In this video, leaders from the WashU Medicine and Barnes-Jewish liver transplant program discuss how innovation and collaboration are advancing the field of liver transplantation. William Chapman, MD surgical director of the transplant program, shares insight into emerging work in xenotransplantation and other research aimed at addressing the global organ shortage.
Adeel Khan, MD highlights the program’s leadership in robotic liver transplantation—including performing the first robotic liver transplant—and the team’s commitment to training the next generation of transplant surgeons.
Majella Doyle, MD discusses evolving approaches to complex liver cancers, including hepatocellular carcinoma and colorectal liver metastases, and how multidisciplinary care is expanding treatment possibilities for patients. Together, these leaders are helping shape the future of liver transplantation through innovation, research, and education.
We are a unique transplant center in a lot of ways. We've been involved in the transplant arena for a long time with the first kidney transplants done in the late 60s and 70s. We were one of the first liver transplant programs. The same is true for heart and the same is true for lung. Our whole field is being driven forward by technology and you know the core is still patient centered care, but because of blending technology and innovation we've been able to enhance that care and I think that's something that robotics is a part of. It's a part of the technological revolution. We were the first center in the country to do a robotic liver transplant, so that is. Something that we have really helped propel forward as technology has advanced, we've been able to incorporate additional features to the robotic platform, so it's not just fine, meticulous operating, it's also using imaging to see better, using feedback on how we move, incorporating ultrasound to be able to do. Things that we have not been able to do before. One of the things that we have seen is that the indications have not just expanded where we are doing complex cases, but we are able to offer these operations to patients who otherwise would not be candidates for transplant. So with robotics we're able to address that a lot more effectively. I was at the office and had some severe back pain. I'd had it before, a couple of months before that, and I didn't go to the hospital, but this time it was really bad. The nurse practitioner there pretty quickly after looking at my blood work, wanted me to get CTs and then I think it was pretty obvious, you know, I had a tumor in my colon. That had spread to 50% of my liver. Doctor Kingham took a second look at my scans, and he wanted me to come visit with Doctor Doyle, uh, here at Saint Louis. And then quickly after that, Doctor Doyle, Doctor Chapman started getting me ready, uh, doing the workup for a transplant. When we are assessing patients, you know, if they are felt to have an indication for a liver transplant, they first undergo comprehensive evaluation where they meet with the transplant hepatologist, the surgery group, and the rest of our multidisciplinary team. Liver transplant is a great model for multidisciplinary care. None of us would have success without one another, so we collaborate very closely with transplant surgery, with our nurse coordinator teams, with anesthesiology, as well as the finance and social work teams to help serve our patients in the best way possible. We have taken a very aggressive approach when it comes to transplantation for cancer, and I think not only were we one of the very few numbers of centers in the US transplanting for advanced, um, hepatocellular carcinoma. One of the first in the US to start transplantation for colorectal metastasis as well as intrahepatic cholangiocarcinoma. So really all of the cancers that even transplantation has been conceived of, we have been at the forefront. There's a plethora of cancer research that goes on. The people who are doing the bench-based research and then bringing it to clinical research both in, uh, Siteteman Cancer Center and at WashU Medicine. I see us being able to treat organs that come from donors. I see us being able to potentially grow organs. I see us being able to try to minimize immunosuppression based on genetic modifications that can be made to organs. We are getting ready to start a trial looking at the use of genetically modified pig organs uh on a profusion system to help support patients who have acute liver failure but cannot receive uh a transplant. The future generation of transplant surgeons has always been a core value for our program. We've had a long history of training some of the best transplant surgeons, and that's a tradition that we do take very seriously. And that also means that we have to constantly change and evolve so that the surgeons that we are training are not just excellent transplant surgeons, but they are well rounded in all facets of transplant so they can better take care of their patients. The changes that happen with transplant are way more dramatic. You take patients who almost always have a pretty shortened life expectancy without a transplant, and 1, you give them back what should be a full life. And 2, the quality of life they have is dramatically improved. I want to say it was 22 months, 24 months was kind of my, my scale for how long I'd be alive. It took a while to soak in and get the motivation to go fight, you know, I was ready for that fight and I was going to do what it took to, to beat this. I get to be more involved in my wife and my daughter's life. If I'm not on chemo, I don't have to sit in the car as much during soccer games or horse riding. I get to go out, you know, have the strength to, to go watch. So I'm pretty excited about that.
