University of Pennsylvania Health System

Liver Transplant Update | Penn Medicine

Friday, October 10, 2014

Meet the Team: Linda Wood, RN, BSN

Penn live liver donor coordinator, Linda Wood, RN, BSN, has provided care to patients as a registered nurse for more than 20 years. She took some time to share with us a bit about how she got started in transplantation and how she feels about her current role serving people who are interested in being evaluated as live liver donors. Here’s a snapshot of what inspires Linda in her work with Penn live donors and their families.

How long have you been providing care for live donors?

I have specialized in living donation for 12 years. I find it so rewarding, and I'm in constant awe of these special people who step forward to give such a special gift to a loved one or friend.

What first interested you in transplant?

It’s hard to believe that I have been a nurse for 23 years – I can’t believe I have done anything for that long! My background was
always surgical intensive care, and I worked in a transplant intensive care unit for a few years.

Transplant patients proved to be a very special group of patients, and I felt like I had an opportunity to witness the miracle of medicine every day. I was later offered a position as a transplant coordinator, which enabled me to see another side of the transplant world. I knew then I had found home.

What do you find most rewarding about your work?

There are a lot of rewarding aspects to this position. Two things come to mind. The first is to hear from a donor or receive a picture of a donor and their recipient – after the surgery – after recovery. It’s great to see the joy in their eyes and see how well they both look. The thought that comes up next is how rewarding it is to see a donor the morning after surgery – and hear them say, “I did it..! I can’t believe I did it!”

It’s exciting because it is a life renewed for the recipient, and the donor made that happen. To feel that I helped facilitate that and had a part of that, in some small way, makes this work very special.

What’s the most interesting part of providing care to people interested in live liver donation?

Helping to bring their desire, their hope, into a reality. We are helping people to help other people. Educating them, guiding them, protecting them in this process is our paramount goal. I love what I do.

Find out more about organ transplant programs and services at Penn.

Thursday, October 2, 2014

Penn Liver Transplant Support Group

The liver transplantation process can present unique challenges throughout each phase of transplantation. Whether you're considering liver transplant, waiting for a liver to become available or continuing with life post-transplant, building a community of support is an important and ongoing process.

One resource that can help you connect with people who are having similar experiences is the Penn Liver Transplant Support Group. This group of people and caregivers meets twice a month and provides an opportunity to discuss all kinds of issues and offer suggestions to others based on what you have learned.

According to liver transplant social worker, Chrystal Liebold, "This group is invaluable for both pre- and post-transplant patients. For those waiting for transplant, being able to hear the stories of those who have been through the process helps get answers to their questions and gives them a sense of community, reminding them that they are not alone."

Liebold also said that it's beneficial for those who have already gone through the process: "Being able to share stories allows post-transplant patients a chance to give back. So there's really something for everyone at a support group."

The next group will meet on Tuesday, October 7 from 12:00 to 1:00 p.m., at the 2 West Conference Room in the Penn Transplant Institute, which is located at the Perelman Center for Advanced Medicine: 3400 Civic Center Blvd., Philadelphia, PA 19104.

Wednesday, September 24, 2014

Fall Means Getting Ready for Flu Season

It's that time of year again... Time for flu vaccines! The Penn Liver Transplant team wants to remind everyone to get their flu shots, especially transplant recipients, their loved ones and their caregivers. Moreover, if you are less than six months post-transplant, please contact your transplant coordinator, so they can advise you whether to be vaccinated now or wait until you are farther out to increase the protection you receive from the vaccine.

Transplant recipients are advised to take only the “inactivated influenza vaccine” that contains killed virus and is given by injection into the muscle or skin. Nasally inhaled (live, attenuated) vaccines are not recommended for people whose immune systems are compromised or weakened. It is best if your family members do not receive the nasal vaccine either, so please ask them to stick with the flu shot. If they do receive the nasal vaccine, we recommend that you avoid contact with them for one week.

This year’s vaccine covers influenza, including H1N1, so only one injection is necessary. While there is a high-dose vaccine available and it has been tested in individuals 65 years of age and older, it has not been proven to be more effective for transplant patients. Although there is no known harm in getting it, it's not necessary.

The “flu” is caused by the influenza virus. Typically spread from person to person, the virus is carried in respiratory droplets created with coughing and sneezing. However, you can unwittingly expose yourself by simply touching a surface that has been contaminated by a droplet and then touching your own mouth, nose or eye. So, wash your hands, wash your hands, wash your hands… and, as always, try to avoid sick people.

It's important to distinguish between cold symptoms and flu symptoms. While both are respiratory illnesses, they are treated differently. Here's a chart that may help determine which “bug” you have:

Flu symptoms 

  • Slow onset of illness (over a day) 
  • Fever over 100.5F 
  • Extreme fatigue 
  • Dry cough 
  • Terrible headache 
  • Achy muscles 
  • Chills 

Cold Symptoms

  • Slow onset of illness (over a day) 
  • Low or no fever 
  • Mild fatigue 
  • Productive cough and runny or stuffy nose 
  • No headache 
  • No muscle aches 
  • No chills 
If you suspect that you may have the flu, please call your transplant nurse coordinator before coming to the Penn Transplant Institute. To minimize the potential spread of the virus, you may be asked to wear a mask and to sit separately from other patients waiting for appointments or even advised not to come to the hospital at all.

Learn more at the Center for Disease Control or contact the Penn Liver Transplant team

Thursday, August 28, 2014

To Swim or Not to Swim? Safe Swimming Tips for Liver Transplant Recipients

It might be Labor Day Weekend, but there's still several weeks of nice weather ahead of us. If swimming is on your list of warm weather activities, take a minute to check out this interview with Emily Blumberg, MD, a national expert in transplant infectious disease and a member of the infectious disease team here at Penn. We asked Dr. Blumberg to explain the risks involved in swimming and her suggestions for avoiding infections while enjoying the activity. Here are her recommendations.

Why is it important for liver transplant recipients to learn about safe swimming?

We know that significant infections can result from water exposure, so it’s critical for liver transplant recipients to understand:
  • where it is safe to swim;
  • where it is not safe to swim; and
  • when it is not safe to swim.

Where is it safe for liver transplant recipients to swim?

It’s safe for liver transplant patients to swim in chlorinated pools. In most cases, the ocean is also okay, but patients should avoid swimming in the Chesapeake because the presence of some dangerous bacteria has been found there in recent years.

If liver transplant patients experience any kind of abrasion while in the ocean, the abrasion should be thoroughly cleaned with soap and an uncontaminated water source -- not the water they are swimming in -- to minimize the risk of infection.

Where is it unsafe for liver transplant recipients to go swimming?

Fresh-water swimming represents a high risk for infection. So it’s not safe for liver transplant recipients to swim in fresh water of any kind, which includes ponds, lakes, creeks, rivers and streams. Since it’s often part of vacation recreation, it’s probably helpful to mention that, because of several infection risks, hot tubs should also be avoided.

When is it unsafe for liver transplant recipients to go swimming?

If a liver transplant recipient has an open wound of any kind, it is not safe to swim at all. In addition, swimming should be avoided if a patient is being treated for rejection.

Remember, if you have questions about safe swimming, before you go, contact your transplant coordinator to verify that swimming is safe option for you.

Friday, August 22, 2014

Two Steps to Staying Safe in the Sun

Summer is coming to a close, but the Penn Liver Transplant Program and Penn Dermatology remind you to continue to think of the skin you are in – regardless of the season. Because early intervention for any skin abnormality is the best way to minimize problems, it’s important for everyone to stay vigilant about skin health. For liver transplant recipients, not only is it important, it’s critical to take skin health seriously and partner with your healthcare providers to protect yourself. You should take every step you can to minimize your risk.

The reason that careful attention to skin is so serious for transplant patients is because some of the medications prescribed to protect a transplanted liver increase your risk for developing skin cancer. This is particularly true for anyone who has ever had sunburn. While people with fair skin and light colored eyes are at a higher risk, even those with darker skin tones are vulnerable to skin cancer, so it’s important to take an active role in this part of your healthcare by practicing early detection and skin cancer prevention.

The good news is that it’s easy to do self exams and protect yourself from the sun all year long. If self exams for skin cancer are new to you, the American Academy of Dermatology (ADA) offers an informative three-minute video explaining the steps of an effective self exam and what specifically to look for. Another helpful tool from the ADA is a free download called the Body Mole Map – a way to record moles and track any changes you observe.

Protecting yourself from the sun throughout the year is also easy to add into your daily routine. By simply wearing protective clothing, such as a wide-brimmed hat and long sleeves, and applying sunscreen with an SPF of 15 or above, you can protect your skin from sun-related skin damage.

In addition to these sun smarts, the Penn Liver Transplant team strongly encourages its patients to see a dermatologist within the first six months following their transplant and once a year after the initial appointment. A dermatologist is specially trained to evaluate and treat disorders of the skin, including infections, rashes and skin cancer. Penn dermatologists offer special expertise in treating post-transplant patients and managing their increased risks.

If you would like to see a Penn dermatologist who specializes in caring for transplant patients, 
please call 215-662-2737 for an appointment.

Friday, August 15, 2014

The Buzz on Raw Honey and Unpasteurized Foods

By Tiffany Donahue, Guest Blogger

Tiffany Donahue, RD, LDN is a clinical dietitian at Penn Medicine. Here she gives some tips on nutrition and types of foods to avoid after transplant.
In the first few months following transplant surgery, it is crucial to follow the recommendations provided from the medical team to ensure proper healing and promotes adequate function of the newly transplanted organ. One essential aspect of the post-transplant care plan is the nutrition guideline provided by the transplant dietitian. A solid nutrition plan is fundamental to your health and is one way you can work to optimize how well the transplanted organ functions.

In general, nutrition recommendations guidelines after transplant include a well-balanced, portion and carbohydrate controlled diet. Your transplant dietitian may further personalize your diet depending on individualized needs when considering pre-existing conditions or risks due to family history.

One important area of focus in the post-transplant nutrition guidelines is to help raise awareness of potential food safety concerns while the immune system is compromised from immunosuppressants – medications that reduce the risk of organ rejection. Although these medications are an essential component of treatment, they may increase a patient’s susceptibility to infection, so it’s important to minimize risks associated with diet.

As more Americans strive for healthier diets, there has been a shift to increase the consumption of fresh and local foods and beverages. While this is a wise choice, transplant patients must choose carefully – especially in the area of unpasteurized food items.

There are several types of pasteurization and all incorporate the method of heating to eliminate potential pathogens and then cooling. The difference lies in how long a product is heated and to what temperature, and how quickly it is taken from the peak temperature to a cooled product.

One popular sweetener that’s gaining the attention of consumers seeking more local products is raw honey. Whether added to a cup of hot tea or a nut butter sandwich, a spoonful of raw honey may potentially expose a recently transplanted person to harmful contaminants or bacteria. Raw honey has not undergone pasteurization, so as part of the nutrition guidelines following transplant surgery, dietitians advise against it. This is also true for unpasteurized milk and any foods made from unpasteurized milk, like yogurt and cheese.

Another trending group of products are juices and smoothies that advertise a “gentle pasteurization.” The gentle pasteurization process is similar to pasteurization in that products are heated and cooled quickly, but the temperature during the heating phase and the total length of the process differ.

One reported benefit of this method is that the fruits and vegetables are able to retain more of their healthy properties; however, it’s not clear whether enough of the potentially harmful bacteria are eliminated in this method. After reaching out to a leading manufacturer of “gently pasteurized” manufactured beverages, a definitive answer has not been offered as to whether these products are without risk for immune-compromised patients. For this reason, it’s also advisable for post-transplant patients to avoid gently pasteurized beverages.

So when putting together a grocery list or making on-the-go food selections in convenience stores, think about the nutrition recommendation guidelines and remember that unpasteurized foods could lead to unhealthy side effects.

I often remember the words of a post-transplant patient who I met with a few days after their transplant surgery. After learning about some changes required to their diet to care for their transplanted organ well, the patient said, “I have been given this gift, and I will do whatever I have to, to say thanks every day.”

Following nutrition recommendations and partnering closely with your healthcare team are two ways to “say thank you every day” and steward the gift of a donated organ well. Please contact your transplant dietitian if you have questions about foods that are safe after transplant.

Find out more about organ transplant programs and services at Penn Medicine.

Friday, August 8, 2014

Meeting the Needs of Live Donors from Near and Far

By Linda Wood, Guest Blogger

Linda Wood, BSN, RN, is a liver transplant nurse and coordinator at the Hospital of the University of Pennsylvania. Here she tells about a special program offered at Penn Medicine for people who are interested in live liver donation but live far from the greater Philadelphia area.

As the region’s largest and most experienced liver transplant program, it’s not a surprise that our team is able to offer Penn liver transplant patients the opportunity to pursue both living and deceased donor options.

While our program is well-known for its clinical expertise in live donor liver transplant, not many people know about the special services we offer for people who are interested in exploring live liver donation at Penn but currently live far from the Delaware Valley.

Interestingly, about 40 percent of our living donor candidates live outside of the greater Philadelphia area, and donors from all over the United States routinely contact us about how we partner with people who are interested in sharing the gift of life through live liver donation with a friend or loved one.

To meet the unique needs of donor candidates who have work and family commitments far from Penn, we developed the Distance Donor Program – a special evaluation protocol designed to accommodate donors who must take a plane, interstate train or interstate bus to travel to our center. The program is also perfect for donors who have greater than a two-and-a-half-hour drive to us.

As part of the program, Distance Donors are asked to stay in the Philadelphia area for a few days during which we can get most (if not all) of the donor work-up completed. Before enrolling in the Distance Donor Program, the donor candidate needs to:
  • Meet certain age and health criteria.
  • Be blood type compatible to their intended recipient.
  • Be a relative or close friend of their intended recipient or their immediate family.
While much of the donor work-up must take place at Penn, testing that can be done local to the donor candidate is maximized.

Now that you know some details about how we partner with distance donors, it’s important for you also to know about the National Living Donor Assistant Grant. This support for living donors is made available through the National Institutes of Health (NIH) and is offered to qualifying donors to assist with travel expenses (airfare, gasoline, train fare, etc), lodging, food and other expenses as well.

If you’re interested in being evaluated on behalf of a child who is on the UNOS transplant waiting list at the Children’s Hospital of Philadelphia (CHOP), our team partners closely with CHOP to facilitate those donor work-ups and is ready to answer any questions you may have about that special type of live donor liver transplant.

In a time when the number of deceased donors cannot meet the demands of the increasing number patients waiting for a liver transplant, we encourage patients on the liver transplant waiting list to broaden your consideration and look to family and friends near and far. Please have all potential donors contact our office at 215-615-0564 for more information about this service.