New liver, new life 

UAMS transplant surgeon Youmin Wu, one of the state's best doctors, lets Arkansans be helped at home.

click to enlarge DR. WU: Liver specialist.
  • DR. WU: Liver specialist.

By the age of 13, Youmin Wu was living on his own, in Nanjing, in China's Jiangsu Province. It was 1968, the Cultural Revolution had begun, and his father (a former general in the People's Liberation Army) and his mother had been sent to work on a farm. He took care of himself through high school, and went to work in a movie theater and a factory while earning a college degree in mechanical engineering.

Then, when the revolution ended with the 1976 arrest of the Gang of Four, Nanjing Medical University opened for the first time in a decade. Only the best students got in. Wu was one.

His tough adolescence was good training, the director of the solid organ transplant department at the University of Arkansas for Medical Sciences said. “Never give up, keep trying,” is what he learned.

His tenacity paid off when University of Pittsburgh liver transplant pioneer Thomas Starzl visited Wu's medical school, where Wu had been made chief surgical resident the first day of his five-year residency. Wu asked Starzl if he could come to the United States to study with him; Starzl told him to ask again when he'd finished his residency.

“So the year before I finished my residency, I sent him a letter,” Wu said. In 17 days, by return mail, Starzl invited him to come to Pittsburgh, and said he'd gotten all the immigration documents taken care of. The speed of the response and arrangements still amazes Wu today.

So in 1987, his residency in China over, Wu went to America to learn how to perform liver transplant surgery, an operation once so iffy no one thought it would ever work, so bloody that doctors worked in rubber boots and patients required several liters for transfusion.

The liver is the largest gland in the body, a reddish, four-lobed lump weighing about three pounds. It breaks down fats, filters toxins from the blood, produces cholesterol and blood clotting factor. Blood is carried to the liver by the hepatic artery and the portal vein, each of which splits off into smaller vessels and capillaries. Blood is carried from the liver to the heart by the vena cava. Early transplant technique involved the dissection of the vena cava to remove the diseased organ.

In an interview, Wu repeated a story told at a recent meeting in Pittsburgh honoring Starzl. Starzl's British counterpart, Sir Roy Calne, recalled an operation in which a surgeon awash in blood called a hematologist on the phone to tell him to come quick to the OR. Which OR? the hematologist asked. I don't need to tell you which OR, the doctor yelled, the blood is pouring out from under the door.

“The bleeding was crazy,” Wu said. Changes in technique — including Wu's own invention — and the introduction of the immunosuppressant drug Cyclosporin improved survival rates from 35 percent in the 1960s and '70s to 85-to-90 percent today.

In 1993, Wu completed his landmark post as Pittsburgh's first Chinese surgeon and moved to the University of Iowa to head the department of transplant surgery, and was on his way to racking up a 10-year record of surviving pediatric patients when UAMS came calling.

In 2002, UAMS' then-new chief of medicine Dr. Albert Reece announced he wanted to start a first-rate liver transplant program at the hospital, a “magnet program” that would attract patients from across the nation and allow Arkansas's liver patients to be cared for close to home. The start-up would require careful planning, certification from UNOS (United Network for Organ Sharing), hiring of new staff, and the promise of reimbursement, which it got from Arkansas Blue Cross/Blue Shield and Medicaid. It also required a first-rate surgeon, and UAMS set its sights on Wu.

Several things set Wu apart from his colleagues. Besides his records for youngest surviving patient (18 days), oldest surviving patient and successful transplant of the oldest donor liver, Wu was the inventor of a surgical technique called cavaplasty. The procedure spares the cava and allows an easier hepatectomy (removal of the liver), avoids a blood flow complication that other techniques risk, and reduces bleeding. The technique is so new it has not yet become standard, but it's been picked up by other institutions and will one day be standard, Wu says.

Wu liked Arkansas and UAMS and arrived in 2004. He began the training of the 30-plus members of his surgical team, traveled all over Arkansas talking to doctors and hospitals about the procedure and performed Arkansas's first liver transplant on May 14, 2005. The recipient, Greg Gilliland, 56, of Hot Springs, is healthy today.

Since Gilliland, Wu has performed 20 liver transplants, all with good outcomes (though one patient died in a car wreck just weeks after the surgery). Half of his patients required no blood transfusions at all, and the other half required an average of less than one unit — a statistic that unpublished data gathered by Wu puts UAMS ahead of all other teaching hospitals in the nation.

When UAMS announced its hiring of Wu, there were 100 Arkansans on waiting lists around the country. Today, there are 13 people on UAMS' list, and the average wait is three months. The number of patients will no doubt grow after it gets Medicare approval, which requires a 70 percent survival rate in at least 12 cases a year post-op, a milestone UAMS should have no trouble reaching next November.

To allocate livers, UNOS divides the country into regions (Arkansas falls in Region 3 with Louisiana, Mississippi, Alabama and Georgia) and allows the distance between patient and transplant center to be taken into account. Status 1 patients — those whose livers are failing and are close to death — trump all others on the waiting list, no matter the distance. (Wu has operated on one such patient at UAMS; the patient went home after four days.) Other patients are chosen based on organ match and MELD (medical end-stage liver disease) score; Arkansans with high MELD scores take priority over others with the same score if the livers are recovered in Arkansas.

In Region 3, there were 1,002 candidates for liver transplants as of March 24. (There are more than 17,000 nationally.) Dr. Bill Fiser, medical director of ARORA (Arkansas Regional Organ Recovery Agency), said 50 livers were recovered in 2005 in Arkansas.

“Dr. Wu has excellent outcomes,” Fiser said. “His time in surgery is short, which means the liver gets blood flow back in quicker time … it makes a huge difference in superior outcomes.” Wu's record is “much better than the national average.” Wu's time record for a liver transplant: 2 hours and 6 minutes. (He's averaged 4 hours at UAMS because of the newness of the surgical team.)

Alcohol, Hepatitis C and cancer account for much liver disease; alcoholic candidates must convince their doctors that they have been sober for a certain period and will remain so should they get a new liver. “If I have 4,500 livers, I want to save 4,500 people,” Wu said.

Surviving the operation is one thing; surviving with the new organ is another. Transplant patients are left vulnerable to infections from the immunosuppressant they take to hinder rejection of the organ.

Wu has his sights set on this problem, also. A study in Japan found that half of a group of transplant patients five years out from surgery who'd quit taking their immunosuppressants were doing fine without them. “We still don't know how to tell” patients who can tolerate foreign organs from those who can't. But, he said confidently, “in the future we will,” making for better quality of life for patients.



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