Liver Transplant Update | Penn Medicine

Taking Care of Your Fitness Post-Transplant

noreply@blogger.com (Penn Medicine) — Mon, 18 Jun 2012 08:33:41 PDT

Are you interested in learning more about how to live a healthy lifestyle post-transplant? The next meeting of the Penn Kidney Transplant patient support group is open to all Penn Transplant Institute patients:

Topic: Taking Care of Your Fitness Post-Transplant
Date: Wednesday, June 20, 2012
Time: 12 – 1:30pm
Location: Clyde F. Barker Penn Transplant House | 3940 Spruce Street | Philadelphia, PA 19104
Speaker: Jason Kilderry, Head Coach, ETA Endurance Training; Kidney Transplant Recipient

Validated parking is available at the Penn Tower Garage. Metered street parking is also available. The Transplant House is accessible by public transportation via the:

Market-Frankford Line (40th St. Stop – 8 minute walk)
#40 Bus (Spruce & 38th St. Stop – 4 minute walk)

Complimentary lunch will be provided.

To register or to receive email updates regarding topics and speakers please contact Margaret Leid, Transplant Community Liaison, at 215-615-4662 or margaret.leid@uphs.upenn.edu.

Gift of Life’s 17th Annual Dash for Organ & Tissue Donor Awareness

noreply@blogger.com (Penn Medicine) — Thu, 29 Mar 2012 07:46:39 PDT

Join the Penn Transplant Institute and the Hospital of the University of Pennsylvania in the Gift of Life’s 17th Annual Dash for Organ and Tissue Donor Awareness.

The Donor Dash is an annual 5K and 10K run, and 3K walk to benefit donor transplantation programs and raise awareness for donor and tissue transplants.

The Hospital of the University of Pennsylvania and the Penn Transplant Institute are once again taking the pledge to support the Gift of Life and its mission to bring awareness to the critical need for organ and tissue donors.

Date: Sunday, April 15, 2012

Time: 8:30 am to noon

Location: Steps of the Philadelphia Museum of Art, 2600 Benjamin Franklin Parkway, Philadelphia, PA 19130

Fee: $30 registration fee, reduced if registered by April 11 online at www.donors1.org

Donor Awareness Counts

The Penn Transplant Institute recently celebrated the 46th anniversary of its first kidney transplant. This incredible accomplishment is a testimony to the mission and vision of the Gift of Life program. Because of donor transplantation awareness and programs like the Donor Dash, lives are saved.

How You Can Help

To continue the success of donor transplant programs like the one at Penn Medicine and to continue to raise awareness about organ and tissue donation, the Penn Transplant Institute team needs your help.

Join the Penn Transplant Team for the 2012 Gift of Life Donor Dash. If you can’t join the team, consider supporting the team with a donation pledge for organ and tissue donor awareness.

Many lives have been saved by organ donors, and so many more people are waiting to receive the same gift.

Together, organ and tissue donor awareness can help save the life of another. Those who register with the Penn team receive a Penn Transplant t-shirt.

Stop by and visit the Penn Transplant Institute table—we would love to see you all.

Author: Rebecca L. Farrell, BSN, RN, CCTN Liver Transplant Coordinator

Safe Acetaminophen (Tylenol®) Doses for Liver Transplant Patients

noreply@blogger.com (Penn Medicine) — Thu, 01 Mar 2012 10:59:35 PST

Acetaminophen (Tylenol®) is the preferred over-the-counter (OTC) pain medication for liver transplant patients to take for general pain, fevers and headaches. However, too much acetaminophen may be harmful. That’s why it is important to know about safe acetaminophen doses, and how much acetaminophen your OTC medications contain.

Because medications may change over time, and new medications continue to become available, it’s recommended you look at all drug packaging and read the ingredients. Knowing how much acetaminophen is in a medication and following the label instructions are the first steps in medication safety.

Also, if the labels or packaging information is confusing or difficult to understand, ask a pharmacist to help you learn the safe medication dosage. Acetaminophen may be abbreviated as APAP (especially on prescription drug labels) so look for this as well.

It is important that you do not take more than one product containing acetaminophen at a time to avoid overdosing.

The maximum amount of acetaminophen that you can take in one day (24 hours) is 2,000 mg.

Learn the acetaminophen dosage

Learn how much acetaminophen you are taking by adding up the amount in each tablet or caplet.

If a tablet contains 325 mg of acetaminophen and you take two tablets/three times a day:

2 tablets x 325 mg = 650 mg per dose
650 mg x 3 doses = 1950 mg

OTC Medications and Acetaminophen Content

Product	Amount of Acetaminophen	Maximum tablets/caplets per day
Regular-strength Tylenol^®	325 mg in each tablet/caplet	6 tablets/caplets
Extra-strength Tylenol	500 mg in each tablet/caplet	4 tablets/caplets
Tylenol Arthritis Pain, Tylenol 8-Hour Extended Release	650 mg in each tablet/caplet	3 tablets/caplets
Tylenol Sinus Congestion & Pain	325 mg in each caplet	6 caplets
Tylenol Sinus Severe Congestion Daytime	325 mg in each caplet	6 caplets
Tylenol Allergy Multisymptom	325 mg in each gelcap/caplet	6 gelcaps/caplets
Tylenol Severe Allergy	500 mg in each caplet	4 caplets
Tylenol Cold Multisymptom Severe	325mg in each tablespoon	6 tablespoons
Tylenol Cold Multisymptom Daytime/Nighttime (liquid)	325 mg in each tablespoon	6 tablespoons
Tylenol Cold Multi-Symptom Daytime/Nighttime (gelcaps)	325 mg in each gelcap	6 gelcaps
Tylenol Cold & Flu Severe (liquid)	325 mg in 1 tablespoon	6 tablespoons
Tylenol Cold & Flu Severe (gelcaps)	325 mg in each gelcap	6 gelcaps
Excedrin^® Migraine, Excedrin Extra Strength, Excedrin Menstrual Complete	250 mg in each tablet	8 tablets
Excedrin Sinus Headache	325 mg in each tablet	6 tablets
Excedrin PM, Excedrin Tension Headache	500 mg in each tablet	4 tablets
Midol^® Complete, Midol PM	500 mg in each tablet	4 tablets
Sudafed^® PE products, Sinus Headache PE	325 mg in each tablet	6 tablets
Vicks Nyquil^® Products	325 mg in each tablet/tablespoon	6 tablets/tablespoons
Vicks Dayquil^® Products	325 mg in each tablet	6 tablets
Non-Drowsy Cough & Cold PE	325 mg in each tablet	6 tablets
Theraflu^® Cold & Cough	1 packet = 650 mg	3 packets
Theraflu Flu & Chest Congestion	1 packet = 1000 mg	2 packets
Theraflu Flu & Sore Throat	1 packet = 650mg	3 packets

Reminder: Penn Transplant Institute Annual Patient Holiday Party

noreply@blogger.com (Penn Medicine) — Tue, 13 Dec 2011 09:48:39 PST

All transplant patients, donors and families are cordially invited to join the Penn Transplant Institute for a holiday open house from

5 to 8 pm on Wednesday, Dec. 14, 2011.

Location:

Perelman Center for Advanced Medicine

1st Floor, Atrium

3400 Civic Center Boulevard

Philadelphia, PA 19104

Please click here to learn more and RSVP. We look forward to seeing you there!

Should I Take a Multivitamin?

noreply@blogger.com (Penn Medicine) — Wed, 30 Nov 2011 10:10:54 PST

Erin Ticehurst, PharmD, transplant pharmacist, discusses the risks associated with multivitamins that contain herbals and other ingredients.

A nutritional supplement is extremely important following liver transplant surgery and doctors often recommend a multivitamin. However, some vitamins contain ingredients that may interact with your medications and increase the risk of rejection.

Multivitamins that claim to “boost” or “enhance” the immune system often contain herbal ingredients such as astragalus, black cohosh, ginkgo and alfalfa that increase the activity of the immune system. Increasing the activity of the immune system contradicts the effects of the immunosuppression medications you must take after transplant and may actually increase the risk of rejection. Some multivitamins also contain ingredients that cause liver damage and should be avoided.

Choosing a multivitamin

· Closely examine every ingredient

· Avoid multivitamins that contain herbal ingredients

· Avoid multivitamins that advertise benefits for the immune system

· Keep a record of your medications and nutritional supplements to share with your care team

If you are not sure if a multivitamin is safe for you to take, please call your liver transplant coordinator at (215) 662-6200 with the exact name of the multivitamin and the company that makes it. If you found the multivitamin on the Internet, please give your liver transplant coordinator the website.

Penn Transplant Institute Annual Patient Holiday Party

noreply@blogger.com (Penn Medicine) — Tue, 13 Dec 2011 09:45:42 PST

All transplant patients, donors and families are cordially invited to join the Penn Transplant Institute for a holiday open house.

Date: Wednesday, December 14, 2011

Time: 5 to 8 pm

Location:

Perelman Center for Advanced Medicine

1st Floor, Atrium

3400 Civic Center Boulevard

Philadelphia, PA 19104

Dinner and soft drinks will be provided.

Please RSVP by December 7, 2011 to Kelly Gallagher at 215-662-6799 or

kelly.gallagher@uphs.upenn.edu, or email Denny DuPont denise.dupont@uphs.upenn.edu.

There are three parking options for the holiday open house:

1. Self-park and pay at Perelman Center for Advanced Medicine. A shuttle bus will pick up guests in the valet area and run continuously between the Perelman Center and the Penn Transplant House beginning at 4:40 pm. The return shuttle from the Penn Transplant House will begin making trips at 7:30 pm with final shuttle departing at 8:20 pm. (The fee to park at the Perelman Center is $6 for up to three hours, and $9 for three to seven hours.)

2. Self-park and pay at Lot #30 at the NW corner of 40th and Walnut Streets (Fresh Grocer). The lot is within walking distance of the Penn Transplant House at 3940 Spruce Street. The fee to park at Lot #30 is $9-$15.

3. Self-park and pay at Lot #40 at the NE corner of 38th and Walnut Streets and walk to Penn Transplant House at 3940 Spruce Street. The fee to park at Lot #40 is $10-$15.

Immunosuppression Medications: Brand v. Generic

noreply@blogger.com (Penn Medicine) — Mon, 04 Jun 2012 11:06:54 PDT

Charisse Henderson, RN, BSN, liver transplant coordinator, and Erin Ticehurst, PharmD, transplant pharmacist, highlight the risks and benefits of generic drugs for liver transplant patients.

Generic versions of many anti-rejection medications are now available for liver transplant patients. These generic drugs usually save patients money as they are generally less expensive than brand-name prescriptions.

Just like brand-name medications, all generic drugs manufactured in the United States are produced under the good manufacturing practice regulations and strict guidelines of the U.S. Food and Drug Administration (FDA). All generic medications also must be approved by the FDA before they are marketed to the public.

In order for a generic medication to be approved by the FDA, it must be identical to the brand-name medication in:

Active ingredient(s)
Form
Strength
Quality
Purity
Stability
How it is taken
The way it works
The way it should be used

The following generic anti-rejection medications have been approved by the FDA for liver transplant patients:

Cyclosporine (brand name Sandimmune®)
Cyclosporine modified (brand name Neoral®)
Tacrolimus (brand name Prograf®)
Azathioprine (brand name Imuran®)
Mycophenolate mofetil (brand name CellCept®)
Prednisone (brand name Deltasone®)

Risks associated with generic anti-rejection medications

Although the Penn Liver Transplant Program approves the use of generic immunosuppressive medications, it is important to be aware of the risks.

Generic medications are tested in healthy adults before they are approved by the FDA. The drugs may react differently in patients who have had a liver transplant. For this reason, the transition from a brand-name medication to a generic must be closely monitored by the transplant team.

Patients who take anti-rejection medications should notify their transplant coordinators if they encounter any changes in their prescription. Differences in the name of the drug manufacturer, or the shape or color of the pills can signal a change in the medication. Manufacturer information can be found on the prescription label or on the packaging used to distribute the medication.

Patients should ask their pharmacists to verify the medication is the same version received the last time the prescription was filled. A transplant coordinator can also help identify these changes and schedule additional lab tests as necessary.

Many states, including Pennsylvania, New Jersey and Delaware, permit pharmacists to dispense generic medications unless the brand-name medication is specifically requested by the prescribing physician.

Patients who wish to continue on a brand-name product should notify their transplant coordinator so the prescription order is written correctly. The pharmacy will fill the prescription with the generic medication unless the prescription contains the statement "brand medically necessary." Many prescription insurance plans also require higher co-pays for brand-name medications.

Patients should contact the liver transplant team at 215-662-6200 with additional questions or concerns.

For more information about Penn Medicine's Liver Transplant Program or to schedule an appointment with a specialist, call 800-786-PENN (7366) or request an appointment online.

Survive and Thrive: Living Healthy After Liver Transplant

noreply@blogger.com (Penn Medicine) — Thu, 01 Sep 2011 07:44:14 PDT

Once you have had a liver transplant, you mustn’t forget about other health maintenance issues. The Penn Liver Transplant Team reminds you to keep up with your annual checkups with your primary care physician and any routine screenings, such as mammograms, colonoscopies, prostrate exams, DEXA scans and so on.

Because of the effects of long-term steroid use, it is also recommended that you have an annual dermatology screening for skin cancer, and always use sunscreen with an SPF of 35+ for skin protection.

Prevent infection by:

Avoiding people with colds or contagious diseases
Wearing proper fitting shoes, not cutting callouses or corns yourself and avoiding going barefoot
Not removing splinters yourself
Washing cuts with soap and water and applying antibiotic ointment
Contacting your primary care physician if your cut is from a metal object; you may need a tetanus shot

Vaccinations: Because you are immunosuppressed after a transplant, you are at increased risk for developing various infections. Some infections can be prevented by vaccination and it is recommended you receive a flu shot every year and the pneumonia vaccine every five years. People who have had a transplant are only permitted to receive inactivated or killed vaccines, and should avoid contact with anyone who receives a LIVE vaccine, which could put you at greater risk.

Drugs and Alcohol: Use of alcohol or drugs not prescribed by your physician can be harmful to your liver transplant and are not permitted. If you have a problem with drugs or alcohol, your social worker can help arrange for counseling and other support services.

Tattoos: Due to the greater risk of infection involved with the use of needles, tattoos are not recommended after your transplant.

Dental: It is currently recommended that you take antibiotics one hour before dental procedures to prevent infections.

If you have any questions, please contact your transplant coordinator.

Author: Charisse Henderson, RN, BSN, Liver Transplant Coordinator

Make Sure Your Prescription Plan Covers Transplant Medications

noreply@blogger.com (Penn Medicine) — Mon, 14 Nov 2011 12:51:06 PST

Transplant medications can be expensive and the time to review your insurance coverage and prescription coverage is before your transplant is scheduled. Below are some helpful tips for reviewing your prescription plan.

Check to see if these medications are covered because you will need some of them after the transplant:

Mycophenolate mofetil (Cellcept®)
Azathioprine (Imuran®)
Prednisone
Tacrolimus (Prograf®)
Acyclovir
Intravenous ganciclovir
Nystatin
Fluconazole (Diflucan®)
Sulfamethoxazole/trimethoprim (Bactrim®)

Look at the monthly co-payment for these medications make sure your budget is able to cover them.

Co-payment and formulary information is available on your insurance company’s website, with the paperwork outlining your coverage that was provided to you by the insurance company or by calling your insurance company directly.

If the monthly co-payments are more than you can afford or the medications are not covered by your insurance, let your transplant coordinator know.

If you live in New Jersey, check to see if you are eligible for PAAD on the New Jersey Department of Health website.

Don’t forget to contact your transplant coordinator with any changes to your insurance coverage!

Authors: Charisse Henderson, RN, BSN, Liver Transplant Coordinator, and Erin Ticehurst, PharmD, Transplant Pharmacist

Practicing Food Safety After Liver Transplant

noreply@blogger.com (Penn Medicine) — Mon, 14 Nov 2011 12:53:22 PST

One important way to protect yourself after a liver transplant involves making safe food choices and practicing safe food-handling rules. The medications you must take after transplantation suppress your immune system to prevent your body from rejecting your new liver. Suppressing your immune system also increases your risk of infection.

Patients who have had transplants experience weakened immune systems and need to protect themselves from all infections. Foodborne illnesses, sometimes called food poisoning, can be caused by raw or undercooked foods and are a real threat to transplant recipients. The Centers for Disease Control and Prevention (CDC) report that every year as many as 76 million people get sick from foodborne illnesses. Those at highest risk for those illnesses are the very young, the very old and those who have weakened immune systems.

Foods to avoid after transplant include:

Raw seafood like clams, oysters, sushi and ceviche
Raw, rare or undercooked meat, poultry and fish
Raw or undercooked eggs
Foods containing raw eggs like cookie dough or homemade eggnog
Unpasteurized milk and unpasteurized cheese
Unpasteurized cider
Bean and alfalfa sprouts

It is also important that you, and anyone who cooks for you, handle food safely. The following suggestions can help protect you from foodborne illnesses. Some of these ideas may seem simple, but it is easy to overlook these important steps.

Be clean. Always wash your hands with hot soapy water before beginning any food preparation. Keep the food preparation area and all utensils used during preparation clean. Replace sponges regularly. Wash dishcloths often. Consider using disposable paper towels. Wash all fruits and vegetables carefully.

Keep things separated. Protect yourself from cross contamination. Cross contamination can occur in your grocery cart when you place a package of meat that is leaking juices on top of other foods. It can also occur in the refrigerator if the juice from thawed meat drips onto other foods. Purchase multiple cutting boards and use one just for meat, another just for vegetables and one for bread. Clean the cutting boards thoroughly after every use. Any dish that has held uncooked food should be washed before using it for the cooked product.

Cook as directed. Always cook foods to the recommended temperatures. A food thermometer helps insure you meet this goal. Suggested temperatures:

Steaks, roasts and fish; 145 degrees F

Pork, ground beef and egg dishes; 160 degrees F

Chicken and poultry; 165 degrees F.

Chill. When food shopping, especially during hot weather, return home promptly and refrigerate perishables. Refrigerate leftovers quickly after a meal. Thaw frozen foods in the refrigerator, not on the counter. You may want to avoid salad bars and buffets when eating out as those foods may be held at room temperature for an extended length of time.

Always check the label of perishable foods for the “Sell-By” date. Do not use foods after the date listed.

Some basic rules: Keep hot foods hot and cold foods cold; and when in doubt, throw it out.

Additional information about food safety can be found on the CDC website.

Author: Carol Bergen, MS, RD, CSR, LDN, Clinical Dietitian Specialist

What Over-the-Counter (OTC) Medicines are Safe to Take?

noreply@blogger.com (Penn Medicine) — Mon, 14 Nov 2011 12:53:43 PST

For liver transplant recipients, the over-the-counter (OTC) medication aisle at your pharmacy can be an overwhelming and dangerous place. Inappropriate OTC medications can affect how well your transplant medications work, worsen or add additional side effects, or affect other medical problems that could impact your quality and quantity of life.

The Penn Liver Transplant team provides some general rules for its patients.

Look at the active ingredient section of the product label to identify safe/unsafe medications (similarly to how you look at food labels).
Only acetaminophen (Tylenol®) can be safely taken for aches and pains. Anti-inflammatory (NSAID) medicines such as ibuprofen (Advil®, Motrin®) naproxen (Aleve®) and aspirin taken above the one tablet a day dose can be harmful to your kidneys when you are on antirejection medication.
Avoid products containing the decongestant pseudoephedrine (Sudafed®) as this can raise you blood pressure and heart rate.
Single active ingredient products such as Tylenol® (acetaminophen) are better choices then multi-active ingredient products that may contain both safe and unsafe ingredients.
Do not exceed the dose on the package or the dose recommended by the transplant team.
Patients with diabetes should try to use sugar-free cough syrup.
Show this list to your pharmacist and ask their help in selecting the right medication for your symptoms.
IF YOU ARE NOT SURE, CHECK WITH YOUR TRANSPLANT TEAM.

Below is a list of over-the-counter medications that the Penn Medicine Liver Transplant Team allows. If your problems/symptoms are not responding to these medications or get worse, please call.

PROBLEM	GENERIC MEDICATION	BRAND MEDICATION
Abdominal bloating/Gas	Simethicone	Mylicon®, Mylanta gas®,Gas-X®, Digel®, Gelusil®
Allergies	Diphenhydramine, loratadine, cetirizine	Benadryl®, Claritin®, Zyrtec®, but not Claritin-D® or Zyrtec-D®
Sneezing, Runny nose	Chlorpheniramine	Chlortrimeton®
Constipation	Docusate, senna, psyllium, bisacodyl, polyethylene glycol 3350	Metamucil®, Colace®, Peri-colace®, Senokot®, Dulcolax®, Miralax®
Congestion	Guaifenesin	Mucinex®, Robitussin® (plain)
Cough	Dextromethorphan	Robitussin CoughGels®, Robitussin DM® (contains guaifenesin), Coricidin® HBP Cough & Cold (contains chorpheniramine)
Diarrhea Notify a coordinator if you have diarrhea for greater than 24 hours or if you also have fever and abdominal pain	Loperamide Do not exceed the recommended doses of any medications	Imodium® Keep yourself well hydrated by drinking at least EIGHT glasses of fluid a day and increase your salt intake
Low-grade fever, joint aches,hHeadache	Acetaminophen Notify a coordinator if your fever rises above 100.4 degrees	Tylenol ® (plain) You can take up to 2000 mg in a 24 hour period
Nausea	Calcium carbonate, fructose/dextrose/phosphoric acid	Tums®, Emetrol®
Sore throat	Menthol, benzocaine	Luden’s®, Vicks®, Chloraseptic®, NICE®, Halls®

Patients from other liver transplant programs can check with their team for medication recommendations.

Author: Erin Ticehurst, PharmD, Transplant Pharmacist

'Tis the Flu Season

noreply@blogger.com (Penn Medicine) — Mon, 14 Nov 2011 12:55:43 PST

It is that time of year again. . . . It is time for flu vaccines. The Penn liver transplant team wants to remind everyone to get their flu shots! It is recommended that transplant recipients, their loved ones, and their caregvivers receive the flu vaccine.

Transplant recipients are advised to take ONLY the “inactivated influenza vaccine” that contains killed virus and is given by injection into the muscle. Nasally inhaled (live, attenuated) vaccines are not recommended for people whose immune systems are compromised or weakened. This year’s vaccine covers influenza and H1N1, so only one injection is necessary.

The “flu” is caused by the influenza virus. Typically spread from person to person, the virus is carried in respiratory droplets created with coughing and sneezing. However, you can unwittingly expose yourself by simply touching a surface that has been contaminated by a droplet and then touching your own mouth, nose or eye. So, wash your hands, wash your hands, wash your hands…and, as always, try to avoid sick people.

It is important to try to distinguish between cold symptoms and flu symptoms. While both are respiratory illnesses, they are treated differently. Here is a chart that may help determine which “bug” you have:

Flu symptoms Slow onset of illness (over a day)

Fever over 100.5F
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

If you suspect that you may have the flu, please call your transplant nurse coordinator 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 even advise you not to come to the hospital at all.

Want to learn more? Visit the Center for Disease Control’s website: http://www.cdc.gov/flu