14 June 2024

In early April, a liver transplant at Austin Health showcased the best in medical innovation and multi-disciplinary teamwork. It began with a donor liver, which became a lifeline for one of our sickest patients.

The patient was critically ill with Primary Sclerosing Cholangitis (PSC), an immune disease that causes bile duct dysfunction. The liver was used for transplant after 21 hours of machine perfusion, a process that improves organ function, longevity and overall transplant success.

During the complex 12-hour transplant, the patient started to lose blood – and while blood loss is common during liver transplantation, they lost 105 litres. Attending Consultant anaesthetist Dr Brett Pearce explains this "super massive blood loss" required a massive transfusion to save the patient.

“To put it in context, you have approximately five litres of blood in your body. In this transplant we took someone's blood out of them 20 times over, while keeping their organs functioning.”

This incredible effort required a team of around 20 people including surgeons, anaesthetists, anaesthetic and theatre nurses, technicians and blood bank experts, who all worked seamlessly together to stabilise the patient. Throughout, the team of anaesthetists tested and ensured vital signs and organ function remained stable.

“There were many times when it was all hands on-deck. In a case like this, you can see this truly is a team sport,” says Dr Pearce. Our Blood Bank was kept busy supplying litres and litres of blood and fluids, including red cells, albumin, plasma and platelets. There were three ‘cell saver' machines at work, washing the patient’s spilt blood to pump it back into them. The theatre technicians did a remarkable job of keeping the cell savers going and the blood washed and ready to be transfused again.

Despite these challenges, the patient is now recovering well thanks to the collective expertise and efforts of the many involved.

Central to success was the specialised equipment and techniques used, from advanced imaging tools like Transesophageal Echocardiography (TOE), to rapid blood infusers, a heart-lung bypass machine and cell savers, to the liver perfusion that made transplant possible initially.

The surgery exemplifies Austin Health’s teamwork, innovation and unwavering dedication to patient care: bringing together expertise, effort and collaboration to save a life.