Special Areas of Expertise
Penn Medicine's liver transplant program is leading health care beyond the limits of conventional medicine by offering patients more options to improve their lives every day. Patients who choose Penn for their liver transplant have access to the most advanced care available.
The Penn Liver Transplant Team has special expertise in treating:
- Liver Cancer
- Hepatitis C
- Patients with heart or lung disease that may require dual organ transplant
- Congenital liver diseases such as biliary atresia
Liver Transplantation for Liver Cancer
The Penn Transplant Institute performs more transplants for primary liver cancer (hepatocellular carcinoma or HCC) than any other program in the region. The outcomes of liver transplant for cancer at Penn Medicine are excellent, with a high chance of cure.
Early detection of HCC is the key to successful treatment. Because liver cancer almost always occurs in patients with a background of cirrhosis, careful surveillance for early cancer in these patients is critical in allowing cure of HCC with liver transplantation.
The care of patients with liver cancer is complex and requires the contribution of several medical specialties. The multidisciplinary liver tumor team provides the patient a comprehensive plan of treatment in an efficient and caring way.
The Penn Liver Transplant Team believes the best outcomes can be achieved when specialists collaborate in one multidisciplinary approach. Penn's team of national and international experts in liver cancer meets every week, review the radiologic images and the clinical information and make an initial assessment. Patients are then evaluated in a multidisciplinary clinic where the team evaluates them in one clinic visit and discusses treatment options. Our approach allows for efficient evaluation, resulting in treatment plans created and implemented quickly in every case.
Frequently asked questions (FAQ) about liver cancer
- What is liver cancer and who is at risk?
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Primary liver cancer is cancer originating from liver cells. In the United States, hepatitis C is among the most common causes of chronic liver disease and hepatocellular carcinoma. For this reason, it is frequently possible to identify patients at risk and to perform tests that allow early detection of HCC. Patients with cirrhosis due to any cause represent the main group of patients at risk of liver cancer and should undergo imaging tests of the liver twice a year to check for early liver cancer.
- When and why is liver transplant needed for liver cancer?
Early detection of cancer in HCC is important because only early cancer can be cured. The traditional treatment for early cancer is surgical removal (resection) of the tumor, but the advent of liver transplant as an acceptable treatment for HCC in the 1990s offers the option of curing liver cancer for a large group of patients where surgical resection is not possible. In fact, in the vast majority of patients with HCC, the damage to the liver is not restricted to the tumor itself. Because HCC almost always occurs in a background of cirrhosis, the remaining liver may not function properly after the cancerous portion is removed, resulting in potentially life-threatening liver failure. As long as the tumor is detected early enough for transplant to be possible, the group of patients at risk of liver failure after resection of HCC is better served by liver transplantation since the entire liver is replaced by a healthy liver from a donor. The other major advantage of transplantation is that it results in complete removal of the cirrhotic liver that could harbor additional HCC tumors or develop new tumors in the future. For this reason, the chance of cancer after treatment is lower in patients who receive a liver transplant compared to patients who receive surgical resection as the curative treatment for HCC.
- What is involved in the process of liver transplant for HCC?
HCC is one of the major reasons for liver transplantation in the United States. Patients with HCC detected early enough for transplant are evaluated for liver transplantation similar to other patients, with additional careful evaluation of the extent of tumor. Transplant candidates with HCC are then placed on the liver transplant waiting list. In order to prevent the tumor from growing while patients are waiting for transplant, additional treatments, often requiring the expertise of an interventional radiologist, are frequently needed. Patients are expected to have the entire tumor, as well as the entire diseased liver with cirrhosis, removed at the time of transplant.
- What is the approach to liver cancer at the Penn Transplant Institute?
The process of early detection of HCC, determination of the extent of tumor, evaluation for transplant candidacy, treatment of the tumor while waiting for transplant, management of the complications of cirrhosis, as well as treatment of any underlying cause of liver disease such as hepatitis C, requires the expertise of many specialists. This includes hepatologists, transplant and hepatobiliary surgeons, radiologists, interventional radiologists, oncologists and radiation oncologists, as well as nurse coordinators, social workers, and nutritionists. At Penn, the various specialists are part of one multidisciplinary liver tumor team that meets weekly and collaborates to provide outstanding care to every patient.
Nearly 4 million people in the United States are currently infected with hepatitis C and about 12,000 people die each year from the infection. Although only a small proportion of people with hepatitis C develop liver failure requiring a liver transplant, the large number of people infected makes this the number one cause of liver failure in the United States, accounting for one in three liver transplants.
The Penn Transplant Institute's comprehensive, long-term approach to the management of hepatitis C brings together the largest group of liver specialists in the region. They are experienced in treating hepatitis C in patients with advanced liver disease awaiting transplantation as well as those who require treatment after transplant. Patients are monitored closely after transplant and treatment for hepatitis C is initiated at an early stage to maximize the long-term health of every liver transplant recipient.
Penn's liver program is home to a dedicated viral hepatitis center where patients with hepatitis C and other viral infections of the liver are treated by liver and infectious disease experts. In addition, the Penn liver program is home to many new and ongoing clinical trials of new agents to treat hepatitis C infection, offering opportunities for therapy not available in other centers in the region.
The Penn Transplant Institute provides liver transplants in a select population of human immunodeficiency virus (HIV)-infected individuals. Penn researchers participated in the original studies measuring the safety and effectiveness of this procedures, and are now of the most experienced programs in the country providing transplants for patients with HIV.
To be considered for the program, patients must:
- Have a T-cell count that is greater than 100 cells per microliter.
- Meet all the same transplant requirements for non-HIV patients.
- Provide informed consent.
- Take preventive medication to avoid certain infections.
- Undergo frequent monitoring, including liver biopsies and treatment, if they have hepatitis B or C.
- Submit laboratory test results within seven days of draw and be willing to notify someone on the transplant team, such as the nurse coordinator, before changing any medications.
- Not be pregnant.
- Not be suffering from significant wasting.