Sharing Mayo Clinic: Transplant patient says ‘I’m in the safest place I can be’

George Caceres’ smile is contagious. Just ask his Mayo Clinic care team, who came to know him well during his 165-day stay after a liver transplant.

“He was so pleasant to visit,” says Lyda Velez, his case manager. “Even on days when he didn’t feel well and didn’t take off his [sleep] mask, he would give us little fist bumps.”

George arrived at Mayo Clinic in Arizona on Dec. 8, 2019, for preliminary appointments for liver disease. He never imagined he wouldn’t return to his home in Portland, Oregon, until halfway through 2020.

“George was one of the sickest patients we have seen,” says Bashar Aqel, M.D., a transplant hepatologist who oversaw George’s care.

George was fortunate to be in the right place at a difficult time.

Advanced disease, and complications

In hindsight, George says he underestimated how ill he was. Before his transplant, he endured a nearly three-hour morning routine getting ready for work because he would become fatigued and need to rest among the tasks of showering, getting dressed, eating breakfast and letting his dog outside.

“Basically my organs weren’t getting sufficient oxygen,” Caceres says. “I was consistently short of breath. I could barely walk a block without feeling like I was going to pass out. Doctors asked me, ‘How can you function on 40% oxygen?’ I didn’t realize how bad off I was.”

George was diagnosed with severe hepatopulmonary syndrome, a rare complication for someone with advanced liver disease, according to Dr. Aqel. “Sixty-two percent of the blood was bypassing the lungs,” he says.

Other places wouldn’t have taken his case. We had the team and the resources to make him well.

_{Bashar Aqel, M.D.}

George was placed on the transplant waiting list on Dec. 24, 2019, and underwent a liver transplant on Dec. 31.

“We got lucky because he qualified for extra MELD (Model for End-Stage Liver Disease) score points,” Dr. Aqel says.

But the short turnaround for surgery belied what was in store.

“Hepatopulmonary syndrome doesn’t reverse itself immediately,” Dr. Aqel says. “That was the reason he was in the hospital for the first few weeks. He was slowly getting better.”

But as George was recovering, he started to complain of headaches with increasing frequency. This triggered a CT scan of his head that confirmed a pituitary tumor. George was rushed to surgery to remove the tumor, which was benign but was causing serious compression on vital structures in the brain.

After surgery to remove the tumor, George’s oxygen levels improved slowly, Dr. Aqel says. It became a matter of time to get him stronger.

Then coronavirus struck.

Read the rest of the story on Sharing Mayo Clinic.