidance and reassurance.

To date in 2018, the team has completed 103 liver transplants, an increase in volume of almost 100 percent over the last three years. Looking to the future, Nissen said projects underway include expanded efforts to reach out to underserved communities and increased efforts to meet the national donor organ shortage by salvaging livers that previously had been discarded. Studies have shown that healthy organs from deceased donors with HIV or hepatitis C could save lives of patients who could die waiting for an organ. The team is also furthering research and developing new treatments for a wide range of liver diseases, including fatty liver disease, alcoholic liver disease and liver cancer.

For Terrell, who has not been readmitted to Cedars-Sinai since the transplant 12 years ago, the support she received has been essential to recovery. Terrell still has blood work completed every six months and a check-up once a year to ensure there are no problems.

“I am where I am today because of the care and support I received from the Cedars-Sinai team,” Terrell said. “My nurses and doctors became my family. They explained everything to me and they treated me like a person, not just a transplant recipient. If I needed to cry, they let me cry. Even today, before I take any medication, I contact the team to make sure it doesn’t interact with my anti-rejection medicine. I trust them with my life.”