Transplantation
Liver Transplantation
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| Mailing Address: |
750 Welch Road, Suite 215
Palo Alto, CA 94304 |
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| Contact Phone: |
(650) 498-7878
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| Fax Number: |
(650) 498-7888 |
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| Contact Email: |
kstandridge@stanfordmed.org |
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| Days and Hours: |
Monday-Friday
8:30 am - 4:30 pm |
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History
Goals of Liver Transplantation
Transplant Services
Resources in Our Community
History
Liver transplantation began at Stanford University in 1991 as part of the Multi-Organ Transplant Program. In 1995 Stanford established the current Adult Liver Transplant Program which has achieved impressive survival rates that surpass national norms. During the past nine years at Stanford, this team performed nearly 700 adult and pediatric liver transplantations at Stanford University Medical Center, with excellent survival rates. The total cumulative experience of Dr. Esquivel and his team in San Francisco and Stanford is now more than 1,350 liver transplantations. with excellent surival rates
High survival rates at Stanford reflect quality patient care.
- Prior to transplantation, the team carefully manages chronically ill patients, which contributes to enhanced recovery rates following transplantation.
The result is a marked decrease in hospital length of stay without compromising survival rates.
- Post-transplant, the team supports an extensive network of outreach clinics designed to provide specialized expertise in all liver-related services. Currently, 13 adult and 17 pediatric clinics exist throughout California, Nevada, Oregon, Washington and Hawaii.
This network reduces the need for patients to travel to Stanford for every procedure, and enables them to receive special care in their own communities.
Liver transplantation is now widely accepted as an effective treatment for a variety of irreversible acute and chronic liver diseases for which no satisfactory therapy is available.
In the face of the major changes in the delivery of health care, we also have been adopting measures to streamline the transplant process and contain costs without impacting on outcome.
- The mean length of stay after liver transplantation at Stanford is
- 16 days for children
- 10 days for adults.
- We now have more than 550 patients on our adult and pediatric waiting lists. Our combined surgical and medical inpatient liver service averages 8-12 patients on the adult program and 3-6 patients on the pediatric service.
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Goals of Liver Translpantion
The overall goals of liver transplantation are to prolong life and improve the quality of life. The selection of appropriate patients for liver transplantation to achieve these goals is crucial.
Liver transplantation is indicated for patients who have:
- Advanced chronic liver disease
- Fulminant hepatic failure
- Inherited metabolic liver disorders
- Hepatocellular carcinoma, when small and not spread beyond the liver
- No alternative form of therapy
- No absolute contraindication to liver transplantation
- A willingness and ability to accept liver transplantation, comply with follow-up care, and provide for the costs of both transplantation and post-transplant care
Adult liver transplantation indications and criteria for listing include:
- Presence of irreversible liver disease and a one-year life expectancy of less than 90 percent (i.e., mortality exceeding that of liver transplantation)
- A Child-Turcotte-Pugh score 7 (determined by assigning points based on the degree of elevation of serum bilirubin and prothrombin time, lowering of serum albumin, and degree of ascites and hepatic encephalopathy)
- Any episode of variceal bleeding or of spontaneous bacterial peritonitis, irrespective of the Child-Turcotte-Pugh score
Contraindications to liver transplantation at Stanford include:
- HIV seropositivity
- Extrahepatic malignancy (cancer somewhere other than the liver)
- Active untreated extrahepatic sepsis (infection)
- Advanced cardiopulmonary disease
- Active alcoholism or substance abuse
- Anatomic abnormalities precluding transplantation
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Transplant Services
In addition to standard cadaver liver transplantation for adults and children, Stanford now offers living donor liver transplantation (LDLT) and split liver transplantation. Stanford programs and services include:
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