Sharon:
I received a liver transplant at Einstein in 1999. I was told that one requirement was that I have no cancer in my body in order to be eligible. Has this changed?

Abraham Shaked, MD, PhD:
There should be no cancer outside the liver to perform this procedure. In addition, it should be primary liver cancer and not coming from outside.

Lisa:
I would like to thank Dr. Shaked and Dr. Olthoff for taking care of me and giving me a second chance at life.

Abraham Shaked, MD, PhD:
Hi Lisa, I know you are doing very well. Thank you for your kind words.

AJC:
After having the liver transplant, will David then be free of Hepatitis C? Because I thought Hepatitis C was in the blood.

James Markmann, MD, PhD:
Hepatitis C will most certainly come back in the new liver but it takes many years for Hepatitis to injure the liver. So, the likelihood long-term survival following transplant for Hepatitis C is very good.

Joanne:
I feel like my kids have grown up and done well. Good job.

James Markmann, MD, PhD:
Thank you.

Jung
What is the natural course of fatty liver? How long does it take to progress to cirrhosis and cancer?

Abraham Shaked, MD, PhD:
It is very difficult to determine. You should be followed by your physician carefully with appropriately liver function tests.

Marianne:
I had a kidney transplant at HUP 1 year ago by Dr. Naji. I would like to thanks him for saving my life. I am doing great now with no problems. Penn has the best doctors and I would recommend them to anyone that need this life saving gift. Once again thank you, I will never forget what you did for me and my family.

James Markmann, MD, PhD:
Thank you.

John:
Is there an age limit for liver transplants? My mother is coming to see you for an evaluation on April 12th and she is 71.

James Markmann, MD, PhD:
There is no formal age limit. Candidacy depends on how healthy the person is. We have transplanted a number of patients in their 70's with excellent results. We look forward to meeting your mother.

Kelly:
How long does a patient need to be alcohol free before he/she can be evaluated and be put on a waiting list?

James Markmann, MD, PhD:
The national policy is that patients with alcoholic liver disease have to be abstinent for six months prior to transplant. We will sometimes begin an evaluation just prior to the six months period if someone is very ill. But they still can't be transplanted until the six month period is up. For more information, please call 1-800-789-PENN.

Michele:
Just because you have an organ donor on your license, can you be certain your organs are donated upon your death? assuming they are healthy.

Abraham Shaked, MD, PhD:
Michele, We hope that the family's when requested to donate respects the deceased wishes, however there is no way that we wish to force families into this decision since doing so may have effect donations in the long term.

Patty:
Thank you HUP doctors and staff. I just celebrated my 10 month anniversary with my new kidney on 4/l.

James Markmann, MD, PhD:
The national policy is that patients with alcoholic liver disease have to be abstinent for six months prior to transplant. We will sometimes begin an evaluation just prior to the six months period if someone is very ill. But they still can't be transplanted until the six month period is up. For more information, please call 1-800-789-PENN.

Paul and sonl:
Dr Shaked and Dr Olthoff thank you for giving me a second chance at life. May 7, 2002 my son was living liver donor. We are both great now. I have gone from 95 lbs to 147 lbs. The whole family can never thank you enough. I only wish more people could have the same gift. Thank you again.

Abraham Shaked, MD, PhD:
We are happy to hear you are doing so well.

Linda:
I do not have a question. I only had an idea in the past of what happen to me on November 21, 1998. Now I have the actual vision. I Love & Thank you, God Bless.

James Markmann, MD, PhD:
Congratulations on behalf of the transplant team!

John:
My brother is in need of a liver, is giving half my liver to him an alternative to waiting for a whole liver?

James Markmann, MD, PhD:
It is possible for a healthy person to donate half of their liver to someone in need. For more information, please contact 1-800-789-PENN.

Joyce:
My husband had a successful kidney transplant (brother donated kidney) at HUP in 1990, which lasted for approx 14 years. He is currently on dialysis, but has an appt. at HUP this month. What age range would make a person a candidate to be a donor?

James Markmann, MD, PhD:
The healthier the donor the better. We have often used donors in their 60s and very rarely donors in their 70s. Please call 1-800-789-PENN for more information.

Theresa:
My husband has been on your liver transplant list for about five years now. He just recently got rushed to the hospital because of bleeding verisies veins and a tear at the top of his stomach. He bled so fast, I thought we were going to lose him. His toxins were very high also (169). We were told about six months ago that my husband was at thetop of the transplant list. Why, if he is at the top of the list, haven't we heard anything to date?

James Markmann, MD, PhD:
Theresa, As you know, there are a number of sick people on the list and livers are being allocated to the sickest first. If you have concerns you should call the office on Monday and I would be happy to speak with you. Or, please call 1-800-789-PENN for more information.

Janet:
My sister is on the liver transplant list at Jefferson. Her meld score is 32. She has complications that are not calculated into the meld. She is very very sick and is in the hospital most of the time now. Our family believes she will not survive the wait for the new liver. She is 48 years old and has two young children. If she was at Penn, what would your treatment be for her now? Is the availability of livers different among hospitals?

Abraham Shaked, MD, PhD:
Janet, It sounds like your sister should have a liver transplant very soon. In our program, we transplant patients with this Meld score and less with outstanding results. If you wish a second opinion, we can certainly arrange an appointment. Please call 1-800-789-PENN (7366), we have staff available tonight to take calls. We will see you as soon as possible.

Laura:
My father was just diagnosed with pancreatic cancer and liver cancer, would he be a candidate for a liver transplant? His dr said no, but I do not fully understand why

Abraham Shaked, MD, PhD:
Laura, We do not transplant patients who have metastasis from other organs to the liver.

Jeff:
What is the current wait for a kidney transplant?

James Markmann, MD, PhD:
Jeff, The wait for a cadaveric kidney transplant ranges from 2 1/2 to 5 1/2 years in our area depending on blood type. Some patients get transplanted more quickly if they are lucky to get a perfectly matched kidney. Because of the long wait we strongly encourage investigating all possible options for living donation. For more information, please contact 1-800-789-PENN.

Cindy:
What a wonderful program. I am a dialysis nurse and know the true meaning of donation. There is not enough donation and your program this evening only reiterated the importance of donation. Thank you.

Donna:
I had my kindey transplant 30 years ago at hup. I have since had 4 children. Dr Naji was involved in my surgery & I want to thank him for the being a great doc & taking great care of me.

James Markmann, MD, PhD:
Donna, Thank you for your thoughts.

Bill:
I have Hep C and I need a liver transplant. My sister has offered to be a live donor. Is this type of transplant done? If so, what are the risks to my sister?

Abraham Shaked, MD, PhD:
Bill, There are risks associated with living donations in the liver setting. We will be happy to evaluate your condition and provide you and your sister with the proper information that will help you make an informed decision. We have done many of those in our program and the results are great if done with the proper recipient and donor combination. Please call 1-800-789-PENN (7366), operators are taking calls this evening.

Ann:
I received a kidney transplant in Sept. of 1983. My sister was the donor. To this day, I feel great, my kidney is working without any problems. I think I remember Dr. Naji was a senior resident at the time. Andrew Axelrod also assisted. Drs. Barker and Perloff headed the transplant dept. at the time. Thank you all!!! My question is, was is the length of time living-related donor transplants last?

James Markmann, MD, PhD:
Ann, It depends on many factors but in some recipients kidney's last for the rest of their lives. I think the longest survival on record is over 40 years. Good luck!

Russell:
This message is for Dr. Shaked. This is Vickie Brown the fiancee of Russell Tillman. He and I just watched the transplant on Vital Signs, and it brought everything back as if it were today. You transplanted Russ 2 years ago March 4 and he is doing wonderful. We just wanted to let you know how very much you and your staff are appreciated. We thank God for you on a daily basis, for your knowledge, your determination and your care. Russell sends his hellos and love and he said the next time he's in for a follow up he wants to stop by and see you. Again a million thanks for what you do. God Bless Vickie Brown

Abraham Shaked, MD, PhD:
Vicki and Russell, We are happy you are doing well.

Chris:
Do you have to be a certain age to donate a part of your liver and does the risk for the donor decrease if the donor is younger?

James Markmann, MD, PhD:
Chris, Donors have to be over 18 years of age and the younger and healthier the donor the less risk their is to the procedure. For more information, please contact 1-800-789-PENN.

Jean:
My mother was just diagnosed with bile duct liver cancer. She has no cancer outside of the liver. She is a 65 year old healthy female besides the cancer of the liver duct. Is liver transplantaion an option? If so, how do we pursue this avenue?

Abraham Shaked, MD, PhD:
Jean, Bile duct cancer is not usually an indication for transplantation unless it's very, very small. You should probably make an appointment with one of our physician or send us appropriate information to determine whether it's possible to consider your mother as a transplant candidate. You should know that some of these patients are done using liver donations.

Stuart:
I just wanted to say hello to everyone at the Transplant Department at Penn. Dr. Naji and Dr. Grossman in particular. I received my kidney 17 years ago due to Polycystic Kidney Disease (2 transplants in 24 hours) and ,thank goodness, I still maintain a creatinine of approximately 1.3. Having a few side effects from 17 years of Cyclosporine, but I guess that's a small price to pay. I was just watching the TV show and decided to post this little note.

James Markmann, MD, PhD:
Stuart, Thank you for your thoughts.

Adrienne:
I am 54 years old and have primary bilary cirrhosis. My daughter age 33 is a perfect match and is willing to donate part of her liver. Do you do live liver transplants at Penn and is live liver transplant safe and the new wave of the future?

Abraham Shaked, MD, PhD:
Adrienne--You may be a great candidate especially if your daughter is a perfect match. Our results and experience with living donor transplants are excellent. We will share our results during the evaluation process. Please call 1-800-789-PENN (7366) for more information.

Mark:
Are there any additional risks associated with having a second kidney transplant?

James Markmann, MD, PhD:
Mark, In general a second kidney transplant is as safe as the first. Some patients who rejected their first kidney may have increased chance of rejecting the second. Overall though, the success of second kidney transplant is excellent. For more information, please call 1-800-789-PENN.

Donna Chasey:
Hello, My name is Donna Chasey. I received a kidney 4 years ago. Dr. Markmann I want to say again to you and all the wonderful, caring people at Penn. Thank you! Thank you! I received a kidney on November 26, 1999. Life is so precious and so beautiful. Thank you so much Dr. Markmann. P/S Maybe you will remember me, I am the young lady who said to you, "Oh, Dr. Markmann just a little incision." All my love, Donna Chasey

James Markmann, MD, PhD:
Donna, I remember you well. I'm glad you are doing so well.

Cheryl:
How long can one live with a liver transplant the show was very interesting as my husband has Hepatitis C and has cirrhosis.

Abraham Shaked, MD, PhD:
Cheryl, The results of liver transplant for Hepatitis C are good as long as they are done at the proper time. When the patients suffer from signs and symptoms of liver failure. The long term survival of the liver graft and the patient should exceed 70% after 5 years.

Mark:
It sounds like the procedure is a lot easier on the donor now then it was 15 years ago. How much different is the recovery for the recipient?

James Markmann, MD, PhD:
Mark, The recipient operation is very much the same as it was fifteen years ago. The survival of kidneys is much better however, and in general, the patients recover more quickly and leave the hospital much sooner. Also, the newer immunosuppresant drugs are less harmful and more effective than they were fifteen years ago. For more information, please contact 1-800-789-PENN.

John:
My mother has primary billiary cirrohsis and needs a liver. She also has a hernia that another doctor was going to operate on prior to any transplant surgery. There is no evidence of any bowel protrusion; the doctor says it should be done to prevent this. How risky is this surgery if done now?

Abraham Shaked, MD, PhD:
John, We do not recommend a routine surgery on patients who suffer from end-stage liver disease since it may lead to further decompensation. We will be happy to evaluate your condition and determine her risks. Please call 1-800-789-PENN (7366) for more information.

Carolyn:
I have Hepatitis C. I was told itdid not pass to the children. Several years ago I had my chldren tested. The results came back negative. Should I have them tested again and what specific tests? Thanks.

Abraham Shaked, MD, PhD:
Carolyn, The risks are there however, we are happy that your children tested negatively. You should probably retest them once again using the more sophisticated methods for the virus RNA. If this is negative they should be fine.

Mary:
How are live donors matched with recipients?

James Markmann, MD, PhD:
Mary, There are only two absolute requirements for live donors that they are blood group compatible and that the recipients blood does not react to the donor (a negative cross match). Otherwise, the key factors are that the donor is healthy and committed to donating to their recipient. For more information, please call 1-800-789-PENN.

John:
Will Mike Dudek's children be susceptible to kidney failure (ie. is it genetic?)

Abraham Shaked, MD, PhD:
John--Not necessarily, the genetic disease does not effect all members of the family.

George Arroyo:
hello i had a kidney transplant i'm so greatful for organ transplantation now i spend my time trying to educate people on organ and tissue awareness i'm a volunter for the gift of life multicultural committee i'm trying to teach the latino community about organ and tissue awareness and i'm so amazed how good you surgeons are and all of the other doctors and staff is at doing this so well may you all be blessed peace to all

James Markmann, MD, PhD:
George, Thank you for your thoughts and keep up the good work promoting donation.

Pamela:
My husband has has two failed kidney transplants. I there limit to how many transplants one can have. Also are there some people that just can't be translanted.

Abraham Shaked, MD, PhD:
Pamela, You should not give up. We will be happy to evaluate and determine whether there is an appropriate match for your husband.Please call 1-800-789-PENN (7366) for more information.

Thomas Rodman:
I have Hepatitis C and Cirrhosis. My CT and I have lynadopapathy hepaduodenal. What is it? Hepotoduodenal ligamenta: 8.17*1.47 and
1.4*0.9cm. What is it? Very large Collateral Veins in right side peir-duodenal from kidney reion. Thanks For Time and Kindness

Abraham Shaked, MD, PhD:
Thomas--Patients with liver disease may have inflammation and as a response may have enlarged lymphnodes. This is common pathology and should not worry you too much. The high blood pressure because of the liver disease can cause enlarged veins as you described. You condition should be evaluated by one of our hepatologists. Please call 1-800-789-PENN (7366) for more information.

John:
What is meant by decompensation? Are you referring just to the liver or to her health in general?

James Markmann, MD, PhD:
John, In most forms of liver failure the liver can be cirrhotic many years before symptoms develop. When cirrhosis leads to life-threatening complications, we term that decompensation. In general, we think that patients with decompensated cirrhosis should be considered for transplantation. When the liver function is this poor, it is often accompanied by a general deterioration in overall general health. We would be happy to discuss these issues with you further. For more information, please contact 1-800-789-PENN.

MK:
What is the criteria for placement on the liver transplant list?

Abraham Shaked, MD, PhD:
MK-The criteria is the development of symptoms and signs of end-stage liver disease. In brief, this can be found by looking at your blood test as well as any specific complaints.

Luther Adcock Sr.:
Thank you Drs. Markman And Shaked for giving me a new life.I'm doing very well and thanks aren't enough to say how I feel.Thank God,thank you

Abraham Shaked, MD, PhD:
Luther, I am glad you are doing well, it is wonderful to hear from you.

Lisa:
Would a person who had a heart attack 25 years ago, but has been healthy since, be a candidate as a live donor?

Abraham Shaked, MD, PhD:
Lisa--We do not like to expose a patient who had any past illness to the risk of live donation. We hope that you are doing well.

Diane:
My husband has active Hep-C and cirrohosis and and will be evaluated by your team shortly.The local Dr. will have your team decide if Hep-C treatment should begin or not. What is that procedure? What does that score mean?

Abraham Shaked, MD, PhD:
Diane--the score for the liver failure is based on the results of blood tests including the bilirubin levels. clotting factors, and kidney function. moreover, we do examine the patient for other signs and symptoms of liver failure. looking forward to meet you.-

Pamela:
Do you do the ferreses procedure, were the blood is cleansed so the receipient can accept another person organ if the antibodies don't match.

James Markmann, MD, PhD:
Pamela, We are currently developing protocols to enroll patients who have antibodies against their donor. We would be happy to discuss this further with you. Please call 1-800-789-PENN for more information.

Mary:
What do you mean by blood group compatible and a negative cross match as criteria for living donors? Is that blood type?

Abraham Shaked, MD, PhD:
Mary--A compatible blood type means if you have , for example, blood type B and the recipeitn has smiliar blood type B. We measure antibodies in the recipient blood against the donor blood to see that the there will not be very rapid rejection.

Theresa:
I wrote about my husband Robert Holland a few minutes ago. I forgot to ask whi I did not receive a call back from you guys after I was told by doctors at Frankford Hospital to call you guys right away. Frankford also told me that you have not been in touch with them either, to get the information. It has been a week now.

James Markmann, MD, PhD:
Theresa, If you can give us your phone number, we will be happy to contact you Monday morning. Or, you can contact me directly.

Wmsrd:
Our son is on the liver list at UOFP. He is doing well. He has Hepatits C, but his last report was the rubin count is a little high, but everything else is fine. Liver is not as big. He's stopped drinking 26 months ago and follows a strict diet of fish and chicken. He is 40 years old and goes up to Penn every 3 months for blood work and everything is good. It is now time for him to have all his work again. He goes in for a liver biopsy and live scan and he is very upset. We hope his outlook may be a little brighter.

Abraham Shaked, MD, PhD:
We will make sure that we look at his blood work very carefully and we adjust his score based on the results. His long term future should be a good if transplant is done at the right time.

Terry:
What exactly are antibodies and how do you measure them?

James Markmann, MD, PhD:
Terry, Antibodies are protein your body makes to fight infection but they can also react to other people's tissues. Common causes for developing antibodies against other people are blood transfusions, pregnancies and prior transplants. Antibodies are measured by a number of tests. The most important is mixing serum from the recipient with blood cells from the donor. If there is no reaction against the donor, it suggests that a transplant may be possible. For more information, please call 1-800-789-PENN.

April:
How many liver transplants does UPENN do in a year?

Abraham Shaked, MD, PhD:
April--We do about 120 liver transplants every year. We are considered to be one of the largest programs in the country.

Eric:
Hello, I have more of a educational question. I am a graduate student at penn at present. I have an interest in the MD/Ph.D program at penn. I have read that MD/Ph.D's are in demand today, and programs need interested students. Do you feel that this is true?

James Markmann, MD, PhD:
Eric, It is absolutely true. Transplant is a field that is ideally suited for combining basic research and clinical patient care. The future of transplant is dependent on finding ways to induce tolerance so that immunosuppression is not required. There are many active labs within transplant who would love the assistance of a combined degree student. I would be happy to discuss this with you further in person or you can page me anytime through the hospital operator. For more information, please call 1-800-789-PENN.

Kelly C:
How often should blood work be preformed on a person with cirrhosis?

Abraham Shaked, MD, PhD:
Kelly--It depends on how advanced the liver disease is. In general , we would do a blood test every three to six months.

Terry:
How long does it take to determine if an cadaver organ is a good match for a recipient?

James Markmann, MD, PhD:
Terry, The usual testing takes about six hours after it is determined that the organs are suitable (this only applies to kidneys and pancreas). We try to do the testing as quickly as possible to minimize the amount of time the organ is outside of the body. We believe this helps promote the organs function post-transplant. For more information, please call 1-800-789-PENN.

Terry:
What is the maximum amount of time a kidney can be out of the body prior to transplantation into another body?

James Markmann, MD, PhD:
Terry, We generally try to get kidneys transplant within 24 hours. But the transplant can be successful with ischemia times of up to 36 hours.

Fran:
My husband has PKD.We have 5 children, two have tested positive also, l does not have it, and the other two hesitate to be tested,both in their 40s. How long should they hold off before finding out if they have it?

James Markmann, MD, PhD:
Fran, This is a difficult question. Finding out the diagnosis could have non-medical implications such as, an effect on getting health or life insurance. Since there is no treatment for the disease, many patients do not find it necessary to be tested. It really comes down to a personal choice and not a medical decision unless one of them is being considered as a kidney donor for another member of the family. We would be happy to discuss these issues further if you would like. For more information, please call 1-800-789-PENN.

Patty:
Is Dr. Sellers still on staff at HUP? He did my kidney transplant on June 1st, 2003.

Abraham Shaked, MD, PhD:
Patty--He is alive and doing well at Penn. We will tell him that you asked about him.

Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.