Liver Transplant Transplant Services

From diagnosis to transplant, education led the way for Ira Marshall

The last thing Ira Marshall expected was to get sick. He had always pursued wellness. He made healthy food choices, swam regularly and managed his stress.

So when his doctor noticed an unusual increase in Marshall’s liver enzymes during a routine blood test, he was caught off guard. Marshall had been feeling a little more fatigued at the end of each day, but he wasn’t experiencing any symptoms that seemed worthy of alarm. Liver failure was the furthest thing from his mind.

His doctor referred him to a hepatologist at Stanford Hospital & Clinics, Dr. Aijaz Ahmed. A comprehensive testing was performed on Marshall at Stanford University Medical Center. Ahmed discovered that Marshall had large esophageal varices caused by portal hypertension, a complication of completely scarred liver (cirrhosis). A liver biopsy confirmed the presence of cirrhosis. Liver biopsy also found evidence of primary sclerosing cholangitis, a narrowing of the bile ducts that had created a threatening condition with increased risk for liver cancer and bile duct cancer. Marshall’s liver was in bad shape. Ahmed informed Marshall that there was evidence of underlying cirrhosis and need for liver transplant in the future.

Marshall started learning everything he could about liver disease and transplantation. As his liver disease progressed, he underwent transjugular intrahepatic portosystemic shunt (TIPS), a procedure to reduce the high level of resistance (portal hypertension) to blood flow within a cirrhotic liver.

As his health failed, Marshall’s wife, Wanda, noticed he had begun to behave oddly and became increasingly confused. She called Stanford and Marshall was evaluated emergently. His liver enzymes were skyrocketing and he was admitted right away at Stanford Hospital.

Days later, Marshall’s liver stopped working altogether and he fell into a coma. Due to severe liver failure, Marshall moved to the top of the liver transplant waiting list. Happily, a compatible liver match was located in Las Vegas, Nevada and it was brought back safely, despite a massive rainstorm along the way, to Stanford.

The donor organ was a perfect match. When he woke up from the 12-hour operation, Marshall had a healthy new liver and was on the road to recovery.

He continues to stay informed about his care and medications. He hasn’t changed his goal of lifelong health and enjoys jamming with his rock band, but now there’s something more to his life. “I want to live as long as I can and enjoy life, and be able to give back,” he said. Now when he leads motivational goal-mapping workshops, he can share his experience with others.

Marshall likes to kid around with his transplant team and appreciates the open relationships they’ve developed over the years. He has grown especially close to Dr. Waldo Concepcion, his transplant surgeon, and Dr. Allen Cooper, his primary hepatologist. “It’s a team deal,” he said. “When I think about the people who helped me and worked on me, I had the best people in the country—the top guns. The care I received was first-rate. I’m alive because of that.”

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