Duke Liver Transplant Program

Overview

The Duke Liver Transplant Program, part of Duke University Health System, is recognized nationally for its comprehensive, patientcentered approach to liver disease and transplantation. With a multidisciplinary team that includes transplant surgeons, hepatologists, anesthesiologists, nursing staff, social workers, and dietitians, the program delivers care from initial evaluation through longterm followup.

Why Choose Duke?

• Experience: More than 2,500 liver transplants performed since the programs inception.
• Research & Innovation: Ongoing clinical trials in organ preservation, immunosuppression, and regenerative medicine.
• Comprehensive Services: From pediatric to adult transplantation, including livingdonor and splitliver procedures.
• Accreditation: Certified by the United Network for Organ Sharing (UNOS) and the Joint Commission.

Conditions Treated

The program evaluates and treats patients with a broad spectrum of liver diseases, such as:

• Cirrhosis (alcoholrelated, viral, nonalcoholic fatty liver disease)
• Acute liver failure
• Primary biliary cholangitis and primary sclerosing cholangitis
• Hepatocellular carcinoma (within transplant criteria)
• Metabolic liver disorders (e.g., Wilson disease, 1 antitrypsin deficiency)

Evaluation Process

Admission to the transplant list begins with a thorough evaluation that includes:

1. Medical Assessment: Full physical exam, imaging (CT/MRI), liver biopsy if needed, and cardiac workup.
2. Laboratory Testing: Blood type, viral serologies, renal function, and psychosocial screening.
3. Psychosocial Evaluation: Assessment of mental health, support systems, and ability to adhere to posttransplant medication regimens.
4. Financial Counseling: Review of insurance coverage, outofpocket costs, and assistance programs.

Patients who meet the criteria are placed on the UNOS waiting list and receive regular updates regarding organ offers.

Surgical Techniques

Duke surgeons employ the latest techniques to maximize graft function and patient outcomes:

• Standard Orthotopic Transplantation: The diseased liver is removed and replaced with a whole donor organ.
• LivingDonor Liver Transplant (LDLT): A portion of a healthy relatives liver is transplanted, offering faster availability and reduced waitingtime mortality.
• SplitLiver Transplant: One donor liver is divided to serve both an adult and a pediatric recipient.
• Machine Perfusion: Exvivo preservation to improve graft quality, especially for marginal donors.

PostTransplant Care

Success after transplantation depends on vigilant longterm management:

• Immunosuppression: Tailored regimens using calcineurin inhibitors, antimetabolites, and steroids to prevent rejection while minimizing side effects.
• Monitoring: Frequent lab work, imaging, and liver biopsies in the first year, followed by less intensive surveillance.
• Lifestyle Guidance: Nutrition counseling, exercise plans, and alcohol avoidance.
• Support Services: Access to transplant coordinators, mental health professionals, and patient support groups.

Research Highlights

Dukes transplant surgeons collaborate with the Duke Clinical Research Institute on groundbreaking studies, including:

• Alternatives to traditional immunosuppression, such as belataceptbased protocols.
• Genomic profiling to predict rejection risk.
• Stemcell therapies aimed at reducing the need for lifelong immunosuppression.
• Outcomes of pediatric LDLT and longterm quality of life.

Results are regularly published in peerreviewed journals and presented at international conferences, reinforcing Dukes reputation as a leader in transplant innovation.

Patient Stories

Realworld experiences illustrate the impact of the program:

After months on the waiting list, I received a livingdonor liver from my sister. The team at Duke made the process clear and compassionate. Today, Im back to work and feeling healthier than ever. Mark S., 42

My 9yearold daughter received a splitliver transplant. The surgeons explained every step, and the nurses supported us nonstop. Shes thriving and back to school. Laura K., mother

Getting Started

To begin the referral process:

1. Ask your primary gastroenterologist or hepatologist to send a referral to Dukes Transplant Center.
2. Call the transplant intake line to schedule a diagnostic workup.
3. Gather previous medical records, imaging, and a list of current medications.
4. Prepare for a team meeting where your case will be reviewed and discussed.

The multidisciplinary team will guide you through each step, ensuring you have the information and support needed to make informed decisions.