Liver transplantation program formed with an international team of experts

The School of Medicine has launched an ambitious new liver transplant program with a team of doctors recruited from across the United States and Europe.

David C. Cronin II, M.D., Ph.D., one of the world’s most experienced pediatric and adult liver transplant surgeons, joined the Department of Surgery in December 2003 as chief of the Liver Transplantation Program. An associate professor of surgery, Cronin came to Yale from the University of Chicago, where he performed or participated in more than 600 adult and pediatric liver transplants.

Cronin spent a year working to assemble a team of surgeons, anesthesiologists, nurses, social workers, dieticians, pharmacists and transplant coordinators. In addition, Mario Strazzabosco, M.D., Ph.D., medical director of the adult liver transplantation program at the Ospedali Riuniti di Bergamo in Italy, joined the Yale faculty in September as chief of transplant hepatology and professor of medicine. Strazzabosco, who trained as a fellow at Yale from 1987 to 1990 under James L. Boyer, M.D., Ensign Professor of Medicine and director of the Yale Liver Center, helped create Italy’s third-largest liver transplant program six years ago in Bergamo. Last year, the Bergamo program performed 90 liver transplants.

Cronin had previously recruited transplant surgeon Sanjay Kulkarni, M.D., from Chicago and anesthesiologist Stephen Luczycki, M.D., from the University of Rochester, one of the world’s busiest live-donor programs.

Between 1983 and 1998, there were 123 liver transplants performed at Yale, but the program was curtailed for re-evaluation after a series of poor outcomes. The revamped transplant service, the result of joint investment by the medical school and Yale-New Haven Hospital through the New Clinical Program Development Fund, listed its first patient in April and performed its first two liver transplants in July and a third in September. Cronin estimates that 10 liver patients will receive transplants by the end of December and another 20 during 2006, given the service’s current capacity.

A search is under way for a third liver transplant surgeon, and Robert Udelsman, M.D., M.B.A., the chair and Lampman Memorial Professor of Surgery and Oncology, expects the program to grow rapidly, to 60 liver transplants annually. Since few surgeons have Cronin’s experience with pediatric cases, Yale’s program is likely to become the first significant pediatric transplant program in New England.

More than 17,000 people are registered on the national waiting list for livers, including 1,121 in New England, according to the United Network for Organ Sharing. Only 6,169 liver transplants were performed in 2004 due to a shortage of donor organs. Cronin estimates that two-thirds of liver patients on the national list will die before an organ is available. It is Cronin’s goal to introduce live-donor transplants, a remarkable procedure in which a healthy donor gives only a portion of his or her liver to the patient.

“Liver transplantation is an extremely challenging operation,” Udelsman says. “It’s also the ultimate kind of transplantation in that the patient will not survive without the organ. Unlike kidney and pancreas [cases], where the patients have other options to keep them alive, these patients have no other options, and they will die from their disease. That’s why it’s so gratifying to see the operation being performed.”