The Hahnemann Liver, Biliary and Pancreas Center is affiliated with the Pediatric Liver Transplantation Program at St. Christopher's Hospital for Children. 

 The Liver, Biliary and Pancreas Center

 The physicians and staff at the Liver, Biliary and Pancreas Center offer comprehensive, multidisciplinary care - from the onset of liver disease, through the medical management of the disease, complex surgeries and transplantation.

Liver Medicine, Surgery and Transplantation

The Liver Center team – from physicians specializing in adult and pediatric liver medicine, surgery, transplant and oncology to nurses, case coordinators, therapists, social workers, financial counselors and support staff – is dedicated to caring for the complex needs of patients with liver disease, and those requiring organ and tissue transplantation.

 Hepatology – Medical Treatment of Patients with Liver Disease
        Hahnemann’s Division of Hepatology, headed by Gillian Ann Zeldin, MD, includes an experienced team of professionals dedicated solely to caring for the complex needs of patients with liver disease.

       Our physicians have extensive experience in treating liver diseases, including: alcoholic liver disease; Alpha-1-antitrypsin deficiency; Amyloidosis; Budd-Chiari syndrome; liver and biliary cirrhosis; hereditary hemochromatosis; alcoholic Hepatitis and Hepatitis A, B, C; HIV/Hepatitis Co-Infection; liver cancer, tumors and masses; acute liver failure, non-alcoholic steatohepatitis; NASH; primary sclerosing cholangitis; and Wilson’s disease

Liver and Hepatobiliary Surgery

The surgeons at the Liver, Biliary and Pancreas Center have extensive experience in cutting-edge and complex surgeries, including:

• Liver Resection
• Minimally Invasive Surgery
• Surgical Oncology
• Portal Hypertension Surgery
• Gallbladder and Bile Duct Surgery
• Pancreatic Surgery

 Transplantation Expertise

Our physicians are specially trained in liver transplantation, including all techniques available today—split liver, partial, domino, piggy-back and live donor.

 Live Donor Liver Transplant

 Our team possesses significant expertise in living donor liver transplantation which was introduced because the cadaveric organ donation could not meet the increasing demand.  The advantages of this innovative approach, especially the reduction of waiting list mortality, have become clearly visible.  Our surgeons perform living donor liver transplants in adults and children, in conjunction with St. Christopher’s Hospital for Children. 

Patient Information on Transplantation

Resources

•  American Liver Foundation (link to www.liverfoundation.org)
• UNOS (United Network for Organ Sharing) (link to www.unos.org)
• Gift of Life Donor Program (link to www.donors1.org)
• American Association for the Study of Liver Disease (link to www.aasld.org)

 Your Liver – An Overview

• What does your liver do?

Your liver is an extremely important organ.  It performs the following functions:

• controls the make-up of your blood, including the amounts of sugar, protein, and fat in the bloodstream.
• eliminates bilirubin, ammonia, and other toxins from the blood. (Bilirubin is a by-product of the breakdown of hemoglobin in your blood cells.)
• processes most of the nutrients absorbed by the intestines during digestion and converts those nutrients into forms that can be used by the body. The liver also stores some nutrients, such as vitamin A, iron, and other minerals.
• makes cholesterol, substances that help blood clot, and certain important proteins, such as albumin.
• breaks down many drugs.

Directions to the Liver, Biliary and Pancreas Center

 From Interstate 95 North or South: Take I-676 West, the Vine Street Expressway. From the expressway, take the Broad Street exit. At the end of the ramp, turn left at the first light onto Vine Street East to Broad Street. The hospital will be on your right. Turn left at Broad Street to get to the hospital’s parking garage.

 From New Jersey:

From the Ben Franklin Bridge, follow the signs for Vine Street Local. Stay in the left lane to Broad Street. Turn left on Broad; the hospital is on the right.

From the Walt Whitman Bridge, follow signs for Interstate 95 North (see directions above).

 Valet Parking is available Monday-Friday, 6 a.m.-6 p.m. at the main entrance on Broad Street. For detailed information on various routes, public and airport transportation, visit our Web site under “About Us” or call 215-762-7000.

The Liver, Biliary and Pancreas Center at Hahnemann University Hospital

216 North Broad Street

5^th Floor Feinstein Building

Philadelphia, PA 19102

Phone:  215-762-3900

Fax:  215-762-8572

Living Donor Liver Transplantation

Why is living donation necessary?

In the last 10 years, the number of candidates for liver transplantation has increased rapidly, relayed to improving results and greater awareness in the medical and general communities of the benefits and availability of this life-saving procedure.  However, the number of deceased donors has risen only slightly.  This has led to a large and widening gap between the number of patients awaiting transplant and the number of deceased donor livers.  At the present time, the risk of dying while awaiting transplant is 10-15 percent.

 Currently, there are approximately 18,000 people awaiting transplants in the United States, but only enough livers to perform about 5,000 transplants each year. Because of this organ shortage, over 1,700 people die each year since 1997 while waiting for a liver transplant.  Also, the longer waiting times have resulted in patients being more ill prior to receiving their transplant, which can result in a poorer clinical outcome. 

 

What is the present experience with live donor liver transplantation?

The crisis in organ supply prompted the use of live donors as a source for organ transplants.  Starting in 1989, pediatric liver transplantation involved the removal of a small portion of an adult liver (one segment, about 20% of the liver) and transplanting it into a small child has become common. Technical problems have decreased with greater experience with these techniques and results of segmental liver transplantation in children are now comparable to whole organ transplantation.

The great shortage of donor livers for adults has led to the development of adult-to-adult living donor liver transplantation (LDLT). This usually requires the donation of the right lobe of the liver from a healthy adult, a family member or close friend, and transplanting this into an adult recipient with end stage liver disease. In the United States alone, over 2,100 live donor liver transplants have been performed in children and adults through mid-2003.

 

What is special about living donor liver transplantation?

The liver is a unique human organ because it retains the ability to regenerate itself.  After removal of a portion of the liver, the liver will grow back to its original size.  From patients who have had a part of their liver removed (to remove a tumor for example), we know that the liver should return to its original size and function and that these patients can return to their previous normal lives. If a portion of the liver is removed from a living donor and transplanted, the donor’s liver should grow back to normal while the portion transplated into the recipient will grown to the normal size for the recipient, thus one liver will have grown into two livers to serve two individuals.

Living donor transplantation is one of the few exceptional situations in medicine where major surgery is preformed on an individual for whom it is not medically indicated.  Throughout the development of live donor surgery the central concern has always been for the needs, health and safety of the donor.  Any risk to the donor has to be balanced against the benefit to the transplant recipient.  For liver transplantation the advantages may include:

 

·                 The ability to perform the transplant before the recipient is too sick.

·                 The ability to optimize the recipient’s condition prior to transplant.

·                 Shorter preservation time with excellent quality donor liver

·                 The increased availability of deceased liver donors for those who do not have a living donor

 

Who is a suitable recipient?

The recipient must first be evaluated to make sure that liver transplantation is the appropriate treatment based on the type and stage of the individual liver disease. In general, almost all liver transplant candidates eligible for deceased donor liver transplantation are suitable for living donor liver transplantation.

Some patients may have specific medical problems so that a liver transplant is not the best treatment for them.  Others may not be particular suitable for living donor transplantation, for technical or medical reasons.

When the transplant evaluation is complete and the liver transplant candidate is put on the waiting list, the option of living donation is discussed with the patient and his/her family.  At this point in time, screening for a potential donor would be appropriate.

What to expect during the donor evaluation?

Potential donors must be adults (over age 18) in good medical as well as psychological health. Most donors are family members (spouse, parent, sibling, son, daughter, nephew, niece, etc.) of the recipient or a close personal friend.  Ideally, the blood types between the donor and recipient should be compatible.

The evaluation is done in steps, and usually requires several outpatient clinic visits or short stays at the Hahnemann University Hospital. Potential donors who live a long distance from Hahnemann may undergo the initial phase of testing in their local community, provided their physician is in contact with our transplant team. 

Following discussion of the evaluation process and the donor surgery with members of our transplant team the tests and studies to be performed include:

·        Blood tests

·        Chest X-ray

·        Electrocardiogram

·        Ultrasound

·        Medical history and physical examination by a hepatologist that is independent from the transplant team (donor advocate)

·        Psychological evaluation

·        Magnetic resonance imaging

·        Liver biopsy

·        Endoscopic retrograde cholangiography

·        Angiography

 

If all of these tests suggest that the individual remains a suitable donor, then the donor surgery and the liver transplant may be scheduled and performed at the earliest appropriate time for donor and recipient. This can be as short as a few hours or as long as several weeks after completion of the evaluation. As part of the preparation, the donor will be vaccinated against hepatitis B, and also donate autologous blood.

The potential donor may find it helpful to talk with another patient who has been a living liver donor to discuss feelings and concerns about becoming a donor. If a potential donor is interested in speaking with another living liver donor, a member of the transplant team can help arrange this conversation.  If at any time during the evaluation a donor changes their mind and decides not to become a donor, then this only needs to be communicated with their doctor.  The recipient will remain active on the conventional transplant list. The recipient may also elect to look for another potential living donor.

 

In principle, any healthy adult with normal liver function and a good relationship to the recipient can be a suitable live donor.

What about the donor surgery and thereafter?

Usually, the donor is admitted to the hospital one day before surgery is performed. The type and extent of liver resection in the donor is dependent on the age and size of the recipient, and may involve the left or right part of the liver (see figures below).

After donor surgery, the average hospital stay is five to seven days with the first 24 hours spent in the Surgical Intensive Care Unit. Most patients are out of bed, with assistance, by the first or second post-operative day. 

The donor may have soft plastic drains exiting out of their abdominal walls to determine if there is any bleeding or bile after the operation.  Pain will be controlled with intravenous pain medication. A bladder catheter is placed after the donor is asleep and is removed on the second or third post-operative day.  The donor is usually drinking fluids on the second post-operative day and the diet is advanced as tolerated to a regular diet. 

 

If the donor lives outside of the Philadelphia metropolitan area, then he/she may be asked to stay in the area for up to two weeks after the donor surgery.  The donor returns for post-operative visits that will include a physical exam by the surgeon and laboratory tests. There will also be follow-up visits including a MRI to check on the restoration of the remaining liver.

Most people are able to return to work after six to eight weeks, depending on how the surgery goes and the type of job they have. If the donor has a desk job, he/she may be able to return to work sooner than patients with a more physically demanding job.

What are the risks for the donor?

Any time major surgery is done there are risks involved. The problems include slow recovery of intestinal activity, wound infection, hernia through the incision and phlebitis (clots in the leg veins.)  More serious problems encountered with liver surgery that are rare include bleeding, reoperation, bowel obstruction and bile duct complications.  

What are the financial issues associated with live donor transplant surgery?

The pre-operative evaluation, surgery and hospital stay and outpatient visits, as well as any medical treatment related to the donor surgery within the first three months, may be paid by the recipient’s insurance.  The donor may be responsible for medications such as pain pills and antibiotics after discharge from the hospital. The donor may also responsible for transportation and non-hospital lodging costs related to the evaluation and surgery.

For further information and questions please contact:

Center for Liver, Biliary and Pancreas Disease

Phone:  215-762-3900

Fax:   215-762-8572

Web:  www.hahnemannhospital.com

Resources

 ·        American Liver Foundation 1-800-GO-LIVER; http://www.liverfoundation.org/

·        UNOS (United Network for Organ Sharing) 1-888-894-6361; http://www.unos.org/

·        Gift of Life Program 1-800-DONORS-1; http://www.donors1.org/

  

 To read an article on our living liver donor program, click here.