Liver transplantation at the University of Tennessee Health Science Center in Memphis, Tennessee: the current era 2006-2012.

Transplantation at the University of Tennessee Health Science Center in Memphis, which began at the William F. Bowld Hospital and transferred to Methodist University Hospital in 2004, includes pediatric transplantation at LeBonheur Children's Medical Center. The multidisciplinary institute is dedicated to the treatment of patients with end-stage liver and kidney disease and allows those patients access to the integrated expertise of transplant surgeons, hepatologists, and nephrologists. The current, and most successful, era for the program began in 2006, when a change in leadership and clinical vision led to a dramatic increase in clinical activity. These changes have included wider acceptance of potential recipients for liver transplantation and broader use of marginal donor allografts. Streamlined surgical techniques have decreased operative times and have limited blood product usage. Additionally, the program uses an innovative immunosuppression protocol with the world's largest reported series of steroid-free, rabbit anti-thymocyte globulin induction and delayed introduction of tacrolimus in an effort to limit adverse effects of immunosuppression. Such adverse effects may include: infections, post-transplant diabetes mellitus, bone disease, and accelerated fibrosis from recurrent HCV related to steroids and impaired renal function from tacrolimus. These changes have resulted in aggressive donor usage with low complication rates and excellent outcomes.