University of Pennsylvania Health System

Liver Transplant Update | Penn Medicine

Thursday, March 26, 2015

Do Prescription Drugs Lead to Liver Failure?

Many people believe that prescription medications are one of the main causes of liver failure. After all, according to the Food and Drug Administration (FDA), drug-induced liver injury (or hepatotoxicity) is the second most common reason drugs are withdrawn from the market.

Infectious disease specialist, Vincent Lo Re, MD, MSCE, and director of the Living Liver Donor Transplant program, David Goldberg, MD, MSCE, set out to uncover the prevalence and outcomes of drug-induced acute liver failure in the United States.

Through their study, Dr. Lo Re and Dr. Goldberg determined that prescription drug-induced liver failure is pretty rare. It’s actually over-the-counter medications and dietary or herbal supplements that most commonly lead to liver failure.

The Study

Dr. Lo Re
To discover the true cause of acute liver failure, the hepatologists and their team analyzed data from an integrated healthcare system, representative of the broader U.S. population. The data they looked at was from Kaiser Permanente Northern California between January 1, 2004 and December 31, 2010.

Among the 5,484,224 patients evaluated, 62 were identified with acute liver failure, nearly half of which were drug-induced. Acetaminophen was associated with 56 percent of cases, dietary and herbal supplements with 19 percent, antibiotics with six percent and miscellaneous medications with 18 percent.

What This Means

Dr. Goldberg
According to Dr. Lo Re, these findings give reason to consider additional regulatory oversight of dietary supplements and herbal products. In particular, acetaminophen (when unintentionally overdosed) often causes acute liver failure.

“These data are reassuring in that they demonstrate that the risk of liver failure, the most dreaded complication from medication-induced liver failure, is a rare event. However, people should still be vigilant about the potential risks of medications and/or supplements, especially for those over-the-counter products that have limited to no proven efficacy.”

If you’ve had liver failure, you know how challenging it can be. Share with your family and friends that they need to be careful about over-the-counter medications and supplements – and amounts –that they choose to take. Make sure to take medications as indicated.


Thursday, March 12, 2015

How to Reduce Sugar in Your Diet

Following transplant surgery, you need to be extra careful with your diet and follow the nutrition guidelines provided by your Transplant dietitian and medical team. In general, nutrition recommendations after transplant include a well-balanced, portion and carbohydrate-controlled diet. Carbohydrate-controlled, in particular, means watching your sugar intake...

While always sweet and delicious, consuming large amounts of added sugar can be more than a dental issue. Sugars in their natural form, like those found in fruits and vegetables, are embraced by our body and are broken down appropriately; however, the addition of refined sugar in processed foods has been clearly linked with health complications.

Following a solid nutrition plan and reducing the amount of refined sugar your consume is one way you can work to optimize how well your transplanted organ functions. To help, we have listed a few alternatives to sugar that you can use in your food and drinks that are healthier, yet just as sweet.

Unsweetened Applesauce

For healthier baking, swap out the sugar for applesauce, which contains more nutrients, as well as fiber, and fewer calories for every cup. Just replace the sugar with equal parts applesauce and you're well on your way to a healthier, sweet snack. Remember, for every cup of applesauce used, reduce the amount of liquid in the recipe by one-fourth cup.

Vanilla

Housed in every baking cabinet, vanilla extract can enhance the flavor without the refined sugar. Even though it can't be used as a 1:1 ratio, it still can reduce the amount of added sugar while keeping the same amount of flavor. A perfect, healthy twist for your favorite cookie! Try cutting a few tablespoons of sugar and using half of a teaspoon of vanilla instead.

Yogurt or Greek Yogurt

Yogurt can provide a good sweet option, as some have relatively low sugar. Nutritionists, Tiffany Donahue, RD, LDN, and Katie Stratton, RD, LDN, suggest adding a little powdered cocoa or a sprinkling of cinnamon to plain Greek yogurt for a fun snack.

Reminder: Remember that honey, maple syrup and dried fruit are natural but concentrated sugars, which should be avoided or limited to small quantities. Raw honey should be avoided completely.

Friday, March 6, 2015

What to Know About Living Liver Donor Transplantation

If you’re on the liver transplant waiting list or know someone who is, we want to make sure you know about Penn’s Living Liver Donor Transplant program. While people are familiar with living kidney donation, they may not be as aware of living liver donation.

Living donor liver transplantation was developed as an alternative to waiting for a deceased donor, which would help to stop the donor shortage and save more lives. You see, in the greater Philadelphia region, there are more than 700 people on the liver transplant waiting list. Last year, despite a 14 percent increase in liver transplants from the year before, only 322 people received transplants in the area.

Living donor liver transplantation allows a healthy adult to donate a portion of their liver to the patient in need. Unlike most organs, the liver has the remarkable ability to regenerate. The donor's remaining liver grows to its original size within weeks.

What Makes a Good Donor?

Linda Wood meeting with a potential donor
There are several characteristics and circumstances that we prefer for you to qualify as a living donor. For a good match, the donor and recipient must have compatible blood types. We’ve done transplants on blood types that were incompatible in emergency situations, but that’s extremely rare. For example a donor could be 0- and a recipient 0+; it’s only the blood type that matters, not the positive or negative status.

In addition, the ideal donor:
  • Has some sort of relationship with the potential recipient: This doesn’t necessarily need to be a family member, but there needs to be some sort of connection.
  • Is in the age range of 21 to 50, although potential donors can be slightly younger or slightly older on a case-by-case basis
  • Does not smoke at all or drink much
  • Is not overweight: An overweight donor could complicate the surgery or have a liver donor graph that has too much fat in it.  However, donors who are mildly overweight can participate in a weight loss program to become eligible.
  • Does not have any medical issues, such as diabetes or bad hypertension 

Is It Safe?

Any type of surgery has some risk involved in it. We do an extremely careful evaluation to make sure that the donor is a good candidate and to minimize any potential risks and complications.

Dr. Goldberg and Dr. Olthoff
“We do everything possible to make sure that anything we do poses as little risk as possible to the donor, and that’s why donors need to be relatively young, healthy and have no other medical issues,” says chief of Transplant, Kim Olthoff, MD.

A lot of experience is needed in a center to determine who can be a good donor, who can be a good recipient, and when is the best time to do the transplant. It’s been recognized that you have to do these on a regular basis, have done them for a long time, and keep doing them to have excellent outcomes. Penn is the busiest center in the region and was the first transplant program in the region to perform an adult-to-adult living donor liver transplant.

“In donors, the outcomes are 100 percent,” states liver transplant nurse coordinator, Linda Wood, BSN, RN.

Possible donors should also be aware that donating your liver should in no way affect your long-term health. After surgery and recovery, you’ll go back to normal. You’ll be able to be active, to get pregnant, and live a long life. You should expect however to be out of work for at least six weeks, and potentially longer depending on the nature of your job.

How Exactly Does the Surgery Work?

The surgery involves taking out anywhere from about 25 percent of your liver if you’re donating a small part to a child, to about 60 percent if you’re donating your whole right lobe to another adult. What’s involved with the actual surgery is an incision that is the shape of a hockey stick, or straight down the upper part of your abdomen if it’s a smaller piece of liver.

The first thing that’s done is assess the liver. By this time, your surgeons have performed an extensive evaluation, but they want to see how the liver, vessels and the anatomy really look. Once they’ve determined that the liver looks good, they do more extensive dissection of all the blood vessels and bile ducts that go to that segment of liver.

“The beauty of the liver is that it’s made up of sections, so we are able to just take a portion of the liver, with its blood vessels and bile ducts, and leave the part remaining in the donor so that person who donates has good liver remaining and is also able to donate a good piece of liver,” explains medical director of Living Donor Liver Transplantation, David Goldberg, MD, MSCE.

Then they have to carefully cut that piece of liver down the middle, essentially going through the liver itself and preserving all the appropriate blood vessels. At the same time that this is happening, the recipient is having their bad liver taken out.

Once the dissection is completed on the donor, they take out that piece of liver. It’s flushed with the special solution and brought to the recipient room to be put in.  From there, the surgeons close up all of the vessels that they had to divide to take the liver out, make sure there’s no bleeding, confirm that the bile duct is okay, close the incision and then finally take the donor to the recovery room.

The actual surgery itself lasts several hours, but donors and recipients are both in the recovery room for a short time and then in the hospital for about five to seven days afterwards.

Living liver donation is a life-saving endeavor, and we are happy to assist a donor in this journey to donation and beyond.


Monday, February 23, 2015

What Does the U.S. Measles Outbreak Mean for Transplant Patients?

Measles Outbreak

Over the past few weeks, the measles outbreak in the United States has been a big topic of conversation. For those of you who may not know about measles, it is a highly contagious virus that spreads through the air via coughing and sneezing. It starts with a fever, runny nose, cough, red eyes and sore throat, which is then followed by a rash that spreads over the body. It is very dangerous and can be fatal.

Measles can be prevented with the MMR (measles, mumps and rubella) vaccine. “One dose of MMR vaccine is about 93 percent effective at preventing measles if exposed to the virus, and two doses are about 97 percent effective,” says the Centers for Disease Control and Prevention (CDC).

According to the CDC, measles was eliminated from the country in 2000; however, measles can be spread by unvaccinated people who catch it while outside of the U.S. They can spread measles to other people who are not protected against it – which is what is happening today.

What This Means for Transplant Patients

Anyone about to undergo transplant surgery – whether receiving or giving an organ – needs to be even more careful about contracting measles. To make sure you’re safe, we’ll be screening all pre-transplant patients and potential living donors born after 1957. Your nurse coordinator may reach out to you. In preparation, we wanted to provide you with the guidelines for how the measles screening will work:
  • Your physician will need to verify that you have two documented doses of the measles vaccine. If you do have the documentation, you won’t need to go through a screening test.
  • If the team isn’t able to confirm two documented doses of measles vaccine, you’ll be screened for immunity with a measles antibody IgG test.
  • Household and family members of transplant patients, transplant candidates and potential living donors should be vaccinated against measles too. If they were born after 1957, have not had measles and have not received two doses of the measles vaccine, they should be vaccinated by their primary providers. 
  • Household and family members of transplant patients, transplant candidates and potential living donors in high-risk jobs, such as teachers, daycare workers and pediatric healthcare workers, should have their immunization status checked and get re-vaccinated if needed.
  • Note: Organs for transplant from deceased donors with active measles at the time of death will not be accepted.
If you have any questions or concerns, please call 215-662-6200 or contact your nurse coordinator. You can also contact your provider through MyPennMedicine.

Thursday, February 12, 2015

I Wanna Hold Your Hand: Hand Washing Tips


Since Valentine’s Day may lead to more hand holding than usual, we thought a quick review of hand washing hygiene might be helpful.

The Centers for Disease Control (CDC) recommends a five-step hand washing protocol: Wet, lather, scrub, rinse and dry. Most people do these steps automatically, but small changes can help increase the effectiveness of your hand washing and maximize the removal of disease-causing germs. Check out the list below to make sure you’re getting the most out your hand washing efforts:
  • Wet your hands with clean, warm or cold running water, turn off the tap, and apply soap.
  • Lather your hands by rubbing them together with the soap being sure to lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 seconds which is about the same amount of time it takes to sing “Happy Birthday” twice.
  • Rinse your hands well under clean, running water.
  • Dry your hands using a clean towel or air dry them.
In addition to recommendations on how to properly wash your hands, there are also important guidelines for when to wash your hands. Here are 10 activities that are wisely coupled with hand washing:
  1. Before, during and after preparing food
  2. Before eating food
  3. Before and after caring for someone who is sick
  4. Before and after treating a cut or wound
  5. After using the toilet
  6. After changing diapers or cleaning up a child who has used the toilet
  7. After blowing your nose, coughing or sneezing
  8. After touching an animal, animal feed or animal waste
  9. After handling pet food or pet treats
  10. After touching garbage
If you’d like to understand the science behind the hand washing recommendations, the CDC website offers a synopsis of the studies on which the recommendations are based.

From the Penn Liver Transplant team, we wish you love, happiness and health this Valentine's Day.

Monday, February 2, 2015

Is It the Cold or the Flu?

This year's flu season is shaping up to be a particularly nasty one. More people this year are reporting having the flu since 2008. And the worst may be yet to come, as flu infections typically peak in February.

For liver transplant patients especially, having the flu is nothing to sneeze at. But when you’re feeling a bit under the weather, it can be difficult to gauge how serious your condition is. It's important to distinguish between cold and flu symptoms to make sure you don't develop any complications.

Here are common symptoms of the flu and the cold that may help determine which “bug” you have:

Flu symptoms
  • Slow onset of illness (over a day)
  • Fever over 100.5°F
  • 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
Whether it's a cold or the flu, the best treatment for both is getting plenty of rest and drinking lots of fluids. Before taking over-the-counter medicines, consult your nurse coordinator to make sure they are safe for liver transplant patients.

Stay on top of your health and listen to your body. If you suspect that you have the flu, please call your transplant nurse coordinator -- and do so 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 we may request that you reschedule your appointment.

Friday, January 23, 2015

Share Your Story

As the most experienced liver transplant program in the greater Philadelphia region, we understand that some of the most helpful support and encouragement for people on the liver transplant waiting list comes from hearing from Penn recipients -- people who know firsthand the challenges that liver transplant can present. They know how feels to be on the transplant waiting list and what it's like to get the call that an organ may be available.

While this support often happens at the weekly Liver Transplant Support Group meetings, not everyone is able to attend the meetings. To help connect our pre-transplant patients with people who have had successful liver transplants, we'd like to invite you to share your liver transplant story in our “Share Your Story” series.

We’d love to hear from any post-transplant patients and their family or friends who may want to share some motivating pointers for those who are waiting. If you're a recipient, readers are often encouraged to hear how you coped with waiting and what life is like after transplant. If you're a caregiver, tips for taking care of yourself while taking care of a loved one are always helpful, as well as unique insights you have from supporting someone on a transplant journey.

These articles are generally 400 to 800 words and contain photos to help readers connect quickly to your story.

You can submit your story to Denise DuPont, manager of Outreach and Communications, by emailing it to denise.dupont@uphs.upenn.edu or mailing a printed copy to:

Denise DuPont
Penn Transplant Institute
1 Founders
3400 Spruce Street
Philadelphia, PA 19104


If you have a story to tell but writing isn’t something you love to do, call Denise at 215-873-7983. She can talk to you about what you'd like to share and work with you to capture your story in writing.

We look forward to hearing from you soon.