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Intermountain among first in U.S. to use diseased livers for transplant

MURRAY — Lorenzo Swank was dying in his 20s.

Diagnosed with a chronic liver disease called primary sclerosing cholangitis in 2010, the Salt Lake man was added to the liver transplant waitlist in 2013.

As bile built up in his liver, Swank began to lose liver function. By May, he was close to dying.

And yet, there was no word that a liver for Swank was coming anytime soon.

That's when doctors at Intermountain Medical Center approached him with an unusual idea: They could do the transplant with a diseased liver.

"I said, 'Sold,'" Swank said. "Let's do it."

Intermountain Medical Center is the first transplant center in Utah and likely the U.S. to use livers infected with hepatitis C to save lives.

After the surgery, organ recipients are put on a treatment regimen to get rid of the virus.

"We're taking damaged goods for these patients to be able to save their lives," said Dr. Richard Gilroy, medical director of the liver transplantation program at Intermountain Medical Center.

Up until five years ago, hepatitis C was considered to have no cure. But in recent years, several breakthrough hepatitis C drugs have hit the market, including Sovaldi and Harvoni.

"In the old days, I don't think anybody would have knowingly done this," Gilroy said. "It's the landscape changing."

Nearly 15,000 people are waiting for a liver, according to the U.S. Department of Health and Human Services, including 188 people in Utah.

About 1,500 people die each year waiting for a transplant. Another 1,700 are removed after getting too sick.

Tracy Schmidt, the executive director and president of Intermountain Donor Services, said the decision to accept hepatitis C-positive livers for donation would save lives.

He asked people to register to be organ donors even if they think they are too ill or too old.

"You're not too old," Schmidt said. "Always register as a donor and let us decide."

Doctors have previously used hepatitis C-positive livers for transplant in patients who were already infected, but they have never before transplanted a diseased liver into an otherwise healthy patient, according to Gilroy.

Now, due to the new treatments, "what is a perceived problem is a solution," he said.

The procedure does not come without some risks. Doctors have to walk patients through the relative risks of replacing one liver disease with another. Gilroy said he reserved the option for the "sickest of the sick."

Because the new hepatitis C treatments have a more than 95 percent cure rate, that means the chance of a patient dying while waiting for a liver transplant is usually much higher than the chance they cannot cure the hepatitis C, Gilroy said.

Another patient, David Ericson, was diagnosed with the same disease as Swank in 1995.

Three years ago, his liver started worsening. Last year, the complications became life-threatening after he contracted a dangerous infection that did not respond to antibiotics.

Each time Ericson returned to the hospital, he was weaker. By the time Intermountain doctors approached him about the possibility of using a diseased liver for transplant, he was close to death.

"We knew there was some potential risk, but we were more concerned about where I was with my current health," Ericson said.

Like Ericson, Swank was in danger of being taken off the waitlist entirely. He was at high risk of developing a cancer that would have instantly disqualified him from getting a liver transplant — essentially a death sentence.

"I was much more concerned that I just wouldn't make it," Swank said.

After undergoing the liver transplant, Swank is now cured of hepatitis C. Ericson is still in the middle of the process, which involves several weeks of taking pills. He is planning to go back to work as soon as he is able. And Swank is already planning to head back to Korea, where he works.

"I have more energy than I've had in years," Swank said. "I've been given another shot at life."

Gilroy said researchers are also looking at the possibility of using livers with fatty liver disease for transplant. Caused mostly by poor diet, fatty liver disease is one of the most common diseases in the U.S., affecting about 1 in 5 people.

"That's going to be the next Everest for us," Gilroy said. "This was just a small hill."