University of Pennsylvania Health System

Liver Transplant Update | Penn Medicine

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.

Wednesday, July 30, 2014

Meet the Team: Rebecca Farrell BSN, RN, CCTN

Liver transplant coordinator Rebecca Farrell BSN, RN, CCTN has been caring for transplant patients for nearly 20 years. As a full-time nurse who serves as the President of the Delaware Valley Chapter of the International Nursing Society and the Captain of the Penn’s DASH for Organ Donor Awareness team, Rebecca doesn’t have a lot of time to spare, but she took a moment to share with us about how her career in transplantation began and what inspires her about her work at Penn. Here’s a snapshot of her passion for her work in transplantation and her dedication to providing care for Penn Transplant patients.

1. How long have you been providing nursing care?

It’s hard to believe, but I’ve been a nurse now for 18 years!

2. What first interested you in transplant?

Transplant was compelling to me because it really is so unique, and the topic of transplantation is typically only briefly covered in most nursing programs - so I was determined to learn as much as I could about it. Once I learned about the intricacies of solid organ transplantation and witnessed such sick patients come visit us as healthy individuals, I was hooked. I was fascinated by the teamwork and dedication that was needed to take care of transplant patients. As a new nurse, the complexity of care and depth of compassion I saw transplant nurses share were inspiring to me. As time went on, I would see transplant recipients come back to the unit after recovering to visit the nurses and thank us for their second chance at life. I think I cried everyday that I worked for the first few months here.

3. How did your career in transplant begin?

Funny story. I was working as a traveling nurse and was moving from San Diego back home to Philadelphia to work an assignment over the holiday season when I was assigned to the Hospital of the University of Pennsylvania (HUP) on a transplant unit. I thought my company misread my resume because I thought I needed critical care experience to work with transplant recipients (moving a whole organ into another human being is pretty serious stuff!). I started at HUP on January 4, 2001, and I’ve been working with transplant ever since. I even met my husband, Tim, here at Penn on Rhoads 4. We had our first daughter on January 4, 2006 (my five-year anniversary at HUP). We have been married for 12 years. Transplant and Penn have been so good to me.

4. What do you most enjoy about working in transplant?

The patients and their families! Hands down. I cannot imagine the struggles they have to endure on a daily basis. If I can help relieve at least one of those struggles, then I feel I’ve done my job. I have met hundreds of transplant recipients and/or donors during my transplant career; each one of them has impacted my life in one way or another. I cannot imagine doing anything else, honestly. The other aspect of my job that I love is the people that I work with. I work with some of the most talented and internationally respected transplant surgeons and hepatologists. How lucky am I? I also work with the most dedicated and talented group of nurses, nurse practitioners, and medical assistants in healthcare. I learn from my colleagues every day. We push each other constantly to strive for excellence. I am so honored to have the career that I do and be able to work with some of the best people in transplantation.

5. How have you been relaxing this summer?

Can you define relaxing? Just kidding. I do indulge in watching Big Brother with my husband. But honestly, I don’t have a lot of down time so I don’t get to relax much. When I’m not working I am a mom of three kids ages eight, six and four. Serving as the President of an international transplant nursing organization keeps me busy as well. I do take time to stop for a few minutes to watch the sun go down and make sure I am reminding myself of all of the things I have in my life that I am thankful for… that’s something I am sure to make time for every day.

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

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.