Clinical Briefing: Liver Transplantation
March/April 2009
The Penn Transplant Institute at the Hospital of the
University of Pennsylvania is among the busiest centers for
adult liver transplantation in the country. With more than 100
procedures performed every year since 2002, Penn consistently
outpaces the national average for 1-month and 1-year survival,
for both patient and graft (Figure 1).
Figure 1. Penn Transplant Program patient and organ survival at
one month and one year, vs. national averages.
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Living Donor Liver Transplantation at Penn
Each year, approximately 10 percent of patients die while on
the waiting list for liver transplantation. To meet the growing
needs of patients with end-stage liver disease, transplant centers
are developing innovative ways to increase the number of livers
available for transplantation.
Currently, the Transplant Institute
at Penn is one of nine centers participating in a National
Institutes of Health (NIH) sponsored multi-center study of
adult-to-adult living donor liver transplantation. Living donor
transplantation, in which a family member or close friend
provides a portion of his or her liver to the recipient, has the
potential to reduce the morbidity and mortality while waiting for
a liver transplant. The typical candidate for living donor
donation is a patient with moderate-to-severe liver disease whose
Model for End-Stage Liver Disease (MELD) score is too low to
ensure a transplant within a defined period of time.
In adult living donor liver transplantation, either a full right
side or full left side of a liver from a healthy adult is transplanted
into another adult with end-stage liver disease.
Case Study
Mr. R, a 57-year-old man with cirrhosis of the liver secondary
to hepatitis C infection, came to the hepatology program at the
Hospital of the University of Pennsylvania following the
development of encephalopathy, ascites and electrolyte disturbances.
When his condition continued to deteriorate despite
intensive medical management, his case was referred by the liver
transplant team to the Penn Liver Transplant Committee for an
assessment of his candidacy for liver transplantation.
After considering
the internal waitlist criteria and reviewing Mr. R’s MELD
score and other factors, the Committee decided that his symptoms
and medical status were appropriate to place him on the United
Network for Organ Sharing (UNOS) liver transplantation list, but
would not be high enough to result in any offers of deceased
donors. After a meeting with the transplant team, Mr. R decided
to consider the possibility of a living donor transplant and went
home to consult with his family.
Several weeks later, his son, AJ,
decided that he wished to be evaluated as a living donor. At age
36, AJ was within the donor age parameters, his physical condition
was good and he had no history of past or current
serious disease. Following medical evaluation, imaging, and
laboratory tests, AJ was determined to be a suitable living donor
candidate. He then met privately with a social worker and psychiatrist
who assessed the psychosocial motivation for his decision
to become a donor. Having determined that AJ arrived at the
decision of his own volition, he was cleared to undergo liver
biopsy, complete his evaluation, and donate a portion of his liver
to his father.
During a full day procedure two weeks later, the right part of
AJ’s liver was transplanted into his father. Though AJ experienced
some pain and discomfort in the days immediately following his
surgery, his recovery was otherwise uneventful. At his three-month
follow-up visit, MRI scans determined that most of the liver tissue
he’d lost had regenerated. Mr. R had no major complications
following his liver transplant, and within days experienced a
dramatic improvement in liver-associated symptoms.
Our Team of Faculty
Penn’s Liver Transplant Program brings together a multidisciplinary
team of physicians, nurse specialists and hospital support
staff who provide coordinated care throughout the entire transplant
process. Our goal is to meet the unique physical and emotional
needs of each patient in a caring, professional environment.
Transplant Hepatologists
K. Rajender Reddy, MD
Medical Director, Liver Transplant Program
Professor of Medicine
Thomas W. Faust, MD
Associate Professor of Clinical Medicine
Karen L. Krok, MD
Assistant Professor of Medicine
George A. Makar, MD
Assistant Professor of Clinical Medicine
Kimberly A. Forde, MD, MHS
Instructor of Medicine
Maarouf Hoteit, MD
Instructor of Medicine
Transplant Surgeons
Abraham Shaked, MD, PhD
Director, Penn Transplant Institute
Professor of Medicine
Kim Olthoff, MD
Surgical Director, Liver Transplant Program
Professor of Surgery
Peter L. Abt, MD
Assistant Professor of Surgery
Transplant Coordinators
Dawn Drazek, RN, CCTC
Meredith A. Grzybowski, BSN, RN
Charisse Henderson, RN
Betsy Knight, MSN, CRNP
Patrice Pfeiffenberger, BSN, RN, CCTC
Catalina Read, BSN, RN, CCTC
Live Donor Coordinators
Sheilagh McCauley, RN, CCTN
Julie Spaulding, MSN, CRNP
Transplant Surgical PA
Georgeine C. Smith, PA
Social Worker
Laura Kotler-Klein, MSW
Financial Coordinator
Andrew Haas, BS
Transplant Psychiatrist
Robert Weinreib, MD
Associate Professor of Psychiatry
Transplant Pharmacist
Erin Wade, Pharm D
Transplant Nutritionist
Carol Bergen, MS, RD, CSR, LDN
Clinical Manager for Abdominal Organs
Kate Ventura, MSN, CCTC
Manager of Penn Transplant
Liver Clinical Research
Mary Kaminski, PA-C
Transplant Network Coordinator
Denise M. DuPont
Outreach to Physicians and Patients
Access
Patient appointments are available at:
Penn Transplant Institute
Hospital of the University of Pennsylvania
Ground Rhoads
3400 Spruce Street
Philadelphia, PA 19104
Division of Gastroenterology
3 Dulles
3400 Spruce Street
Philadelphia, PA 19104
Division of Gastroenterology
Penn Presbyterian Medical Center
Wright-Saunders, Suite W218
38th & Market Streets
Philadelphia, PA
Penn Medicine at Radnor
250 King of Prussia Road
Radnor, PA 19087
To refer a patient and/or consult with a doctor:
Call 800.789.PENN (7366) or refer
a patient online.
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