The strength of UW Health’s Pediatric Liver Transplant Program is shown through simple data. Since the first transplant in 1984, surgeons have performed more than 270 pediatric liver transplants. According to UW Health, the program has excellent long-term outcomes, with 89% of patients having received a pediatric liver transplant between 2000 and 2009 surviving over 10 years.
The program is part of UW Health Transplant Center, which is one of just six centers in the nation, and the only one in the Midwest, that is certified and actively transplanting five organs — heart, kidney, liver, lung, or pancreas — for children and adults. The Pediatric Liver Transplant Program expanded its expertise and reach over several years to become even more effective, echoing UW Health’s strong legacy and history in organ transplantation.
In August of 2017, a liver transplant surgeon, David Al-Adra, MD, PhD, was recruited to add to the center’s experience with both pediatric liver transplants as well as living liver donation. Al-Adra is assistant professor in the Department of Surgery’s Division of Transplantation.
In November of 2019, the UW recruited a deeply experienced pediatric hepatologist with 35 years of experience in pediatric hepatology and pediatric transplant hepatology. That physician is Katryn Furuya, MD, professor in the Division of Gastroenterology, Hepatology, and Nutrition, who since her arrival has served as the medical director of the Pediatric Liver Transplant Program.
In 2020, the Pediatric Liver Transplant Clinic was relocated to the American Family Children’s Hospital (AFCH), and in 2022, a pediatric transplant surgeon, Kelly Collins, MD, associate professor in the Department of Surgery’s Division of Transplantation, became the surgical director for pediatric liver and kidney transplants after the retirement of Anthony D’Alessandro, MD, who was the surgical director of the Pediatric Liver Transplant Program from 2006 to 2022.
Through strategic structural planning, protocol development, and the recruitment of top-level clinicians, UW Health’s Pediatric Liver Transplant Program has today reached a remarkable level of success for its transplant patients.
Furuya had served as medical director for pediatric liver transplant programs at three other hospitals from 2002 until 2016, and then in 2016 joined the Mayo Clinic College of Medicine and Science in Rochester, Minnesota. She served there as associate professor and medical director of Mayo Clinic’s pediatric liver transplant program until the UW School of Medicine and Public Health Department of Pediatrics recruited her.
One month after Furuya joined the faculty, the first pediatric liver transplant under her watch took place. Before she arrived, it had been more than two years since the last pediatric liver transplant at UW Health. Since then, Furuya recounted, “We’ve done 14 in the five years I’ve been here. And the great news is that we’ve had 100% graft survival — and 100% patient survival.” The program is doing better than expected, as reflected in data in the Scientific Registry of Transplant Recipients (SRTR).
A recent pediatric liver transplant performed by the program encompassed much of the drama of many transplant stories — as all liver transplants are life-saving procedures. An adopted infant, Ellie, was found at four months of age to have a serious liver disease, biliary atresia, in which the bile ducts in the liver close off and are not able to transport bile from the liver to the intestinal tract.
Ellie’s family practice nurse practitioner had noticed her yellowish eyes at her four-month appointment and consulted with a physician. The parents were told to take her to the emergency department right away. Furuya, who was finishing her call week, had heard that the baby was coming in that Friday evening. “I’m here, I’ll go down and see them,” Furuya said. “That was when I first met the parents and Ellie.” After admission to AFCH for diagnosis and a subsequent operation to try to ameliorate her condition was not successful, a liver transplantation was proposed to save her life.
“The really great thing about working at the UW is that we do have a living donor liver program,” Furuya said. “Not all transplant programs have living donor programs. Without a living donor program, a patient has to wait for a deceased donor to come along.”
Ellie’s parents learned about the living donor program during her liver transplant evaluation. They inquired further about the program themselves and decided to be tested for a match. One of her parents matched and became a living donor for her liver transplant.
Furuya noted, “Generally speaking, a piece of a liver from a living donor, provided the donor is relatively young, usually results in better outcomes.”
Pediatric patients with suspected liver disease find their way to Furuya and the Pediatric Liver Clinic through many routes. She gets referrals from nurse practitioners and primary care practitioners who are family practice or pediatricians. They will refer children who have abnormal liver function tests. She also sees children who have fatty livers based on ultrasound findings, follow-ups from inpatient children with liver problems, and those from the NICU when they go home if they are jaundiced. Furuya sees most of the outpatient kids who have any sort of liver problem.
Family practice physicians and pediatricians have responded to the increased prevalence in children of what used to be called nonalcoholic fatty liver disease (NAFLD) — now known as metabolic dysfunction-associated steatotic liver disease (MASLD) — with focused attention to diet and exercise: getting those children to lose weight. MASLD can lead to cirrhosis of the liver over time. “Their liver disease is reversible,” Furuya said. “If we can get them to lose weight and change their lifestyle, it will have a profound impact on the rest of their lives.” She noted that she works with excellent dieticians at UW Health Kids. “I give them complete credit for helping with this issue,” she said. After Furuya does her workup and evaluation, she will often refer these patients to the Pediatric Fitness Clinic, which is composed of a team of dieticians, fitness coaches, health psychologists, and physicians.
According to Furuya, there are a number of reasons why children may require a liver transplant. Children may develop chronic liver conditions that lead to cirrhosis and end-stage liver disease and liver failure. Other children Furuya sees are referred by genetic/metabolic specialists. Those patients may have organic acidemias, urea cycle defects, or other inherited metabolic disorders in which enzyme deficiencies prevent the body from processing some proteins, carbohydrates, or fats, leading to toxic buildups in the body. Depending on the type of metabolic disease, a liver transplant may cure their disease or it may only stabilize their condition.
Other referrals are those children who are often seen in the emergency room in acute liver failure. When she sees such a patient, Furuya determines whether the child will get better on their own, or if she thinks a liver transplant is needed. After the patient is followed closely with blood work and other tests, Furuya and the pediatric transplant surgeon, Kelly Collins, decide whether the patient should undergo evaluation and subsequent listing for liver transplant.
Furuya chose pediatric hepatology 40 years ago because of one of her early mentors, a pediatric liver pathologist. “When I was a medical student, he was terrible in lectures, but in small groups and one-on-one you could just see the excitement and passion he had for pediatric liver disease,” Furuya explained, “and it was catching. I thought these diseases that affect children were very interesting. After I did my pediatric GI fellowship, I decided to focus on liver disease; this was before the existence of pediatric transplant hepatology training and qualifying examinations. So when these examinations were first required, I qualified to sit them based on my experience; so my pediatric transplant hepatology certificate is number 12.”
Furuya’s advice for physicians just starting out is simple. “I often tell young trainees, whatever you pick, make sure you’re passionate about it and that you love it, because otherwise it’s just a job,” she explained. “And if you’re looking after other people, it can’t be just a job. It is a calling for me.”
Furuya also does research, serves as a reviewer for journals, and publishes, and she often works on weekends. “I will do whatever it takes to help our program grow, to get it into national recognition across the U.S., and to help it continue into the future,” she said.
Photo by Kate Feldt/Department of Pediatrics