“I was sort of running out of steam,” Fleming said. She


began to retain so much fluid in her legs that her shoes no longer fit. In 2010, she sought care at Froedtert & The Medical College through the Gastroenterology and Hepatology Clinic, and was subsequently evaluated by the physicians of the Liver Transplant Program.


Fleming, like all patients referred to the program, received


a comprehensive evaluation. During that process, diagnostic scans detected a cancerous tumor on her liver. Cancer was a setback for Fleming, but it ranked her higher on the transplant waiting list.


“Although having a liver tumor can position a patient


higher on the transplant list, if it grows too large, the patient may no longer be a transplant candidate,” said Robert A. Hieb, MD, FSIR, a Medical College of Wisconsin vascular and interventional radiologist. Therefore, these patients often undergo treatment. Treatment is typically either therapy with radioactive microspheres or, as in Fleming’s case, high-dose chemotherapy, delivered directly through an artery to the tumor. Her response was good, and the tumor shrank significantly.


Fleming then began to prepare in earnest for a transplant.


complete transplant team The liver transplant team includes hepatologists, surgeons,


radiologists, specialized transplant nurses, physician assistants, psychologists, a pharmacist, plus dietitians, social workers and financial liaisons. In addition to extensive medical testing and psychosocial assessment, the transplant team focuses on readying patients for surgery and optimizing their opportunity for a successful procedure and a good recovery. Smoking cessation and abstinence from alcohol and recreational drugs are critical. The team also emphasizes good nutrition and physical fitness.


Fleming met with David Cronin II, MD, PhD, FACS, a Medical College of Wisconsin transplant surgeon and


director of the Liver Transplant Program at Froedtert & The Medical College of Wisconsin since 2008.


“He told me I should take care


of myself and lose weight for optimal health,” Fleming said. “On the way home, I stopped at Weight Watchers and joined the YMCA.” Fleming worked hard for weeks, and it paid off. The day she hit her 25-pound goal was the same day she received the late-night call informing her that a donor liver was available.


n david cronin ii, md, phd, facs


exceptional outcomes Dr. Cronin understands what makes a transplant successful. “Performing a liver transplant is doing the highest level


of surgery on the sickest patients,” Dr. Cronin said. “It’s technically and intellectually demanding, incorporating medicine, surgery, immunology and pharmacology.


“The key to a good outcome,” he said, “is comprehensive


management of the acute and chronic complications that occur before and after transplantation.”


This attention to detail makes a difference. Nationally,


89 percent of liver transplant patients survive a year or longer after their procedure. For transplants performed by the Froedtert & The Medical College team, patient survival is 95 percent (www.ustransplant.org, July 2008 – Jan. 2011).


Great expectations When Fleming arrived at the hospital, the transplant


team was in full swing. She was prepped for surgery, waited for several hours and, at 10:30 a.m., was brought to the operating suite. Dr. Cronin and the team operated for more than seven hours.


Managing Kidney Failure and TransplanT Patients with kidney failure typically rely on dialysis to cleanse toxins from their bloodstream. Some see


kidney transplant as a last resort, but most patients would benefit greatly from a transplant first approach. “Kidney dialysis is a life-saving therapy, but it is usually not the best long-term solution,” said Christopher


n christopher johnson, md


Johnson, MD, a Medical College of Wisconsin transplant surgeon and director of the Kidney Transplant Program. A typical patient undergoes dialysis three times a week for three hours each session. That’s nine hours of treatment per week, but during the remaining 159 hours toxins are building up in the body,” he said. “In just a few years, this takes a heavy toll on the heart, blood vessels, nerves and many other systems.”


“Early kidney transplant allows patients to avoid these complications, and data shows they will live longer than people who have dialysis for several years before transplant,” Dr. Johnson said. The Kidney


Transplant Program at Froedtert & The Medical College of Wisconsin is a national leader in quality and outcomes. The three-year kidney graft survival rate for patients in the program is 92 percent – about 6 percent higher than the national average. The program is currently No. 1 in the country for risk-adjusted three-year outcomes for centers that perform 80 or more transplants per year. There are about 70 such centers in the United States.


“One reason for our success is our comprehensive care team of nationally recognized nephrologists, transplant surgeons and specialized staff who work together, making sure patients receive optimal care,” Dr. Johnson said. n


12 Froedtert Today January 2012 froedtert.com


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