They were also instrumental in developing a team approach to dealing with liver disease, drawing together everyone from those involved in drug research and patient care to transplant surgeons.
In 1988 doctors Igal Kam and Fritz Karrer reinstituted liver transplants at University. Soon the hospital had one of the best records in the country for long-term survival of transplant patients, as well as an excellent reputation for its work in the field. Vierling went on to Cedar-Sinai Hospital at UCLA, and Dr. Charles Howell, who'd trained under Everson, moved to the University of Maryland as the medical director of its liver department.
University's program didn't focus solely on transplants, though. When the FDA approved interferon for testing a few years ago, Everson went after what research dollars were available from pharmaceutical companies. There was not, and still is not, any federal money for such projects. To run the studies he recruited Claire Reilly, a transplant nurse who'd gotten burned out on the life-and-death struggle and wanted to work on something that might prevent others from reaching that stage.
Interferon is produced naturally in the body and stimulates the production of white cells: the body's defense against viruses. It's the stuff that makes you feel lousy in the first 24 hours of the flu.
There are high hopes for interferon as a treatment for cancer and AIDS. And so far, inteferon has been shown to knock out hepatitis C activity. That's the good news. The bad news is that the virus comes right back when treatment is stopped; only 10 percent of the hepatitis C patients remain in remission.
The effects of such long-term use of high doses of inteferon are unknown, although that issue is currently under study at University Hospital. The flu-like symptoms--nausea, headaches, fatigue--seem to abate over time. A bigger concern is whether, in the immune system's checks and balances, interferon increases white cell productivity but kills other cells that attack invaders such as bacteria, which may be more immediately dangerous.
The drug also seems to cause depression, Reilly says, and patients must be carefully monitored for suicidal tendencies and psychological problems.
Interferon is years away from approval for long-term treatment of hepatitis C patients. The only way for them to get it now is through a research program.
Mike Lamb first heard about hepatitis C in September 1993--from the doctor who told him he had it. He will never know for sure how he was infected, but he keeps thinking back to Vietnam.
After he returned to this country in 1967, Lamb went to college and, like so many others of his generation, experimented with drugs, including a one-time injection of heroin. But as a former medic, he was well aware of the dangers of sharing needles; years later, he still maintains that he used a sterile hypodermic.
By the mid-Eighties Lamb had begun noticing that he didn't have the stamina he once did. Sometimes his feet would swell up and he couldn't wear his ski boots. He'd always stayed in shape, but now no matter how hard he worked out at the gym, he couldn't get rid of his gut. He attributed it all to middle age. How many fortyish guys didn't have a spare tire?
But by that September, he knew the swelling and fatigue were more than age. His Colorado Springs doctor diagnosed his problem as congestive heart failure and sent him to University Hospital for further tests.
Lamb had just walked into University's emergency room when Dr. Roshan Shrestha, a hepatologist recruited by Everson, spotted him. Shrestha took one look and told him he had hepatitis.
Tests indicated that not only did Lamb have hepatitis C but that his liver function was almost nonexistent. The gut he'd been unable to lose was caused by fluids building up in his abdomen.
Shrestha wanted to keep him in the hospital. "You could die," the doctor warned.
"I could have died yesterday," Lamb replied, and checked himself out.
The University doctors put him on a pageful of medications, mostly to help relieve the fluid buildup. There wasn't much else to do, they explained. His disease had progressed far beyond the help of interferon. What he needed was a new liver.
After passing hospital criteria for a transplant that includes financial, physical and psychological issues, Lamb was on the list. All he had to do was wait--and survive.
After Vietnam, the first was comparatively easy. But he almost failed the second test late in spring '94, when he was sitting in the bathtub and began vomiting blood. He would have bled to death if his girlfriend hadn't come home and rushed him to the hospital.