Transplant and Hepato-Pancreato-Biliary (HPB) Institute

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   Transplant and Hepato-Pancreato-Biliary (HPB) Institute

Kidney Transplant

  • About Us

    About St. Vincent Kidney and Pancreas Transplant Institute

    St. Vincent has been caring for the Los Angeles end-stage renal disease population since 1975 and continues to serve outlying cities from the Central Valley to San Diego and from the coast to Palm Springs. We have a 28-year relationship with nephrologists and dialysis centers in these areas and are continuing to expand.

    Program Directors

    The Multidisciplinary Team

    In order to successfully guide you through the process, we have a full team of specialists to meet all of your medical and social needs. These include:

    • Transplant Surgeon
    • Transplant Nephrologists
    • Transplant Coordinators
    • Social Workers
    • Registered Dieticians
    • Pharmacists
    • Financial Counselors

    Our campus is located near downtown Los Angeles with a satellite office in Bakersfield which serves our Central Valley population.

    SVMC Building

    St. Vincent Medical Center

    2131 West Third Street
    Los Angeles, CA 90057
    (213) 484-7111
    SVMCInfo@verity.org

    Campus Map | Parking


    Monday - Friday | Open 24 hours
    Saturday - Sunday | Open 24 hours

    St. Vincent Medical Center is located at the corner of Third and Alvarado streets in downtown Los Angeles.

    • From the South: Take the Harbor 110 Freeway north, exit at Third Street and proceed west approximately two miles to Alvarado Street. The medical center is on the corner of Third and Alvarado streets.
    • From the North: Take the Hollywood 101 Freeway south, exit at Alvarado Street, proceed south on Alvarado 3/4 of a mile. The medical center is on the corner of Third and Alvarado streets.
    • From the West: Take the Santa Monica 10 Freeway to the Harbor 110 Freeway north, exit at Third Street and proceed west approximately two miles to Alvarado Street.
    • From the East: Take the San Bernardino 10 Freeway to the Harbor 110 Freeway north exit at Third Street and proceed west approximately two miles to Alvarado Street.
    Bakersfield building

    Bakersfield Satellite

    8501 Camino Media, Suite 100
    Bakersfield, CA 93311
    (661) 665-1500


    Monday - Friday | 8 AM - 3 PM
    Saturday - Sunday | Closed

  • The Transplant Process

    The Transplant Process

    In order to undergo kidney transplantation, a number of steps and procedures must be followed to ensure a successful transplant process. These steps include:

    • 1. Referral

      Patients are usually referred to us by their nephrologist or their dialysis center social worker. We do accept self-referrals!

      Patients referred are either already on or are approaching dialysis. For patients not yet on dialysis but with established, moderate-to-severe renal insufficiency, our goal is to fast-track listing to avoid initiation of dialysis.

      Patients are encouraged to seek transplant evaluation as soon as diagnosed with moderate renal insufficiency. This is to establish records and plan on possible preemptive transplant if a live donor is available. In case of no potential live donor, we can assist in evaluation for listing in deceased donor kidney list.

      Referral
    • 2. Workup

      The Work up Process

      After successfully completing your initial pre-transplant evaluation, your transplant coordinator will begin scheduling appointments for testing and procedures needed prior to transplant. Some of these tests or procedures will need to be updated annually. Your transplant coordinator will notify you when a test or procedure needs to be updated. It is important to keep up with your tests and procedures so that you can be transplanted when you get the call.

      Required Testing

      • Simple blood tests including blood typing
      • EKG
      • Chest x-ray
      • Dental exam
      • Abdominal Ultrasound
      • Coronary Angiogram (for all patients over 45, diabetic, or risk factors/history of heart disease)
      • Cardiology consult (if you have risk factors, are diabetic or over age 45)
      • Colonoscopy (for all patients over the age of 50)
      • Mammogram and Pap smear for all women over the age of 40
      • Recent Prostate Specific Antigen (PSA) for all men over the age of 40
      blood tests
    • 3. Patient Selection Committee

      All patients will be presented at the Patient Selection Committee Meeting (PSC) after they have completed all their testing and have been seen by the multidisciplinary transplant team.

      The purpose of the PSC is to review the results of testing, discuss visits with the multidisciplinary team, and to determine if they qualify for placement on the transplant wait list.

      The results of the PSC discussion will be conveyed to the patient and referring physician within 10 days.

      patient selection
    • 4. Listing

      If you are approved and cleared by the multidisciplinary team in PSC, you will be added to the National Waiting List for kidney transplant. You will be placed on the waiting list based on your blood type and antibody test. If you have a live donor, you do not need to be listed on the National Wait list.

      The national organ waiting list is managed by an organization called the United Network for Organ Sharing (UNOS), a private, nonprofit agency that works with the federal government. UNOS keeps track of all the people in the United States who need kidney transplants, and matches them with donors.

      If you are not approved for listing at the time of PSC, your transplant coordinator will explain any additional testing or requirements to get you listed for transplant. On some occasions, you may not qualify for transplant. Your coordinator will explain in detail as well as send a letter to your primary doctor explaining the reasons you cannot be transplanted at this time.

      patient waiting
    • 5. Day of Transplant

      Organ Offers

      When a suitable donor is found, the surgeon and coordinator will first review donor history and testing results. If the offer is suitable for you, the surgeon will give the OK to admit you for your transplant. In some cases, the surgeon or transplant coordinator may call and discuss the organ offer with you.

      happy patient in bed

      Getting the Call

      Once you have received a call from the coordinator and you have accepted the organ offer, you will then be instructed to arrive at St Vincent as soon as possible. Please drive to St Vincent with as many important members of your family as necessary.

      Your coordinator will ask you the following questions:

      • What time did you last eat or drink anything?
      • When was your last dialysis session?
      • Have you had any recent admissions to the hospital or new health problems?
      • Have there been any changes to your life situation (ie, support, financial, or emotional states that may impact your post-transplant care?

      Once these questions have been answered, you coordinator will instruct you not to eat or drink anything and come to the hospital. If you are diabetic, please inform the coordinators so that instruction about medication dosing can be given. You should bring all current medications and a bag with a set of clothes and other essentials for hospital admission.

      Arrival to the Hospital

      We strive to proceed with transplant ASAP, however we realize there may be need for further evaluation and or need for dialysis. You will be directed to Admissions and then the floor for nursing assessment, have some additional testing done including blood work, EKG, and chest xray, and any other testing that needs to be updated since your last clinic visit. You may require dialysis prior to your transplant. The transplant surgeon will order dialysis if needed.

      On arrival to the hospital, you will be greeted by your surgeon. He will prefer to speak to you and your family members about the details of the process, including risks and benefits.

      happy patient getting phone call

      The Transplant Operation

      When everything is ready, you will be taken down to the operating room. By this time your surgeon has already prepared the organ for transplant. (Please note: on rare occasions- an imported kidney once evaluated by your surgeon may not qualify as suitable for you and thus a last minute cancellation and discharge home for a better transplant is possible. But don’t be discouraged if this happens--the intent is to assure you receive the best organ possible!)

      If the organ is suitable, you will be escorted into the preoperative waiting suite. There, the anesthesiologist will greet and evaluate you. Once complete, you are transferred to the operating room. The process of anesthesia and IV line placement can be 1-2 hours depending on your general health condition and ease at establishment of IV access. Surgery commences upon incision and is terminated upon closure of skin. Surgery time is in general 2-3 hours.

      A 6-8 inch incision is made in your lower, front abdomen, and this is where your new kidney is transplanted. The new kidney comes with blood vessels that are connected to the blood vessels that supply and drain blood in your legs. The ureter is a long tube portion of the kidney that drains urine. This tube is connected to your bladder. After sewing the ureter to your bladder, we leave a plastic tube or stent, 4 inches in diameter, and thinner than a spaghetti noodle in place. This tube assists in the healing of your bladder and is removed within 4-6 weeks of your transplant at the office under a simple office bladder camera procedure. This procedure is fairly painless and takes no more than 3 minutes.

      We do not remove your own kidneys unless there are indications to remove them. Indications for removal of your own kidneys (one or both) include: kidneys that have growths suspicious for cancer, kidneys that contain infected stones, kidneys with many cysts that frequently bleed or lead to urinary tract infections or kidneys that are too large to allow room for implantation of another kidney.

    • 6. Post-Transplant
      • Hospital Recovery

        Once surgery is complete, you are then awakened and transported to the recovery room or directly to the Intensive Care Unit (ICU), which is located on the 4th floor

        Your surgeon will have spoken to your family and they should be able to visit you within 1-2 hours of arriving at the ICU. Once your doctors consider your condition stable they will then transfer you to the 5th or 7th floor.

        In general by now you will be free from most IV lines and allowed to eat and ambulate. During surgery a catheter will be placed into your bladder to drain urine. This catheter in general is removed on post op day 3-4. On rare occasion depending on your condition- the catheter may stay longer or you may even be sent home with a catheter to have a voiding trial later at the clinic.

        By post-op day 4-5 you are ready for discharge.  Instructions include:

        • Avoiding excess water intake.
        • Avoiding any food products with high potassium.
        • Resuming diabetic diet and care if diabetic.
        • Appropriate precautions for infection control.

        Possible complications following kidney transplant include:

        • Clot in the kidney: Usually noted within the first 24-48 hours post-op, and can present with sudden abdominal pain.  The treatment for this condition is unfortunately removal of the kidney, and we are not able to salvage an organ under these circumstances.   You may in the future qualify for a second transplant.
        • Delayed Graft function: Sometimes the transplanted kidney may not function immediately, and occurs in approximately 30-50 percent of deceased donor kidneys and less than 10% of live related or non-related kidneys.  During this delay, the kidney is either making little urine or no urine at all, and you may need dialysis.  Sometimes you may be discharged home on dialysis as we monitor improvement in your kidney function over time.
        • Post-op pain
        • Post-op bleeding requiring blood transfusion
        • Infections that may include large abscesses which require wash out procedures and placement of drains.
        • Urine leakage from the bladder suture line, for which you will be taken back to surgery for an attempt at correction.
        • Hernia formation requiring surgical intervention.
        nurse and doctor talking to patient
      • Discharge from Hospital

        Going Home from Transplant

        During your admission to the hospital for kidney transplant, the transplant coordinator will meet with you and your designated caregivers to discuss and educate you about how to take care of your new kidney. A log book and manual will be given during your first teaching session.

        You will be taught to monitor for:

        • Signs and symptoms of rejection or infection
        • How to record your weight, urine output, blood pressure, heart rate, and temperature
        • The education sessions take place immediately after transplant, throughout your hospital stay, and upon discharge.

        Medications

        A transplant Pharmacist will review all of your new life-long medications to prevent rejection. All other medications you are taking will also be reviewed with you before discharge.

        If you are diabetic or require insulin injections after transplant, a diabetes educator will review your insulin regimen with you and teach you how to inject insulin if needed.


        discharged happy

        24-Hour Nursing Care

        A nurse is available 24 hours a day, 7 days per week including weekends and holidays. They can be reached at (213) 484-5551. The nurse can answer any questions you have related to transplant and call your doctors with any urgent needs.

        nursing care on call
      • The First 90 Days

        After leaving the hospital, you will follow up in the transplant clinic closely, as frequently as daily until you are stabilized. Labs are done every clinic visit in the morning before you take your medications. The transplant team will monitor your lab results, urinary output, vital signs, and incision closely to assure no complications arise.

        What to bring to your clinic visit

        • Your log book (tracks urine output, vital signs, and blood sugar if necessary)
        • Medication list
        • All your medication bottles
        • Snacks, comfort items (pillow, blanket, books, etc) while you are waiting

        At the end of your clinic visit, your transplant coordinator will review any medication changes and provide a new medication list, prescriptions and lab orders for the next visit. It may be necessary to call you at home with lab results. Keep your medication list with you and be prepared to write down any changes to your medications.

      • The First 5 Years

        Once you are more stable, you will be seen less frequently in the transplant clinic. You will need to follow up with your primary doctor and primary nephrologist 90 days after transplant and regularly after that. Your primary doctor will manage any related health issues such as high blood pressure and diabetes, and your regular annual health exam and cancer screenings. You will also need to follow up with any specialist physicians regularly such as Endocrinology and Cardiology.

        What to bring to clinic

        • Medication list
        • Any new medications or changes prescribed by another doctor
        • Any requests or orders from your primary or other doctor(s)
      • Five Years and Beyond

        Your transplant doctors will continue to watch for any signs of problems with your kidney. These can include:

        1. Chronic Rejection: this occurs when your transplanted kidney slowly stops working. Usually, this type of damage may be caused by your immune system attacking the organ. Sometimes, other issues such as high blood pressure, diabetes, high cholesterol, or high levels of immunosuppressants, or the original cause of your kidney disease, may also slowly damage your new kidney.

        2. Some of the most common symptoms of rejection include:

          • Fever
          • Decreasing urine output
          • Tenderness over the kidney
          • Elevated blood creatinine level
          • High blood pressure
          doctor looking through microscope
          A needle biopsy may be needed to find the reasons for ongoing problems with the kidney transplant. Possible treatments for chronic rejection include different types of immunosuppression, steroids, or other medications.

        3. Coronary heart disease

        4. Cancers, including skin, breast, vulvar, cervical and colon cancer

  • Understanding Your Kidneys

    Understanding Your Kidneys

    About Your Kidneys

    The kidneys are 2 bean shaped organs located at either side of the spine below the rib cage. They are consided to be in the abdominal region of your body. The kidneys filter blood to produce urine, composed of wastes and extra fluid. They allow us to excrete waste.

    The kidneys have 2 main functions:

    1. Filtration
    2. Collection

    kidney
    Kidney

    kidney

    Kidney Disease

    • About Kidney Disease

      Symptoms of Kidney Disease

      Diseases of the kidneys can present with a variety of symptoms including itching, muscle cramping, trouble sleeping, too much urine or too little urine.

    • Diagnosis

      Kidney disease is often not diagnosed early enough as patients tend to not feel symptoms until the disease is advanced. It is important to be mindful of your personal and family history especially pertaining to diabetes, high blood pressure and heart disease.

      See your doctor for a physical exam and have them run certain tests to diagnose kidney disease.

      Blood tests

      Creatinine is a chemical waste product in the blood that passes through the kidneys to be filtered and eliminated in the urine. When the kidneys are damaged they have a hard time filtering waste efficiently, causing a rise in creatinine levels in the blood. Your creatinine levels are also used to calculate your GFR or glomerular filtration rate. Your GFR tells you your stage of kidney disease to help your doctor determine your treatment plan. GFR of 60 + is normal, GFR below 60 may mean you have kidney disease

      Blood Tests

      Urine Tests

      Checks for protein that can pass into the urine. The amount of protein leaked, shows the extent of your kidney damage.

      Urine Test

      Imaging

      Tests used to get a picture of the kidney and used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.

      Imaging
    • Treatment

      Kidney disease can be contolled if your doctor is able to slow or control the cause of the disease. Treatments are dependant upon the patient’s health and lifestly needs. Poorly controlled diabetes, high blood pressure and diet are harder to manage.

      If your kidneys fail completely, the damage can not be reversed and there is no cure. Treatments for kidney failure include dialysis or transplantation.



    normal to chronic

    CKD

    • About CKD

      CKD involves gradual to permanent loss of kidney function. The kidneys filter wastes and excess toxic substances and relesses them in your urine. As the disease progresses, your kidneys

      Stages of CKD

      Stage 1: kidney damage and GFR greater than 90
      Minimal loss of kidney function
      Stage 2: kidney damage and GFR 60 to 89
      Mild to moderate loss of kidney function
      Stage 3: kidney damage and GFR 30 to 59
      Moderate to severe loss of kidney function
      Stage 4: kidney damage and GFR 15 to 30
      Severe loss of kidney function
      Stage 5: kidney damage and GFR less than 15
      Kidney failure
    • Diagnosis

      Signs of CKD are easy to miss. Most severe signs do not show until the kidneys start to fail. It is important to watch out for symptoms which include: changes in your urine, dry/itchy skin, swelling in your body, upset stomach and fatigue.

      Blood tests

      Creatinine is a chemical waste product in the blood that passes through the kidneys to be filtered and eliminated in the urine. When the kidneys are damaged they have a hard time filtering waste efficiently, causing a rise in creatinine levels in the blood. Your creatinine levels are also used to calculate your GFR or glomerular filtration rate. Your GFR tells you your stage of kidney disease to help your doctor determine your treatment plan. GFR of 60 + is normal, GFR below 60 may mean you have kidney disease.

      Blood Tests

      Urine Tests

      Checks for protein that can pass into the urine. The amount of protein leaked, shows the extent of your kidney damage.

      Urine Test

      Imaging

      Tests used to get a picture of the kidney and used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.

      Imaging
    • Treatment

      Treatment of CKD will depend on your stage of kidney failure.

      Kidney damage can continue to worsen even if the underlying disease, such as diabetes and/or high blood pressure are controlled.

      If your kidneys fail completely, this is called End Stage Renal Disease (ESRD). ESRD cannot be reversed and there is no cure. Treatments for ESRD include dialysis or transplantation.



    Diabetic Nephropathy

    Diabetic Nephropathy

    • About Diabetic Nephropathy

      A disease in which the blood sugar is too high. The blood becomes concentrated and causes stress to the small vessels in your kidneys. When the vessels become damaged, the kidneys no longer filter waste from the blood. This will cause the kidneys to fail over time.

      • Type 1: Chronic condition in which the pancreas produces little to no insulin. These patients are insulin dependent. This type of diabetes is ususally diagnoised at a young age.
      • Type 2: Chronic condition in which the body does not make or use enough insulin.

      Symptoms

      • Increased thirst
      • Frequent urination
      • Extreme hunger
      • Fatigue
      • Irritability
    • Diagnosis

      Diabetes is diagnosed by checking blood sugar levels. There are also signs and symptoms of diabetes such as: excessive thirst, frequent urination, excessive hunger, fatigue, weight loss, blurred vision, and slow healing sores or frequent infections.

      A1C

      A blood test, that shows the average blood glucose level for the past 2 to 3 months. A level of 6.5% or higher may indicate diabetes.

      Fasting Plasma Glucose

      Checks your fasting blood glucose levels. It is done after not having anything to drink for at least 8 hours before the test.

      GLUCOSE RESULTS

      Less than 100 – normal, 100 to 125 – prediabetes, 126 or higher may indicatate diabetes.

      Oral Glucose Test

      Involves drinking a beverage containing glucose and then checking your blood suger every 30 to 60 minutes for up to 3 hours.

      GLUCOSE RESULTS

      If higher than 200 at 2 hours you may have diabetes.

    • Treatment

      Treating your diabetes includes diet changes, medication and exercise. Your doctor will best be able to help you come up with a long-term plan that will be based on making lifestyle changes.

      Glucose Testing

      You will test our blood sugar before every meal and at bedtime as prescribed by your doctor.

      Medication

      Oral Hypoglycemics

      Oral medications that can control your blood sugar levels.

      Insulin Injections

      An injection you will give yourself with meals and at bedtime depending on how high your blood sugar is.

      Oral Hypoglycemics and Insulin Injections

      This is a combination of oral medications and insulin injections that are sometimes prescribed to type 2 diabetics.

      If your kidneys fail completely, this is called End Stage Renal Disease (ESRD). ESRD cannot be reversed and there is no cure. Treatments for ESRD include dialysis or transplantation.



    blood pressure

    Hypertension

    • About Hypertension

      Hypertension is also known as high blood pressure. It is a long term medical condition in which blood pressure in the arteries is elevated. High blood pressure puts a lot of pressure on the kidney’s blood vessels. When left untreated, the vessels and filtering units in the kidneys become damaged and can no longer remove waste from the blood.

      Symptoms

      HTN may not cause any symtoms however some may experience: headache, shortness of breath or nosebleeds.

    • Diagnosis

      Diagnosing hypertension involves measuring your blood pressure. It will take several readings to confirm the diagnosis.

      A blood pressure reading has two numbers, the first or upper number measures the pressure in your arteries when your heart beats this is your (systolic pressure). The second or lower number measures the pressure in your arteries between beats (diastolic pressure).

      Normal pressure
      It is normal if it measures below 120/80 mmHg
      Elevated blood pressure
      Is a systolic pressure from 120 to 129 mmHg and a diastolic pressure less than 80 mmHg
      Stage 1 hypertension
      Consistent systolic pressure ranging from 130 to 139 mmHg or a diastolic pressure ranging from 80 to 89 mmHg
      Stage 2 hypertension
      Consistent systolic pressure ranging from 140 mmHg or higher and a diastolic pressure of 90 mmHg or higher
    • Treatment

      Treating hypertension includes diet changes, medication and exercise. Your doctor will best be able to help you come up with a long-term plan that will be based on making lifestyle changes.

      If you are unable to maintain an ideal blood pressure of 120/80 mmhg, your doctor may use medications to reach that level. The medication prescribed will depend on other medical problems you may have.

      If you take more than four different medications to control your blood pressure, you are considered to have resistant hypertension. The possibility of a secondary cause of the high blood pressure should be considered.

      If your kidneys fail completely, this is called End Stage Renal Disease (ESRD). ESRD cannot be reversed and there is no cure. Treatments for ESRD include dialysis or transplantation.



    Poly Cystic Kidney

    Polycystic Disease

    • About Polycystic Disease

      This is a genetic disorder in which numerous fluid filled cysts grow in the kidney. This causes the kidneys to enlarge and loose function overtime. Polycystic kidney disease can cause serious complications including high blood pressure and kidney failure.

      Abnormal genes cause polycystic kidney disease, in most cases the disease runs in families.

      Symptoms

      • HTN
      • Itching
      • Muscle cramping
      • Trouble sleeping
      • Back/side pain
      • Blood in the urine
      • Kidney stones
      • Urinary tract/kidney infections
    • Diagnosis

      Since PKD is an inherited disease, your physician will interview you about your family history. Routine blood and uring tests may be done to check for anemia, infection and blood or protein in your urine.

      To better diagnose the condition your doctor may order:

      • Ultrasound
      • CT Scan (Computerized Tomography)
      • MRI (Magnetic Resonance Imaging)
    • Treatment

      PKD treatment involves managing your symptoms and avoiding complications. Medication may be prescribed to control blood pressure and manage any pain associated with the disease.

      PKD treatment may be prone to bladder or kidney infections, if bacteria is discovered in the urine you may be prescribed antibiotics if necessary. Inform you doctor immediately if you experience any problems urinating, if you feel pain when urinating or see blood in your urine.

      Discuss your diet with your nutritionist and be sure to maintain a low-sodium intake.

      If your kidneys fail completely, this is called End Stage Renal Disease (ESRD). ESRD cannot be reversed and there is no cure. Treatments for ESRD include dialysis or transplantation.

End Stage Renal Disease (ESRD)

About End Stage Renal Disease or (ESRD)

When the gradual loss of kidney function reaches an advanced state. In ESRD, your kidneys are no longer able to function on a permanent basis to meet your bodies needs. With ESRD, you need dialysis or a kidney transplant to stay alive.

Diabetic Nephropathy Kidney Disease

Diagnosis confirmed

Blood tests
Determine blood cell counts, electrolyte levels and kidney funtion
Urinalysis
Checks protein and blood in urine
Serum Creatnine test
Determines if creatnine is building in the blood
urine test

Treatment

Hemodialysis, peritoneal dialysis or kidney transplant.

Dialysis

About Dialysis

A treatment that removes excess water and toxins from the blood for those whose kidneys who have lost the ablity to do so on their own.

There are 2 options for Dialysis.

Hemodyalisis

Uses a machine and a filter to remove the waste and water from the blood using a solution. It is done outside the body then returned to you. To get the blood into the machine, the doctor needs to make an entry into the blood vessels. This is done by joining an artery to a vein under the skin to make a bigger blood vessel called a fistula. Or a soft plastic tube can join an artery and a vein under the skin, called a graft.

hemodialysis

 

Peritoneal Dialysis

Uses a fluid (dialysate) that is placed into the abdominal cavity to remove the waste. The blood is cleaned inside your body. A catheter is placed into the abdomen to absorb the waste from the blood that passes in the abdominal cavity. The fluid is then drained away.

peritoneal dialysis

Intensive Care Unit (ICU)

What can I expect if I am in the ICU after surgery?

Patients undergoing liver kidney, and pancreas surgery may require a short stay in our ICU on the 4th floor at St. Vincent Medical Center.  This is a common and expected part of your hospital course.

What to expect immediately after surgery in the ICU

In addition to the IV in your arm, the catheter in your bladder, tube that may be placed in your stomach and small tubes that may be placed into your abdomen during surgery that were previously described, the following are some other catheters that may need to be placed prior to or during your surgery and may be in place in the ICU.

Some patients after surgery may require their breathing tube to remain in place over night while in the ICU. If this occurs, you will receive continuous medications through your IV to alleviate anxiety and control pain until we are ready to remove the breathing tube.

Nurse Adjusting Patient's Pillow

Most patients will have a small catheter, the same size as the IV in your arm, placed into an artery in either of your wrists. This catheter will allow us to monitor your blood pressure every time your heart beats and also to draw blood samples from your arterial circulation as needed.

Nurse Attaching IV Drip On Male Patient's Hand

Some patients will require the placement of a larger intravenous catheter into a vein either on the side of your neck or just below your collarbone. This catheter will allow us to give medications that cannot be given in the IV in your arm and also allows us to monitor your heart during your procedure.

If your Anesthesiologist feels it would be beneficial, you may have a small catheter called an epidural placed into your back that will give you a continuous infusion of pain medication to alleviate the pain that accompanies surgery in your abdomen.

Woman Lies with Epidural Anesthesia

Each of these procedures is done in a sterile fashion, after you receive a local anesthetic and are done inside the operating room prior to starting your surgery. Each catheter will be removed once the ICU team and surgery team agree that it is time for them to be taken out.

As an alternate method of pain control, your anesthesiologist may start you on a patient controlled analgesia pump after surgery. This pump gives pain medication through your IV in your arm and allows you to control when you receive injections of pain medication, without having to request it from the Nurse.

Female patient with IV drip needle piercing in hospital room

After surgery some patients may have a tube that goes into bladder that allows it to drain during and after surgery. Your surgery team usually removes this tube once you are up and out of bed.

Closeup Of Urine Bag

Every hour while you are awake you will be exercising your breathing using an incentive spirometer (pictured below), which is used to prevent pneumonia and is an essential part of your ICU care. Additionally your Nurse will be getting you out of bed on your first day after surgery, which is another essential component of preventing problems with your lungs after surgery.

Breathing Exercise in Hospital
Nurse next to a patient with IV tower

When can my family visit?

Visiting hours in the ICU are from 8 AM to 7 PM and then from 8 PM to 7 AM. Patients are allowed to have two visitors at the bedside at any one time, with exceptions made on a case-by-case basis. We want our patients to have restful nights of sleep, so we encourage families to go home after 830pm each night but they are welcome to call the ICU for updates at any time. We do not allow fresh flowers in the ICU, but we do encourage families to bring in any assistive devices like glasses a patient may need to increase their comfort. We also encourage the use of eyeshades and earplugs for sleep or headphones with music as needed.

Who will manage my care in the ICU?

We have a team of trained Physicians, Physician Assistants and Nurse Practitioners that are in the ICU 24/7 who will manage the minute by minute care you receive while in the ICU, while remaining in contact with your Surgeon to discuss any changes and to give updates on your progress. Additionally, our hepatobiliary surgical team will see you each day to review findings of surgery, plans for each day and when you can expect to transfer out of the ICU.

Doctor and nurse talking to a patient

Tara Seery, MD

Seery's photo

Tara Seery, MD
Hematology/Oncology, Director of Pancreatic Cancer Oncology

Request an appointment

 

Locations

Chan Soon-Shiong Institute for Medicine

23961 Calle De La Magdalena, Suite 130
Laguna Hills, CA 92653
(949) 770-0797
(949) 770-0730

 

Education

  • University College, Dublin School of Medicine (Dublin)
  • Caritas St. Elizabeth Medical Center (Boston, MA)
  • Caritas St. Elizabeth Medical Center (Boston, MA)
  • Caritas St. Elizabeth Medical Center (Boston, MA)
  • University of Illinois at Chicago

 

Board Certifications

  • American Board of Internal Medicine, Medical Oncology
  • American Board of Internal Medicine, Hematology
  • American Board of Internal Medicine

 

Professional Society Memberships

  • American Society of Clinical Oncology
  • American Society of Hematology
  • SWOG
  • Alliance for Clinical Trials

 

Selected Publications

  1. Villano, J.E., Seery, T.E., Bressler, L.R. Temozolomide in malignant gliomas: current use and future targets. Cancer Chemotherapy and Pharmacology, 2009 Mar; 64 (4), 647-655
  2. Seery, T.E., Ziogas, A., Lin, B., Pan, CG, Stamos, M., Zell, J. Mortality Risk After Preoperative versus Postoperative Chemotherapy and Radiotherapy in Lymph Node Positive Rectal Cancer. Journal of Gastrointestinal Surgery, 2013 Feb; 17, 374-381
  3. Tsang, W. Ziogas, A., Lin, B., Seery, T.E., Karnes, W., Stamos, M., Zell, J.  Role of Surgical Resection Among Chemotherapy-Treated Colorectal Cancer Patients with Stage IV Disease: A survival Analysis. Journal of Gastrointestinal Surgery; Mar 2014, Vol. 18 Issue 3, p592.
  4. Joon-II Choi, David Imagawa, Priya Bhosale, Puneet Bhargava, Temel Tirkes, Tara E Seery, Chandana Lall.  MRI following treatment of advanced HCC with sorafenib. Clinical and Molecular Hepatology, 2014. June; 20(2):218-222.
  5. M. Nayyar, D. Imagawa, T. Tirkes, A. Demirjian, R. Houshyar, K. Sandrasegaran, C. Nangia, T. Seery, P. Bhargava, J. Choi, C. Lall. Composite liver tumors: A Radiologic-Pathologic Correlation. Clinical and Molecular Hepatology 2014; 20:406-410.
  6. R.K. Ramanathan, S.L McDonough, H.F.Kennecke, S. Iqbal, J.C. Baranda, T. E. Seery, H.J. Lim, A. F. Hezel. G. M. Vaccaro, C. C. Blanke. A Phase II Study of MK-2206, an Allosteric Inhibitor of AKT as Second Line Therapy for Advanced Gastric and Gastroesophageal Junction Cancer, a SWOG Cooperative Group Trial (S1005). Cancer. 2015 Mar 30. Doi:10.1002/cncr.29363
  7. A. Le Rolle, S. Klempner, C. Garrett, T. Seery, E. Sanford, S. Balasubramanian, J. Ross, P. Stephenas, V. Miller, S Ali, V. Chiu.  Identification and Characterization of RET fusions in Advanced Colorectal Cancer.  Oncotarget. 2015 May 30
  8. R. Tang, T. Kain, J Herman, T. Seery. Durable Response using Regorafenib in An Elderly Patient with metastatic Colorectal Cancer: Case Report. Cancer Management and Research 2015:7 1-3.
  9. A. Grothey, J. Marshall, T. Seery. Current Options for Third Line Treatment of Metastatic Colorectal Cancer. Clinical Advances in Hematology & Oncology. Volume 14, Issue 3, Supplement 3 March 2016
  10.  V. Chung, S. McDonough, PA Philip, A. Wang-Gillam, L Hui, MA Tejani, T Seery, IA Dy, T. Al Baghdadi, AE Hendifar, LA Doyle, AM Lowy, KA Guthrie, CD Blanke, HS Hochster. Effect of Selumetinib and MK-2206 vs Oxaliplatin and Fluorouracil in Patients With Metastatic Pancreatic Cancer After Prior Therapy: SWOG S115 Study Randomized Clinical Trial. JAMA Oncol. 2016 Dec 15. Doi: 10.1001/jamaoncol.2016.5383. [Epub ahead of print]
  11. T. Seery, A. Choudhry, A Eapen, Y Cheng. Pancreatic Neuroendocrine Tumors Therapy. JOP. J Pancreas (Online) 2017 Dec 18;S(3):216-220.
  12. S. Hingorani, L. Zheng, A. Bullock, T. Seery, W. Harris, D. Sigal, F. Braiteh, P Ritch, M. zalupski, N Bahary, P Oberstein, A. Wang-Gillam, W. Wu, D. Chondros, P, Jiang, S. Khelifa, J. Pu, C. Aldrich, A. Hendifar. Halo 202: Randomized Phase II Study of PEGPH20 Plus Nab-Paclitaxel/Gemcitabine Versus Nab-Paclitaxel/Gemcitabine in Patients with  Untreated, Metastatic Pancreatic Ductal Adenocarcinoma. Journal of Clinical Oncology 36, no. 4 (February 1 2018) 359-366.

 

 

Arvind M. Shinde, MD, MBA, MPH

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Arvind M. Shinde, MD, MBA, MPH
Director, Hepatopancreatobiliary (HPB) Hematology & Oncology

English, Spanish

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

 

Education

  • University of Southern California, Los Angeles, CA
  • Cedars Sinai Medical Center/West Los Angeles Veterans Administration, Los Angeles, CA
  • Cedars Sinai Medical Center/West Los Angeles Veterans Administration, Los Angeles, CA
  • City of Hope/Harbor UCLA, Los Angeles, CA
  • UCSD/Scripps/San Diego Hospice and Institute for Palliative Medicine, San Diego, CA
  • Harvard University, Boston, MA
  • University of Southern California, Los Angeles, CA

 

Board Certifications

  • American Board of Internal Medicine - Internal Medicine
  • American Board of Internal Medicine - Medical Oncology
  • American Board of Internal Medicine - Hospice and Palliative Medicine

 

Professional Society Memberships

  • American College of Clinical Oncology
  • American Academy of Hospice and Palliative Medicine

 

Selected Publications

  1. Shinde A, Pal S, Hurria A. “Geriatric Oncology.” The American Cancer Society’s Principles of Oncology: Prevention to Survivorship. First Edition. Ed. American Cancer Society. Atlanta: John Wiley & Sons, Inc., 2018. 323-31.
  2. Gresham G, Schrack J, Gresham L, Shinde, A et al. “Wearable activity monitors in oncology trials. Current use of an emerging technology.” Contemporary Clinical Trials. 2018; 64: 13-21.
  3. Shinde A, Dashti A. “Palliative Care in Lung Cancer.” Lung Cancer. Cancer Treatment and Research. Vol 170. Ed. Reckamp K. Springer, Cham., 2016. 225-250.
  4. Gong J, Tuli R, Shinde A, Hendifar A. Meta-analyses of treatment standards for pancreatic cancer. Molecular and Clinical Oncology. 2016;4(3):315-325.
  5. Shinde AM, Zhai J, Yu KW, et al. “Pathologic complete response rates in triple-negative, HER2-positive, and hormone receptor-positive breast cancers after anthracycline-free neoadjuvant chemotherapy with carboplatin and paclitaxel with or without trastuzumab.” Breast. 2015;24(1):18-23. 
  6. O’Connor T, Shinde A, Doan C, Katheria V, Hurria A. “Managing Breast Cancer in the Older Patient.” Clinical advances in hematology & oncology. 2013;11(6):341-347.

 

 

Elise Diner PA-C

Diner's photo

Elise Diner, PA-C
Transplant & Hepatopancreatobiliary (HPB) Surgery

English

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

Chang Soon-Shiong Institute for Medicine

2040 E Mariposa Ave
El Segundo, CA 90245

 

Education

  • University of Colorado, Boulder, CO
  • Midwestern University, Glendale, AZ

 

Board Certifications

  • National Commission on Certification of Physician Assistants

 

Professional Society Memberships

  • Americas Hepatopancreatobiliary Association
  • International Hepatopancreatobiliary Association

 

 

Jamie Taylor, MD

Taylor's photo

Jamie Taylor, MD
Director, Anesthesia/Critical Care

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

 

Education

  • Louisiana State University School of Medicine
  • Harbor-UCLA - Anesthesiology
  • University of Pennsylvania - Critical Care Medicine

 

Board Certifications

  • Anesthesiology, Critcal Care Medicine

 

Professional Society Memberships

  • American Society of Anesthesiology
  • Society of Critical Care Medicine
  • Society of Critical Care Anesthesiologists
  • International Liver Transplant Society

 

 

Julio Gutierrez, MD

Gutierrez's photo

Julio Gutierrez, MD
Transplant Hepatology, Medical Director of Liver Transplant

English, Spanish

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

St. Francis Medical Center

3630 E Imperial Hwy
Lynwood, CA 90262

 

Education

  • Mount Sinai School of Medicine (2007)
  • Internal Medicine, UCSD (2009)
  • Gastroenterology, UCSD (2013)
  • Transplant Hepatology, University of Miami/Jackson (2014)
  • BA, UC Berkeley (2000)
  • MS, Columbia University (2003)

Areas of Expertise

  • Cirrhosis
  • Liver Cancers
  • Ascites
  • Hepatitis C
  • Fatty Liver
  • Primary Biliary Cholangitis

 

Board Certifications

  • ABIM - Internal Medicine
  • ABIM - Gastroenterology
  • ABIM - Transplant Hepatology
  • ABOM - Obesity Medicine

 

Professional Society Memberships

  • American Society of Anesthesiology
  • Society of Critical Care Medicine
  • Society of Critical Care Anesthesiologists
  • International Liver Transplant Society

 

 

Brian Van Ness PA-C

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Brian Van Ness PA-C
Anesthesia/Critical Care

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Locations

St. Vincent Medical Center

2200 West 3rd Street
Suite 200
Los Angeles, CA 900057

 

Education

  • Seton Hall University, Physician Assistant Program
  • Seton Hall University

 

Board Certifications

  • National Commission for the Certification of Physician Assistants

 

Professional Society Memberships

  • Society of Critical Care Medicine
  • Eastsern Association for the Surgery of Trauma
  • American Academy of Physician Assistants
  • California Academy of Physician Assistants
  • New Jersey State Society for Physician Assistants