Penn State Hershey Liver Center marks two years of providing comprehensive liver care
For those with diseases like hepatitis C or fatty liver disease, Penn State Hershey has offered the region’s comprehensive liver care – including the ability to do live donor transplants – for the past two years. Penn State Hershey Liver Center has been diagnosing and managing liver disease since evolving out of the hospital’s transplant program in October of 2013.
Dr. Thomas Riley, a hepatologist and medical director of the center, has seen many advances in liver care, especially for hepatitis C, since the beginning of the transplant program in the mid-1990s. The team slowly grew over the years, including the addition of Dr. Zakiyah Kadry, the center’s surgical director, in 2005.
“We had the outer rim of a wheel in place before Dr. Kadry came,” Riley said. “We just needed to insert someone with her skill set in the middle to connect the spokes. Once that happened, things started rolling.”
The first living donor liver transplant was completed shortly after her arrival.
Living donation is a complex process where a donor gives a portion of his or her liver to the recipient, with both having enough liver for proper body function. The liver has the ability to regenerate, so both recipient and donor have full-size fully-functioning livers within a few months. The process includes everything from lab work and testing to psychological assessments for both donor and recipient.
“It’s a very stringent process and only 30 percent of the people who come forward to donate can,” Kadry said. “But because there is an organ shortage, we want our patients to benefit from this additional option for getting transplanted.”
Live donor transplants also require a specific form of expertise and institutional support — careful coordination of logistics and extensive staff training. To date, 11 living donor transplants have been done at Hershey.
The recipient works with a surgeon, transplant hepatologist, nutritionist, specialized cardiologist, transplant anesthesiologist and infectious diseases transplant specialist, as well as surgical and medical oncologists if the indication for transplant is liver cancer, and a pathologist who specializes in liver disease. A psychiatrist, social worker, addictions specialist and transplant program coordinator are also part of the team.
The donor undergoes thorough medical and psychiatric evaluations and works with a dedicated program coordinator who is different to that of the recipient’s coordinator as well as an independent donor advocate. Donors have access to the same group of transplant-certified specialists that the recipient does.
Transplant is just one aspect of care. The team cares for many more people who have a number of liver conditions – people like Wesley Mallicone.
Mallicone lived with ulcerative colitis since he was 9, and a secondary disease called primary sclerosing cholangitis since he was 13. He always knew he would need a liver transplant when he was in his 20s, and he was placed on the transplant list in October 2009.
In July 2011, cirrhosis of the liver caused the lower portion of his esophagus to bleed and he began vomiting blood. The director of sports medicine at Shippensburg University spent more of the next six weeks inside the hospital than out.
“You have all kinds of different thoughts,” Mallicone said of that time. “I had lived my whole life knowing at some point I would need a transplant, so even though I was sick, I was comfortable knowing the end could be near because I had done everything I could to give myself the opportunity for a transplant.”
Kadry came into his room and told him they had found a potential liver.
“It ultimately comes down to the availability of a matching organ at the time and place you need it,” Mallicone said.
Working in the medical field and having been listed on the transplant lists of other hospitals, Mallicone said he can appreciate the difference in care he got at Penn State Hershey.
“The interpersonal skills and true caring are things that are so important,” he said. ”And their medical process is second to none.”
Forming relationships with patients is important for health.
“We can establish a relationship with patients long before they need a transplant,” Riley said. “By being part of their early preventative care, we can prolong the need for transplant and keep patients from coming to us too late.”
Riley said non-alcoholic fatty liver disease – which is related in part to obesity – is replacing hepatitis C as the most common reason for needing a transplant.
“There is more medication research going on, but right now losing weight and maintaining a healthy lifestyle is the best way to prevent that,” he said.
When it comes to hepatitis C, advances in care have come a long way since the mid-1990s. The cure rate for hepatitis C has increased from 5 percent when Riley came to Hershey in 1996 to 95 percent. The treatment is also more tolerable.
“In the past, it was like going through chemotherapy, but now it is simply taking a pill,” Riley said. “That really has been a big change.”
Doctors can now cure patients with hepatitis C at any point in their disease – even while on a transplant list and after transplantation.
“There is some thought that in 10 years, anyone seeing a doctor for hepatitis C will be cured,” Riley said.
The Liver Center also cares for patients with liver tumors, masses, cysts and cancers, as well as cirrhosis, chronic inflammatory liver disease, acute liver failure and complications resulting from those conditions.
- Jennifer Vogelsong