The Liver Transplantation Program in the Department of Surgery at the University of Minnesota Medical School is reaching significant milestones. 

Ten years ago, the Liver Transplant Program made a conscious commitment to improving transplantation outcomes to gain the necessary achievements for advancement. 

Led by the program's Surgical Director, Srinath Chinnakotla, MD, MCh, FACS, MBA, a professor in the Division of Transplantation and Executive Medical Director of Pediatric Transplantation at M Health Fairview, began engaging surgeons and experts in various specialties of the Medical School to collaborate in building up a comprehensive program. 

After years of incremental improvements, Dr. Chinnakotla and faculty surgeons (Drs. Raja Kandaswamy, Vanessa Humpreville, Timothy Pruett, Karthik Ramanathan and Andrew Adams) with Hepatologists and clinical teams at M Health Fairview performed 116 successful liver transplants in 2021 - a new record for the academic health system. 

Entering the 21st century with novel outcomes, he credits the team-oriented approach to care that no specialist can do alone. "Liver transplantation is a team sport," said Dr. Chinnakotla. "A surgeon is like a quarterback. You can throw the ball but need a receiver to catch it." 

Previously in 2020, the team performed roughly 75 liver transplants before increasing the record volume in 2021. 

Through multidisciplinary understanding, the program could take on more complicated cases from high-risk patients, including liver donations from those with hepatitis C, steatosis of the liver, and those who suffered a cardiac-related death. The treatment for hepatitis has also improved, attributing to increased acceptance numbers of related organ donations. 

"Leveraging our surgical experience, the organs we thought wouldn't be successful for patients, we are now making them work,” said Dr. Chinnakotla. "We are now expanding our indications for liver transplantation to include cholangiocarcinoma, colorectal metastasis and multi-organ transplants (combined heart liver). We also intend to use extended criteria livers to further our organ acceptance.” 

Post-Transplantation Survival Care

Recently, the Scientific Registry of Transplant Recipients (SRTR) published a report on liver transplant outcomes. The registry determined the Liver Transplant Program with the University of Minnesota Medical Center to have one of the most successful outcomes on survival after transplantation in the nation by SRTR criteria - 5/5 bars. A first for the program, only ~ 10% of transplant programs in the US achieve the rating. The University of Minnesota is the only program in Region 7 (MN, WI, IL, ND, SD) to achieve this status.

"Performing a successful transplant operation is just the first step," said Dr. Chinnakotla. "If the aftercare isn't sufficient enough, the patient could die in the ICU. The results truly speak for themselves. Our care teams provide outstanding care to our patients, which makes us a true hub of excellence."

Training the Next Generation of Transplant Surgeons 

The Department of Surgery offers a unique fellowship in transplantation. With the increased number of accepted organ donations, the department can train surgical fellows to perform liver transplants by participating in roughly 50 operations each year. Credentialed by the American Society of Transplant Surgeons (ASTS), fellows can also meet the guidelines in high volumes set by the ASTS for training requirements. 

The Liver Transplantation Program is preparing to start normothermic perfusion of donor livers, simultaneous sleeve gastrectomy and liver transplants in patients with Non-Alcoholic SteatoHepatitis (NASH).

"In the future, with expertise from Division Chief of Transplantation, Andrew Adams, MD, PhD, we hope to initiate tolerance protocols for patients receiving liver transplants,” explained Dr. Chinnakotla. "The bottleneck in the field of organ transplantation is organ availability and Xenotransplantation holds a bright future for the field.”