Lawrence McMullen knew his chance of surviving liver cancer for one year was zero – without a liver transplant. With a transplant, his odds jumped to 50/50.
“I was playing a game called ‘time’,” said. McMullen, 55, of Chesterfield – “Mac” to his friends and co-workers. “Any chance to live was a plus to me.”
He got that chance Nov. 3, with a liver transplant at Barnes-Jewish Hospital.
McMullen had hepatocellular cancer (HCC), one of the most common cancers in the world. Though it is not as common in the US, the number of HCC patients has risen dramatically in the last five years, and will continue, according to Dr. Will Chapman, director of the HCC clinic at Barnes-Jewish Hospital. That trend will continue because HCC often results from chronic hepatitis B and hepatitis C infections. With an estimated four million Americans infected with hepatitis C, Dr. Chapman expects an explosion in HCC in the next few years.
New medication regimens have been effective in slowing or halting hep C, and several treatments, all available at the HCC clinic, have shown promise in treating early stages of HCC. These treatments include chemoembolization, radiofrequency ablation and chemotherapy. The HCC clinic’s goal is to keep the disease under control and keep the patient as healthy as possible until they receive a transplant.
But Dr. Chapman notes that both hep C and HCC are often silent diseases – with the hepatitis virus or the liver tumor causing no outward symptoms until the disease is in its later stages.
This was the case with McMullen. He had always been active. He had worked as a registered nurse for 25 years, many of those as a surgical assistant, “an extra set of hands,” for some of the best cardiac surgeons in the country. He hunted, fished and traveled with his wife, Nancy. They raised a son. McMullen had noticed he was slowing down a little. But he chalked it up to normal aging.
“I noticed that I wasn’t quite as full of vim and vinegar as I used to be,” he said.
When his father-in-law had surgery in 1995, McMullen donated blood. He was stunned when the blood bank called to say his blood tested positive for hep C.
The hepatitis C virus is spread through contact with blood. McMullen doesn’t know exactly when he was infected, but career in cardiothoracic surgery meant frequent blood exposure to patients’ blood.
In 2001, his gastroenterologist referred him to Washington University School of Medicine hepatologist Dr. Jeffrey Crippin, one of the leading hep C experts in the world and medical director of the Barnes-Jewish Hospital liver transplant program. Dr. Crippin started McMullen on a drug regimen that can put the hepatitis into remission. But the drugs lowered McMullen’s platelet count. All doctors could do was monitor his condition to try to catch liver failure or cancer as early as possible.
McMullen’s liver scans were clear until April 2004, when doctors found two tumors. McMullen was immediately sent to Dr. Daniel Brown, interventional radiologist with the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, for chemoembolization treatments.
Chemoembolization is a way of delivering cancer treatment directly to a tumor in the liver. Under x-ray guidance, a small catheter is inserted into an artery in the groin. The catheter's tip is threaded into the artery in the liver that supplies blood flow to the tumor. Chemotherapy is injected through the catheter into the tumor, mixed with particles that embolize or block the flow of blood to the diseased tissue, thus attacking the cancer in two ways.
McMullen underwent three chemoembolization treatments, enough to do “pretty serious damage to the tumors, but not enough,” he said.
He was evaluated for liver transplant. His transplant nurse coordinator, Paloma Reichert, RN, sent the paperwork to the United Network for Organ Sharing on Oct. 16. Reichert told McMullen that could be two to six weeks before he was placed on the list. Early in the morning on Nov. 3, he got a call from Reichert that not only was he listed, but a liver had also become available.
Despite his confidence in his doctors and the transplant staff at Barnes-Jewish, McMullen said he was nervous on this drive to the hospital for the operation.
“You think you can prepare yourself for something like this, but you can’t,” he said. “It occurred to me that this could be the last day of my life.”
But the transplant went well, with McMullen recovering quickly. Only five days after the surgery, McMullen had a cardiac catheterization to have a drug-eluting stent placed in a partially –blocked cardiac artery. Two days later, McMullen was discharged from the hospital – only seven days after his transplant.
Since then, he regained his energy and focused on enjoying his family – especially granddaughter Izabella.
But the other family he thinks of often is the family of his donor. He gives thanks daily for family who made the generous decision in the midst of a difficult time to donate their loved one’s organs.
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