Two liver transplant donors – one living, one deceased – save a young life at UCHealth

November 21st, 2018

Two years ago this month, Eric Rice received a liver transplant at UCHealth University of Colorado Hospital on the Anschutz Medical Campus (UCH).

One year ago this month, he received another liver transplant at UCH.

Rice, 28, is now as healthy as he has ever been.

Eleven months after his second liver transplant, Eric Rice is back in the saddle.
Eleven months after his second liver transplant, Eric Rice is back in the saddle. Photo courtesy Eric Rice.

“I literally feel like I’m aging in reverse,” Rice says. “This time last year, I felt like I was an 80-year-old man, and now I feel like I’m 18. It makes me giddy, sometimes, even.”

Rice does not have two livers. His is a story of courage and generosity among the living and the dead, and a reminder that, as it is so often in this life, success is born of failure.

In 2012, Rice had recently graduated from Colorado State University when he learned that his bloating, listlessness, jaundice and other worsening health problems probably stemmed from Budd-Chiari syndrome. Budd-Chiari can have many causes, but the effect is the same: blood can’t get out of the liver, through which flows the digestive system’s blood en route to the heart. Circulatory backups result, leading to pooling fluids and overstretched veins that leak and even rupture. Lessened blood flow saps energy, as does a diminished ability to turn food into energy. Rice’s liver specialist, UCHealth hepatologist Dr. James Burton, worked with the UCHealth’s Transplant Center at University of Colorado Hospital team to get Rice on the waitlist for an organ from a deceased donor.

The wait began. In Colorado only about one in four of those listed for a liver are transplanted within a year. Forty percent wait more than three years, and more than half of them wait for five years or longer. Rice would be among them.

Eric Rice rides a motocross bike and flies over a dirt mound.
Eric Rice, who had two liver transplants at UCHealth’s Transplant Center at University of Colorado Hospital, flies high at the Thunder Valley Motocross Park in Lakewood on Oct. 20. Photo courtesy Eric Rice.

His health declined. A 6-foot-2, 185-pound frame capable of muscling a motocross bike withered into the 140s. His family worried he might die before a liver arrived. They explored another option: a living-donor liver transplant.

Good neighbor

Kidney donations are intuitive: you need one kidney, but have two. So you can give one away. You can’t give away your whole liver. But livers are amazing things. Take away more than half of it and the remaining portion grows back within about a year. The recipient’s portion similarly grows whole once transplanted.

Rice and Karen Kennedy at the 2018 Donor Dash in July.
Eric Rice and Karen Kennedy at the 2018 Donor Dash in July. Photo courtesy Eric Rice.

About 5 percent of liver transplants are from live donors nationally. About 15 percent of the liver transplants at the UCH Transplant Center are from living donors.  An additional 10 or so adult-donor surgeries are performed at UCH to be transplanted at Children’s Hospital Colorado, says surgeon Dr. James Pomposelli, UCHealth’s Director of Liver Transplantation.

Rice was by then back at his parents’ home in Castle Rock. Two doors down lived Karen Kennedy and her husband Jim. The Kennedys and the Rices were close. Eric and the Kennedys’ son Cole were the same age and pals growing up. Karen, a registered nurse, knew that she had the same blood type as Eric, and that, while the donation would require major surgery, the risks were small.

“I want you to know: I would be happy to donate,” she told Eric’s parents.

There was something else. Two years earlier, Cole, an expert climber, was killed by an ice avalanche in Peru. Now Karen Kennedy saw his childhood friend on a downward spiral and her old friends facing a loss she knew too well.

Forty-seven tests and weeks later, on Nov. 8, 2016, Kennedy and Rice were wheeled into their operating rooms. UCHealth surgeon Dr. Elizabeth Pomfret, the University of Colorado School of Medicine’s chief of transplant surgery, performed Kennedy’s surgery. Pomposelli and Dr. Michael Wachs, two of UCH’s most experienced transplant surgeons, teamed up to work on Rice. Kennedy did well, and Rice experienced the striking turnaround transplants bequeath. He felt like his young self again.

A photo of Dr. James Pomposelli
Dr. James Pomposelli

Relapse

It didn’t last. The symptoms returned, and within months worsened to the point that he was at UCH twice a week to have fluid trained from his belly and lungs. The simplest of things –breathing – became a struggle. Infection followed infection. His hair fell out. He shed weight. Burton, the liver specialist, told him he needed another transplant. The doctor was frank: given Rice’s weakened state, he might not survive the surgery. Rice agreed that the risk was worth it. He was physically miserable, and it had seeped into his mental state.

“There were times when I didn’t want to be living,” Rice recalls. “I wouldn’t have minded passing. I was so depressed and down.”

Burton went to work to make sure Rice didn’t die on the waiting list. The case was unique. Rice’s liver, when examined after the first surgery, showed no signs of disease that might lead to Budd-Chiari syndrome. But there was evidence of inflammation in the blood vessels, known as vasculitis. That had presumably caused thick scar tissue to form in the inferior vena cava – the main pipeline for blood from the lower body back to the heart – between the liver and the heart.

Pomposelli and Wachs, with hundreds of liver transplants between them, had never seen anything like it. Nor had Burton, the University of Colorado School of Medicine’s medical director for liver transplant. The surgeons had, during the initial transplant, cut away scar tissue around the vena cava to improve flow. Tests afterward showed that it had worked. Now it appeared that the scar tissue had come back.

A photo of Dr. Elizabeth Pomfret
Dr. Elizabeth Pomfret

Burton worked with UCHealth surgeons, rheumatologists and other specialists to make the case that vasculitis in that section of the vena cava had indeed been the underlying cause. Strange was that the scarring was limited to just that section of vein. Usually, vasculitis manifests broadly, to be treated with immunosuppressants or even chemotherapy. With Rice, such treatments might not work – and high-dose chemotherapy could kill him. Burton wrote out his reasoning and petitioned a panel of nine experts on the Organ Procurement and Transplantation Network’s regional review board to move Rice up the transplant priority list. In addition to laying out the seriousness of the medical case, Burton reminded them that the first transplant was from a live donor, so Rice wasn’t jumping back in line.

Also, Rice needed a deceased donor this time. As Pomposelli describes it, the liver “sits on the vena cava like a saddle on a horse, and historically, the entire vena cava, with the liver sitting on top of it, was replaced.” Kennedy and other live donors, though, need to keep their vena cavas.

Burton was persuasive. Less than a month afterward, on Nov. 18, 2017, Pomposelli and Wachs again transplanted Rice, this time with the liver and accompanying vena cava of a 16-year-old boy.

‘Because of them’

A month passed, then two, then three. Rice took pleasure in the simplest of things. “I would wake up, I would shower, and my hair wouldn’t fall out. I would look in the mirror and my eyes were bright white. That would bring me so much joy: to look in the mirror, into clear eyes, and know your body isn’t falling apart.”

Dr. James Burton
Dr. James Burton

Monthly blood tests continued to look good. He moved to an apartment in Denver. He got a job in supply chain management at Arrow Electronics. He’s got a girlfriend; he’s back on his dirt bike. He is grateful – to the doctors, nurses and staff at UCHealth; to Karen Kennedy; to the boy whom he thinks about every day.

Dr. Michael Wachs
Dr. Michael Wachs

“Every time I accomplish something great at work it’s because of Karen and my donor. And every time I go out and have a great time riding or have a great weekend, it’s because of them,” Rice says. “I’ve never had more fun than I’m having right now, and I wouldn’t be doing it if I hadn’t received the gift of life from these two generous people and their families.”

Kennedy says she’s thrilled that he’s doing so well. And besides taking an over-the-counter antacid every other day, her life hasn’t changed a bit.

“I told Eric I won’t be able to be a bikini model anymore, but I wasn’t doing that either way,” she says.

It took both donors – one very much alive, one gone far too soon – to save a life.

“He got to where he is today through that first liver transplant, and if he didn’t have that, I don’t know where he’d be,” Burton says. “He had to go through those steps to get to where he is today.”