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Second Opinion at Duke Offers Hope for Liver Transplant

Patient Turned Down Elsewhere Is Placed on Duke Waiting List

October 16, 2018
Lemuel Stewart sits on a bench outside of Duke University Hospital

Lemuel Stewart, 71, was listed for a liver transplant at Duke after his age and previous heart surgery disqualified him for transplant at another medical center.

Lemuel Stewart was on track to being approved for a liver transplant when he got the bad news: His age and previous heart surgery disqualified him for a transplant at a local medical center. That changed a few weeks later, when he sought help at Duke Health. “In three days, Duke did the testing that took six months at the other center,” said Stewart, who is 71 and lives near Richmond, VA. “The next week, Duke called and said, ‘We’re going to put you on the list.’”

Diagnosed with NASH

Stewart is one of four cousins with a liver condition called nonalcoholic steatohepatitis, or NASH, which affects people who drink little or no alcohol. It causes inflammation and scarring of the liver that can eventually lead to irreversible liver damage.

While the cause of NASH isn’t known, the condition often runs in families. It’s also linked to several conditions that can lead to fat deposits in the liver. For example, people who are overweight or obese are more likely to develop NASH. So are people with high blood sugar, diabetes, and high levels of triglycerides, a fat found in the blood.

Stewart had never been seriously overweight and didn’t have other risk factors associated with NASH. He and his cousins were diagnosed after three family members died of the condition.

After Rejection Elsewhere, He’s Approved at Duke

When Stewart was initially turned down for a liver transplant, his hepatologist recommended he get a second opinion at Duke.

“We’re increasingly able to successfully transplant patients who are not candidates at other centers,” said Carl Berg, MD, a hepatologist who runs the liver transplant program at Duke.

For Stewart, Duke was his last, best chance. While Stewart is older and had a heart valve replacement, Dr. Berg felt that wasn’t enough to make him ineligible for a transplant. Rather, he looked at Stewart’s overall health when determining if he would have success with the procedure.

“I don’t care what your driver’s license says your birthday is. What I really care about is how fit you are,” Dr. Berg said. “We felt Lem had the right physical strength and the right psychological resilience. We’ve successfully brought similar patients through the transplant process.”

Duke put Stewart on the waiting list for a liver in spring of 2018.

Among Best Liver Transplant Programs in the U.S.

While Stewart is a challenging patient, his case isn’t unusual for Duke. Its transplant program is known regionally and nationally for its success with challenging cases. In fact, Duke is consistently ranked among the best liver transplant centers in the U.S. by the Scientific Registry of Transplant Recipients.

According to Dr. Berg, Duke’s success with liver transplants is due to its high level of collaboration among skilled experts. “Collectively, we have well more than 100 years of experience,” he said. The entire team works together to make the best decisions for each patient.

Waiting for the Call

The clock is ticking for Stewart as he waits for a liver. But he has confidence in the process at Duke. “They are excellent,” he said. “I know other people who have had their liver transplant there, and they are doing really well.”

For Michelle Hendricks, Stewart’s transplant coordinator, Duke’s personal commitment to its patients helps make that happen. “Our goal is never just to prevent someone from dying,” she said. “It’s to return them to their former state of health.”

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Liver Transplant