Getting a New Liver
Trio of liver transplant experts provides woman seamless care for more than a decade
It had been a while since Kim Lumpkins had a regular physical exam. So during a visit to her internist after a knee injury, the doctor urged her to take time for routine blood work.
"I knew something was wrong when she called me later and asked me if I was feeling okay," the Oak Lawn resident remembered. Test results showed elevated enzymes in her liver.
Getting that unexpected news began a 13-year journey from diagnosis of two autoimmune liver diseases in 1999 to a liver transplant in 2012. Along the way, the wife and mother of two girls says that "it took a village" of physicians, nurses and family members to care for her and help her through.
Managing an Uncommon Condition
Hepatologist Donald M. Jensen, MD, was one of the first specialists to see Lumpkins. Jensen, who is director of the Center for Liver Diseases at the University of Chicago Medicine, has been caring for liver transplant patients since the lifesaving procedure first became available 35 years ago.
Lumpkin’s diagnosis was challenging. An overactive immune system was attacking her bile ducts and her liver cells. Jensen identified two immune-mediated diseases -- primary biliary cirrhosis overlapping with autoimmune hepatitis. While neither illness is rare by itself, they are seldom seen together in the same patient.
Jensen informed Lumpkins that although her condition was not curable, inflammation could be adequately controlled for a long time with immunosuppressive medications. However, he said, the disease would gradually progress and, in ten to 15 years, she would need a liver transplant.
"The medications worked to slow things down," Lumpkins said of the time period after her diagnosis. "I stayed strong, exercising and eating healthy. Still I felt the fatigue and had to pace myself. I knew I was getting worse, but I didn’t let that stop me from doing what I would normally do."
Eventually Lumpkins started to get fevers due to infections in her bile ducts. She was in and out of the hospital. And then on a bright spring day in 2011, one of her daughters observed the sun shining on her mother’s face and said, "Mommy, your eyes are yellow."
Lumpkins’ liver was retaining bile and causing jaundice. Soon after, failure of the bile ducts brought on extreme itching, which affected her all over, "from the top of my head to my toes." Jensen confirmed what Lumpkins suspected: "Kim, you are on the way to transplant."
Expanding the Donor Pool for Transplant
Jensen transferred her care to his colleagues, transplant hepatologist Helen S. Te, MD, and transplant surgeon, John Renz, MD, PhD.
Te had cared for Lumpkins during several of her hospitalizations so was familiar with her medical course. "I knew this was coming," she said. "At this point, my role was to keep Kim clinically stable so she’d be in the best physical shape possible for transplant and recovery."
While several family members, including her daughters, offered to be living donors, none were found to be compatible. Lumpkins was placed on the liver transplant list in August 2011.
Although the illness was progressing and symptoms were worsening, her type of disease did not place Lumpkins high on the transplant list. "We were very concerned about how Kim was doing relative to her position on the wait list," Renz explained. "So we explored all available options to get her a donor liver." In a pivotal study, Renz showed that organs that do not meet the usual conditions for transplant still could be healthy enough for successful transplantation. He would use his experience to expand the acceptable donor pool for Lumpkins.
On two occasions, the transplant team called their patient about a potential donor liver, but soon determined the organs were not suitable for her. But on March 1, 2012, Renz called Lumpkins at 3 a.m. and told her, "Kim, I’ve got a liver and this one is yours. It looks good." With bags already packed, she and husband, Rick, arrived at the medical center less than an hour later.
"The experience I had at the hospital couldn’t have been better," she recalled. "The medical team was diligent about keeping me pain free. The nurses kept my spirits high; we even found ourselves laughing at times. The hospital was accommodating with my large family. It sounds funny to say, but I really enjoyed my stay. I received the best of care."
In the days and months after surgery, "Kim sailed right along, with no signs of rejection," according to Renz. Her team of physicians continues to follow Lumpkins, but they don’t expect new complications.
"When I see the doctors now, it’s not an appointment, it’s a visit," she said. "They are like family. Many good things have come from my transplant."