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Saturday, July 19, 2014

Practicing Food Safety After Transplant


One important way to protect yourself after a transplant involves making safe food choices and practicing safe food-handling rules. The medications you must take after transplantation suppress your immune system to prevent your body from rejecting your new organ. Suppressing your immune system also increases your risk of infection.

Patients who have had transplants experience
weakened immune systems and need to protect themselves from all infections. Foodborne illnesses, sometimes called food poisoning, can be caused by raw or undercooked foods and are a real threat to transplant recipients. The Centers for Disease Control and Prevention (CDC) report that every year as many as 76 million people get sick from foodborne illnesses. Those at highest risk for those illnesses are the very young, the very old and those who have weakened immune systems.

Foods to avoid after transplant include:
  • Raw seafood like clams, oysters, sushi and ceviche
  • Raw, rare or undercooked meat, poultry and fish
  • Raw or undercooked eggs
  • Foods containing raw eggs like cookie dough or homemade eggnog
  • Unpasteurized milk and unpasteurized cheese
  • Unpasteurized cider
  • Bean and alfalfa sprouts
It is also important that you, and anyone who cooks for you, handle food safely. The following suggestions can help protect you from foodborne illnesses. Some of these ideas may seem simple, but it is easy to overlook these important steps.
  • Be clean. Always wash your hands with hot soapy water before beginning any food preparation. Keep the food preparation area and all utensils used during preparation clean. Replace sponges regularly. Wash dishcloths often. Consider using disposable paper towels. Wash all fruits and vegetables carefully.
  • Keep things separated. Protect yourself from cross contamination. Cross contamination can occur in your grocery cart when you place a package of meat that is leaking juices on top of other foods. It can also occur in the refrigerator if the juice from thawed meat drips onto other foods. Purchase multiple cutting boards and use one just for meat, another just for vegetables and one for bread. Clean the cutting boards thoroughly after every use. Any dish that has held uncooked food should be washed before using it for the cooked product.
  • Cook as directed. Always cook foods to the recommended temperatures. A food thermometer helps insure you meet this goal. Suggested temperatures:
    • Steaks, roasts and fish; 145 degrees F
    • Pork, ground beef and egg dishes; 160 degrees F
    • Chicken and poultry; 165 degrees F.
  • Chill. When food shopping, especially during hot weather, return home promptly and refrigerate perishables. Refrigerate leftovers quickly after a meal. Thaw frozen foods in the refrigerator, not on the counter. You may want to avoid salad bars and buffets when eating out as those foods may be held at room temperature for an extended length of time.
  • Always check the label of perishable foods for the “Sell-By” date. Do not use foods after the date listed.
  • Some basic rules: Keep hot foods hot and cold foods cold; and when in doubt, throw it out.

Additional information about food safety can be found on the CDC website.

Author: Carol Bergen, MS, RD, CSR, LDN, Clinical Dietitian Specialist

Thursday, July 17, 2014

Penn Medicine Recognized as Pennsylvania Donate Life Hospital Challenge Winner

The Hospital and Health System Association of Pennsylvania (HAP) recognized Penn Medicine as the health system with the “Highest Total Points Achieved” for its efforts to increase donor awareness and designations during the 2014 Pennsylvania Donate Life Hospital Challenge.

HAP partnered with the Pennsylvania Department of Health, the Gift of Life Donor Program and the Center for Organ Recovery and Education (CORE) – the organ and tissue procurement organizations serving PA – to support the 2014 Pennsylvania Donate Life Hospital Challenge.

From February 28 to May 14, participating hospitals and health systems held activities to increase donor awareness and designations within their hospital families and communities, and captured those activities on a scorecard.


Penn Medicine received the “Highest Total Points Achieved for a Health System” honor for completing the widest variety of activities by a hospital or health system to help increase donor awareness. We subsequently attained “Platinum-Level Achiever” by reaching more than 1,000 scorecard points.

We are thrilled, and strive to spread even more awareness and inspire donations in the time to come.

Wednesday, July 2, 2014

Life After Transplant: What Tops Your List?

Last month, we asked, “What tops your list of life after transplant?” We heard back from Richard Fallstich, a liver-lung transplant recipient. Here’s what Richard is most thankful for as he approaches the 10-year anniversary of his transplant.

Here’s an example of a top three list we received from Richard Fallstich, a patient who had a liver and lung transplant:

In July 2005 I had a combination lung-liver transplant at HUP. I had alpha-1 antitrypsin deficiency which affected both my liver and lungs. My liver disease included cancer, so it was fairly certain that I would have died without the transplant. Since my year-year anniversary is coming up in a month, I thought I'd write to you with my top three.

  1. I was able to see my son continue to grow and prosper, and recently enter medical school.
  2. Having gone through the transplant has given me the courage to do public speaking to various groups about the importance of organ donation and why they should commit to donation.
  3. I am excited to show pre-transplant patients that transplants work, and they can go back to a very normal life. I do my best with the success of my transplant to inspire patients that are waiting for a transplant – that while the prospect may be frightening, a transplant will not only save their life, it will also greatly improve it.
If you’d like to learn more about Richard’s transplant journey, check out the lung transplant e-newsletter article.

If you have any questions about putting your list together, feel free to contact Margaret Leid, transplant community coordinator, at 215-298-3929 or margaret.leid@uphs.upenn.edu. If you already have a list ready to go, it can be emailed to Margaret or mailed to:

Margaret Leid, Transplant Community Coordinator
Penn Transplant Institute
Hospital of the University of Pennsylvania
3400 Spruce Street / 1 Founders
Philadelphia, PA 19104

Monday, June 23, 2014

Live Donor Liver Transplantation

Since the first deceased donor liver transplant in 1967 by Dr. Thomas Starzl at the University of Colorado, many medical and surgical advances have improved the long-term survival of transplanted livers. Advances in liver transplantation also have increased the number of conditions that liver transplantation can effectively treat.

These advances have led to more people exploring liver transplantation as a treatment option, with continued annual increases in the number of people being added to the United Network of Organ Sharing (UNOS) liver transplant waiting list.

According to data from the Organ Procurement and Transplant Network (OPTN), in the United States, there are currently 15,767 people waiting for deceased donor livers. In the greater Philadelphia region, there are more than 700 people waiting.

Thanks to the Gift of Life Donor Program, this region’s federally designated, organ procurement organization, significant advances in organ donation continue to be made. For example, last year the number of liver transplants increased by 14 percent in our region. Unfortunately, even with this notable improvement in the number of deceased donor livers, less than half of those waiting for a liver received one and only 322 people in the greater Philadelphia region received liver transplants in 2013.

Source: OPTN data, June 2014

Despite the increased support for organ donation and the increase in the number of deceased donor livers that become available, the number of people being added to the liver transplant waiting list dramatically outpaces the number of deceased donor livers that become available. As a result of this gap between deceased donor livers and those waiting, many patients die before a deceased donor liver becomes available.

While work to increase organ donation from deceased donors continues, living donors are an important part of the solution to this critical shortage. Living donation allows a patient in need of a liver transplant to receive an organ sooner, and eliminates the risk of dying while waiting for a deceased donor organ.

“A person only needs a portion of their liver to survive, which is why living liver donation can occur,” explained David Goldberg, MD, MSCE, medical director for Living Donor Liver Transplantation at Penn. “The liver has the ability to regenerate, and within three to six months of donation, the liver of both the donor and recipient will have re-grown to near full size.”

Dr. Goldberg went on to explain that the first two questions he is often asked is whether it is safe to be a living donor and if the recipient is expected to have a similar outcome to those receiving a deceased donor transplant. 

Nationally, approximately one-third of live liver donors have some complications after donation; however, the vast majority are minor and reversible. The risk of death associated with live liver donation in the U.S. is less than 0.2 percent -- less than the risk of death that is associated with motor vehicle accidents in our country. Furthermore, recent work from Dr. Goldberg and his colleagues from the University of Pennsylvania, currently in press at Hepatology, demonstrates that outcomes in recipients of living donor liver transplants are as good as those receiving a deceased donor graft and in certain recipients transplanted at an experienced living donor transplant center, superior to that of deceased donor recipients.

Source: Goldberg D FB, Abt P, Olthoff K, Shaked A. Superior Survival Using Living Donors and Donor-Recipient Matching Using a Novel Living Donor Risk Index. Hepatology. 2014. In Press.

“From the first donor evaluation consultation to the liver donation procedure, the donor’s safety is the primary concern of the Living Donor Liver Transplant team,” said Goldberg. “However, it is a major surgery, and as such, there are always risks which make choosing an experienced transplant center very important.”

Since the transplant team at the University of Chicago performed the first live donor liver transplant in 1989, more than 3,500 people in the United States have donated a portion of their liver to friends or family members and 36 transplant centers now offer live donor liver transplants.

In the Gift of Life service area, which is eastern Pennsylvania, southern New Jersey and Delaware, adult live donor liver transplant began at the Penn Transplant Institute in 1999 followed by Hahnemann University Hospital from 2002 to 2008, Penn State Hershey in 2008 and Thomas Jefferson University Hospital in 2010.

The graph below highlights how many adult living donor liver transplants have been performed in Philadelphia from 1999 to June 2014.


For more information about live donor liver transplant, please contact the Penn Living Donor Liver Transplant team at 215-662-6200.

A free download regarding the live donor liver transplant surgery and evaluation process is offered on the UNOS website.

If you are interested in learning if it is safe for you to be a living donor for a friend or family member at Penn, please complete the Living Donor Health Screening Questionnaire.

Thursday, June 12, 2014

Before Quitting Smoking, Liver Transplant Patients Should Talk to Their Doctor

While smoking cessation is important for everyone, for liver transplant patients, quitting tobacco is a critical component of preparing yourself for transplant and maintaining your health after transplant. Because health issues are often complex and many liver transplants patients take different kinds of medications, it’s very important to talk with your doctor before starting any smoking cessation product.

According to clinical transplant pharmacist, Erin Ticehurst, Pharm D, there are a variety of tools available to help patients stop smoking. “Some examples of helpful smoking cessation products include nicotine patches, gum, lozenges, inhalers, and nasal spray,” said Ticehurst. “There are also non-nicotine options, including prescription Zyban® and Chantix®. But whichever type of smoking cessation product you choose, it’s critical to first talk with the transplant team before taking any of these medications.”

Fortunately, the Penn Lung Center’s Comprehensive Smoking Treatment Program offers specialized services to partner with people who want to be free from tobacco use and the toll it can take on a person’s overall health and well being.

“We know from serving thousands of patients that trying to quit tobacco can lead to a cascade of difficult challenges,” explains Frank T. Leone, MD, MS, director of the Comprehensive Smoking Treatment Program. “Our patients have shared that facing the challenge of quitting tobacco often brings on sadness, anger and hopelessness. They also explain that breaking the habit can be frustrating and confusing; sometimes even embarrassing and shameful. Many of our patients tell us that they feel trapped between desperately wanting to stop and desperately wanting not to stop.”

Because of the complexity of emotions and habits associated with smoking, the smoking treatment team works hard to understand every patient’s specific needs based on what’s happening right now with their health, family, work and other aspects of their lives.

“One of the most important aspects of the treatment is to help smokers and their families understand how nicotine addiction actually works to make them feel trapped and powerless to change,” said Leone. “Our program is founded on the belief that every smoker has the right to quit comfortably, so our treatment strategies are aggressive with medications that empower people to be successful.”

For more information about safe, over-the-counter smoking cessation aids, contact your transplant coordinator. If you, or someone you know, needs information on how to quit tobacco safely, contact the Penn Smoking Cessation Team at 1-888-PENN-STOP.

Friday, June 6, 2014

Life After Liver Transplant: What Tops Your List?

During recovery from a liver transplant, patients and their friends and family often share with us a variety of experiences that they are very thankful for. Sometimes, these are important life celebrations that they were able to be a part of, such as the birth of a grandchild, a wedding or a graduation. Sometimes they are special trips or personal goals that they were able to achieve after their transplant.
Patients also share with us the gratitude they feel for being able to experience small parts of everyday life that they took for granted before they became sick – things that may seem small on a day-to-day basis but actually make a big difference in a person’s quality of life.

These expressions of gratitude never fail to encourage and inspire us, so we thought we’d give you an opportunity to share with the larger liver transplant community your very own top 10 list of what you are most thankful for after your liver transplant. This could even be a fun project for the whole family.

If you have any questions about putting your list together, feel free to call Margaret Leid, Transplant Community Coordinator, at 215-298-3929. 

Please email or mail your list, along with your phone number, to:
margaret.leid@uphs.upenn.edu

Margaret Leid, Transplant Community Coordinator
Penn Transplant Institute
Hospital of the University of Pennsylvania
3400 Spruce Street / 1 Founders
Philadelphia, PA 19104

Monday, June 2, 2014

Calling All Chefs: Assist Families at the Penn Transplant House!

For many transplant patients, the good news of a life-saving organ match is accompanied by feelings of uncertainty and a whole new set of challenges, especially if they have to travel out of town for care. To accommodate these patients, the Penn Transplant Institute created the Clyde F. Barker Penn Transplant House, a convenient guest house for transplant patients and their families and caregivers.

In the Transplant House, guest chefs are welcome to share their love of cooking and food with those who stay there. By preparing and sharing a meal with the guests, guest chefs provide a touch of kindness and comfort that helps to make the house a home.


If you're interested in serving as a guest chef at the Penn Transplant House, here are some quick facts about the program and ideas for participation:

Number of Guests

The anticipated number of guests is confirmed on the Friday afternoon prior to the meal date, when most new reservations are made. The number of expected guests for the following week may increase.

Preparing the Meal

It is perfectly acceptable to cook food in advance and simply reheat it. The Transplant House has two ovens, and different dishes can be cooked at the same time. Guest chefs may arrive several hours ahead of time to prepare the entire meal, but they are asked to notify the house manager prior to their arrival.

Kitchen Supplies

The Transplant House has a fully stocked kitchen with pots, pans, cookie sheets; cooking, serving and eating utensils; and bowls. It has all of the dinnerware and glassware needed for the meals, as well as a food processor, blender and hand-mixers. If there is a unique item needed to prepare the meal, please check with the house manager to find out if it is available.

Meal Planning and Dietary Restrictions

Since meals are not prepared each night and guests are not always the same, specific dietary needs and restrictions of guests are not known. Previous dinners have consisted of both patients and family members of patients. A typical meal may include: soup or salad, a protein, a starch, veggies, dessert and a beverage. (Please note: The Transplant House is an alcohol-free facility).

To be as welcoming and hospitable to all of the guests as possible, a vegetarian option should be available for each meal. Having a diabetic option for the desserts is also helpful and has been greatly appreciated by guests in the past. If you would like help in creating a meal plan, or would like to speak with someone about meal ideas, please contact the house manager, Kirsten King, at 215-662-4540.

Dinnertime

Dinner is generally served between 6:30 and 7:00 p.m. Please let the house manager know prior to the date of your dinner what your anticipated meal time is, so that the guests may be notified and plan accordingly.

Clean-up

Since this house is also home to its guests, anyone who uses the kitchen is asked to clean up. To assist in the cleaning process, the house has three dishwashers, as well as the necessary cleaning supplies for the countertops and kitchen surfaces readily available.

The guest chef program is a fun way for individuals and groups to get involved in the important support the house provides. Our guests are always appreciative of the food and community building, as well as the generous gift of time and talent that each guest chef gives.

For more information on becoming a guest chef
or to schedule a dinner with the Transplant House,
please contact the house manager,
Kirsten King, at 215-662-4540.