Transplant and Hepato-Pancreato-Biliary (HPB) Institute

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   Transplant and Hepato-Pancreato-Biliary (HPB) Institute

Liver Transplant

About St. Vincent Liver Transplant Institute

St. Vincent has been caring for the Los Angeles 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 recently been accredited by UNOS to perform liver transplantation.

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 Hepatologists
  • Transplant Coordinators
  • Social Workers
  • Registered Dieticians
  • Pharmacists
  • Financial Counselors

Our campus is located near downtown Los Angeles.

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.

The Transplant Process

In order to undergo liver 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 hepatologist or oncologist. We do accept self-referrals! Patients are encouraged to seek transplant evaluation as soon as diagnosed with moderate hepatic insufficiency. This is to establish records, perform the appropriate workup, and proceed with transplant listing.

    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 liver transplant. You will be placed on the waiting list based on your blood type and antibody test.

    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 liver 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?
    • 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. 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.

    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
    Helicopter transporting transplant organ

    The Transplant Operation

    The process of anesthesia, prior to the actual surgery starting, can take 1-2 hrs. The anesthesia portion involves sedation, paralysis, intubation (insertion of a breathing tube), IV lines (arterial, central venous, cardiac monitoring), and occasionally transesophageal echocardiography.

    In addition, prior to surgery a catheter will be placed into your bladder to drain urine and tube in our stomach via your nose (nasogastric tube). These catheters are generally removed on post op day 3-4. On rare occasion depending on your condition - the catheters may stay longer.

    In some instances, surgery starts by proceeding with incisions made in your upper chest and grown for placing large IV lines to allow for blood "bypass". Once this is completed an incision on your abdomen.

    bypass incisions

    Your old liver is removed and your new one is replaced.

    The two veins, one artery, and bile duct of the new liver all require surgical reconstruction. These are major blood vessels in the body and extreme care is taken during the re-sewing of these vessels.

    Surgery time varies from 6 hours to as long as 14 hours. More or less time does not mean better or worse results. Every patient is different and unique in their own way that can affect surgery time.

    On rare occasions there is a planned scenario to bring the patient back to the operating room during the course of the next 1-3 days. This is often not related to complications but more so related to anticipated staging steps of the operation for certain people. You are then awakened and transported to the recovery room or directly to the intensive care unit (ICU). While in the ICU your blood pressure, heart rate and lung oxygen exchange will be closely monitored. The ICU is a busy location with critical patients and thus family visits and intervals are limited. Once your doctors consider your condition stable they will then transfer you to the transplant floor outside the ICU.

    Old Liver
    Liver Replaced
  • 6. Post-Transplant

    After successfully receiving a transplant, our job is not done. A transplanted organ requires periodic maintenance and follow-up care to make sure both the organ and the patient continue to thrive!

    • 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.

      Post-transplant in some instances you may experience situations which may require re-operation/re-evaluation:

      • Bleeding
      • Bile duct issues
      • Vessel clotting
      • Cardiac infarction
      • Pulmonary embolism
      • Infection
      • Graft rejection/dysfunction
      • Other

      Other more common issues that arise post-transplant during the later course of the hospital stay include:

      • Pain
      • Nausea
      • Vomiting
      • Constipation
      • Difficulty eating
      • Difficulty ambulating
      • Medication side effects
      • Swelling/drainage of leg and arms
      • Leaking fluid from abdominal incision
    • Discharge from Hospital

      Going Home from Transplant

      During your admission to the hospital for liver 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 organ. 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.


      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.

      Clinic Visits

      • You will be given an appointment to see your surgeon within 1-7 days of discharge and it is vital you follow instructions and present on time for your blood draw. 
      • Your clinic visits are focused on your wound care and evaluation of your liver function based on labs and clinical condition.
      • If while you are home and you experience any symptoms such as fevers, chills, vomiting, pain, shortness of breath, etc. you should contact your coordinators ASAP and present to SVMC ER.
      • If you are well and your labs are improving as expected - then you doctor will briefly advise you on adjustments needed on your immunosuppressive medications with all attempts at lowering the dose as soon as possible.
      • You may be seen in the clinic upwards of 1 times per week for the first 4 weeks post op, and then on month 3, month 6, and 1 year anniversary

      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 liver. These can include:

      1. Chronic Rejection: this occurs when your transplanted liver 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 liver disease, may also slowly damage your new organ.

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

        • Fever
        • Tenderness over the liver
        • Elevated liver function tests
        • High blood pressure
        doctor looking through microscope
        A needle biopsy may be needed to find the reasons for ongoing problems with the liver 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

The liver is an important organ located in the right upper abdomen. It is responsible for more than 500 different tasks in your body! Some of the important ones include:

  1. Conversion of food to energy
  2. Detoxification of drugs and poisons
  3. Metabolism of medications
  4. Production of bile for digestion
  5. Production of blood clotting factors

Problems with your Liver

The liver has an amazing ability to regenerate when damaged.  However, there are certain conditions which permanently effect the liver and require medical intervention.  Some of these include:

Liver Function
Liver and its Functions


hepatitis

Hepatitis

  • About Hepatitis

    Hepatitis is a viral infection that affects the liver. There are different types, but the two most common are Hepatitis B and Hepatitis C. The virus is spread through contact or contamination of blood.

    If the disease has been left untreated for many years, hepatitis may lead to cirrhosis, cancer, or end-stage liver disease requiring liver transplant.

  • Diagnosis of Hepatitis

    The first sign of hepatitis may be flu-like symptoms or yellowing of the skin and eyes (jaundice). In some cases no symptoms might be noted.

    jaundice eyes

    If a patient has risk factors for infection, hepatitis can be diagnosed with blood tests.

    Blood Test

    Sometimes patients may require further specialized imaging or liver biopsies to determine the extent of damage to the liver.

    liver biopsy
  • Treatment of Hepatitis

    There are a number of FDA approved medications for hepatitis B and C. Newer medications are all-oral and have low side effects. After taking these medications, more than 95% of people are cured for life. Patients who develop liver cancer or cirrhosis may require surgery or transplant.

    Hepatitis Pill


fatty liver

Fatty Liver Disease

  • About Fatty Liver Disease / NASH

    Fatty liver occurs when the liver begins to store fat at levels that are not normal. This usually occurs when a patient is at least 20 pounds overweight. In some individuals, the liver becomes fatty but no damage is done, this is called non-alcoholic fatty liver disease or NAFLD. In other people, the fat in the liver causes damage, and this is known as non-alcoholic steatohepatitis (NASH). NASH is the form of fatty liver that is very dangerous to your health.

    NASH occurs when there is inflammation of the liver because of fat. This often occurs in people who are overweight, pre-diabetics/diabetics, those who have high cholesterol, or people who take certain medicines. Because of the damage being done to the liver, the "enzymes" become elevated, which is another way of saying your liver cells are dying faster than expected. As your liver cells die, they are replaced with scar tissue (fibrosis).

  • Diagnosis of Fatty Liver Disease / NASH

    Fatty liver may not cause any symptoms in some people, others may complain of pain on their right side where the liver is. The liver actually does not have nerves to sense pain, but it has a capsule or skin around it that does have nerves. As the capsule stretches because of the fat, patients may experience a constant dull pain. If a patient’s weight increases 10% above the ideal amount, then probably fatty liver is present.

    Blood tests

    If fat is harming the patient would be to check a blood test, specifically measuring liver enzymes. If the AST and ALT are high, this may be a sign that the patient has NASH.

    Blood Tests

    Imaging

    Fatty liver disease can be diagnosed by a ultrasound, MRI, CT or fibroscan, which can also tell your doctor if there is serious scar tissue present.

    Imaging

    Liver Biopsy

    A liver biopsy can tell us what stage you are at and confirm the diagnosis of NASH.

    Liver Biopsy
  • Treatment of Fatty Liver Disease / NASH

    Currently, the best treatment for fatty liver is diet and exercise, along with good control of other medical condition like diabetes and high cholesterol. Losing just 20 pounds brings most patients back to health. Vitamin E may help but increases risk of heart disease and prostate cancer, so we don’t recommend it.

    What is the best diet for me?

    • Please avoid animal fat and refined sugars. Red meat, fried food and sweets are especially harmful. This may be because of a genetic difference between you and other people.
    • Diets rich in vegetables, fruits, nuts, olive oil and lean meats like salmon is a good option, this diet is commonly known as the Mediterranean diet.
    • A registered dietician is the best person to go through this with you. We will help you find one.
       

    What can I eat?

    Breakfast

    • Fruits: Papaya, berries (raspberries, strawberries, blueberries), peaches, apricots, apples, pears, kiwi and melons.
    • Non-fat yogurt is the only dairy you are permitted to eat.
    • High fiber cereals.
    • No bacon or ham.
    • Don’t use butter.
    • No milk, eggs, or cheese. If you plan on eating eggs, only eat egg whites.
    • Vitamin D and calcium pills can replace your dairy intake.
    • Lots of water. Coffee is good.
     

    Lunch

    • Soup is best. Should be a clear broth with vegetables.
    • Chicken is "OK".
    • No excessive pasta. Small amounts may be ok.
    • Avoid canned food since it often has a lot of salt.
    • Salads should never contain anything white. No cream or cheese.
    • Avoid sodas.
    • Drink water or green tea.
    •  

    Dinner

    • Vegetables and fish. Fish should not be bigger than your palm and salmon is preferred.
    • No bread/tortillas, no rice, no potatoes.
    • Absolutely no RED meat. No pork.
    • Fish or organic chicken that has not been fried is acceptable.
    • No sugary desert. Artificially sweetened or fruit may be the best replacement.
     

    What can’t I eat?

    • Avoid anything from a cow or a pig.
    • Nothing fried.
    • Reduce the amount of milk and cheese significantly.
    • Avoid butter.
    • No white bread or tortillas.


Cirrhosis

Cirrhosis

Cirrhosis occurs when the liver becomes “scarred,” oftentimes due to chronic alcohol use or infection with hepatitis virus.

  • About Cirrhosis

    Cirrhosis is inflammation and scarring of the liver. It can be a consequence of fatty liver disease, hepatitis, or heavy alcohol abuse. Both women and men who drink too much can have this condition. Some information suggests that genetics and problems with alcohol metabolism can make this condition worse. Cirrhosis can also occur at any age, but usually takes many years to develop.

    Cirrhosis
  • Diagnosis of Cirrhosis

    Cirrhosis can be diagnosed by clinical exam. Patients with cirrhosis oftentimes can develop:

    • Jaundice
    • Swelling in the belly and legs
    • Confusion
    • Severe fatigue
    • Bruising and easy bleeding
    • Coma

    Cirrhosis can also be diagnosed by:

    Blood tests

    Patients will have low albumin and high bilirubin levels, both of which are markers of liver function. Additionally, as the liver becomes more scarred blood is shunted to spleen and platelets get trapped there, which causes patients to have very low platelet counts.

    Blood Tests

    Imaging

    Cirrhosis can be diagnosed by a ultrasound, MRI, CT or fibroscan, which can also tell your doctor if there is serious scar tissue present.

    Imaging

    Liver Biopsy

    A liver biopsy can tell us what stage of cirrhosis you are at.

    Liver Biopsy
  • Treatment of Cirrhosis

    Unfortunately there is no cure for cirrhosis. However, the ability to slow down the disease from getting worse is critical. Liver doctors are known as hepatologist, and they are usually the medical specialist best suited to handle complex cases of the liver.

    In cases where cirrhosis progressed to end-stage liver disease, patients may need a liver transplant evaluation, which can be curative.



liver cysts

Liver Cysts

Liver cysts are usually benign, but can sometimes lead to problems which require treatment.

  • Liver Cysts

    What are liver cysts?

    Cysts in the liver can be single or multiple. They usually contain fluid which is either consistent with serum or bile. Sometimes they can contain infectious materials.

    What are the signs and symptoms of liver cysts?

    The symptoms of liver cysts can be variable, but oftentimes include nausea, vomiting, pain, or jaundice. Some patients may not have any symptoms.

    Liver Cysts

    • Simple cysts
    • Biliary cystadenoma
    • Hydatid cysts
    • Polycystic liver disease
    • Choledochal cysts
  • Diagnosis of Liver Cysts

    How are liver cysts diagnosed?

    Cysts of the liver are best diagnosed by an imaging procedure. Common tests include:

    CT Scan

    Sometimes referred to as a “cat” scan, CT imaging uses x-rays to create very detailed black and white images of your insides. Oftentimes it is necessary to inject contrast dye into your veins during a CT scan to better visualize tumors.

    CT Scan
    CT Machine
    Xray
    CT X-ray

    Ultrasound

    Using sound waves, ultrasound is a non-invasive and painless way to detect liver tumors. The procedure is typically performed by an ultrasound technician after application of ultrasound “gel” on your skin.

    Ultrasound being taken
    Ultrasound being taken
    Ultrasound Image
    Ultrasound Image

    MRI

    after being placed in a tube, a magnetic field is applied which can then be used to visualize your liver. Oftentimes it is necessary to inject contrast dye into your veins during a MRI to better visualize tumors. If you are claustrophobic or have metal implants, pacemakers, or shrapnel, please alert your care team prior to undergoing an MRI.

    MRI machine
    MRI Machine
    MRI Image
    MRI Image
  • Treatment of Liver Cysts

    How are liver cysts treated?

    Once a liver cyst is diagnosed, the next step involves a treatment plan depending on a number of factors, including symptom, concern for malignancy, or infectious risk. The vast majority of cysts do not require any treatment, but sometimes may be treated with:

    Observation

    If cysts are thought to be benign on imaging or atypical for a simple cyst, sometimes your doctor may want to recommend close follow-up with repeat imaging or laboratory tests to make sure the cyst doesn’t grow or warrant treatment.

    Surgery

    The goal of liver surgery is to either remove the cyst completely or "unroof" the cyst to allow it to drain freely into your abdomen. Surgery can be performed using an abdominal surgical incision ("open surgery"), laparoscopic "keyhole" surgery, or with the assistance of a robot.

    Liver Surgery
    Liver Surgery 2

    Antibiotics

    If the cyst is suspected to be infectious, oftentimes antibiotics are started for control. If the infection resolves and the cyst becomes smaller, no further treatment is required. However, if the infection persists then sometimes percutaneous drainage or surgical drainage is performed.

    Drainage

    Typically for infectious cysts that are not responding to antibiotics, patients undergo placement of a small drainage catheter through the skin to drain the cyst. The catheter is then removed after the cyst resolves. Percutaneous drainage is not performed for simple cysts because once the catheter is removed, the simple cyst usually reaccumulates!



Liver Tumor

Liver Tumors

Tumors in the liver can start in the liver or spread to the liver from other sites (“metastases”).

  • Liver Tumors

    Tumors in the liver can either start in the liver (“primary”) or spread there from cancers that start in other parts of the body (“metastatic”). The symptoms of liver tumors can be variable, but oftentimes include weight loss, fatigue, jaundice (yellowing of the skin or eyes), itching, or pain. Some patients may not have any symptoms

    Liver Tumor

    Primary Tumors

    Metastatic Tumors

    • Colon Cancer
    • Rectal Cancer
    • Neuroendocrine
  • Diagnosis of Liver Tumors

    How are liver tumors diagnosed?

    Tumors of the liver are best diagnosed by an imaging procedure and confirmed with a biopsy once detected. Common tests include:

    CT Scan

    Sometimes referred to as a “cat” scan, CT imaging uses x-rays to create very detailed black and white images of your insides. Oftentimes it is necessary to inject contrast dye into your veins during a CT scan to better visualize tumors.

    CT Scan
    CT Machine
    Xray
    CT X-ray

    Ultrasound

    Using sound waves, ultrasound is a non-invasive and painless way to detect liver tumors. The procedure is typically performed by an ultrasound technician after application of ultrasound “gel” on your skin.

    Ultrasound being taken
    Ultrasound being taken
    Ultrasound Image
    Ultrasound Image

    MRI

    after being placed in a tube, a magnetic field is applied which can then be used to visualize your liver. Oftentimes it is necessary to inject contrast dye into your veins during a MRI to better visualize tumors. If you are claustrophobic or have metal implants, pacemakers, or shrapnel, please alert your care team prior to undergoing an MRI.

    MRI machine
    MRI Machine
    MRI Image
    MRI Image

    PET scan

    Because tumors are typically metabolically active, a special type of sugar is injected into your veins a few hours prior to the scan. Those areas of your body which use a lot of sugar (like tumors) will light up on the scan. It is important to not eat or drink anything before the scan for most accurate results.

    PET scan machine
    PET Scan Machine
    PET Scan Image
    PET Scan Image

    Biopsy

    After a tumor is identified, frequently a biopsy must be performed to confirm the presence of a cancer. A biopsy is a procedure where a needle is passed through your skin and a small piece of the tumor is removed for analysis. Biopsies usually require the assistance of ultrasound or CT scan to precisely guide the needle into the tumor. The majority of biopsies are outpatient procedures and patients can go home the same day!

    Biopsy
    Biopsy Being Performed
    Biopsy assisted by cat scan
    Biopsy Assisted by CAT scan
  • Treatment of Liver Tumors

    How are liver tumors treated?

    Once a liver tumor is diagnosed, the next step involves a treatment plan after discussion of your case in a Multidisciplinary Tumor Board. Safe and effective treatment of liver tumors depends on the type of tumor, its location, your general liver health, and other underlying medical problems you may have.

    Observation

    If tumors are thought to be benign on imaging or atypical for cancer, sometimes your doctor may want to recommend close follow-up with repeat imaging or laboratory tests to make sure the tumor doesn’t grow or warrant treatment.

    Surgery

    The goal of liver surgery is to either remove the tumor completely. Surgery can be performed using an abdominal surgical incision (“open surgery”), laparoscopic “keyhole” surgery, or with the assistance of a robot.

    Liver Surgery
    Liver Surgery 2

    Transplant

    Depending on the type of tumor you have and size, sometimes liver transplant is the best option for long-term cure.

    Ablation

    Liver ablation is a procedure which can be performed through your skin (percutaneously) or surgically via laparoscopic (“keyhole”) or open surgery. The goal of ablation is to destroy tumors with energy.

    Liver Ablation

    Embolization

    Most tumors have a dominant blood vessel which feeds it with nutrients. The goal of embolization is to block that vessel and prevent the tumor from receiving nutrients and oxygen. Sometimes at the same time, chemicals like chemotherapy or radiation are directed to the tumor as well to help destroy it. Access to the blood vessel is usually gained through an artery in your groin or leg.

    Embolization

    Chemotherapy

    For tumors that are advanced beyond the point of surgery, ablation, or embolization, sometimes chemotherapy is best option. Chemotherapy can be delivered through a pill form or intravenously depending on the tumor type. For some patients, chemotherapy may be offered before or after surgery, ablation or embolization to help control the tumor.

Multidisciplinary Tumor Board

A Multidisciplinary Tumor Board is a team of doctors and nurses who discuss your individual case to recommend the best treatment options for you based on your specific information. The members of Tumor Board include:

  • Surgeons
  • Oncologists
  • Radiologists
  • Pathologists
  • Gastroenterologists
Tumor Board
Tumor Board Meeting

When does Tumor Board meet?

Usually once a week

When will I be presented at Tumor Board?

The Tumor Board needs to have the latest imaging available to make accurate recommendations. Patients are typically presented after all of the appropriate tests are completed.

Am I allowed to participate in Tumor Board?

Because multiple patients are presented at a single Tumor Board, having patients attend is discouraged for privacy concerns. However, you will learn the recommendations of the Tumor Board at your next clinical appointment.

Liver Ablation

  • About Liver Ablation Surgery

    About Liver Ablation Surgery

    Liver ablation is an effective way of treating liver tumors. During an ablation, a needle is guided into the tumor at which point energy is applied to heat tumors to the point where the tumor is destroyed. After the tissue is destroyed, your body will reabsorb the cellular material. Ablations can be performed using an abdominal surgical incision (“open surgery”) or laparoscopic “keyhole” surgery.

    ultrasound picture
    An ultrasound Is performed to locate the tumor

    Before
    Before

    After
    After


    laparoscopic surgery scar
    Laparoscopic Surgery Scar

    How big will my incision be for an ablation?

    Most ablations are performed laparoscopically (via “keyhole” surgery). Sometimes, depending on the location of the tumor, the ablation will need to be performed using an “open” incision.

    chevron surgery incision
    Chevron Incision


    Do I need to remove stitches after ablation?  Is it painful?

    Typically, stitches and medical “Super-Glue” will be used to close your incisions, and there is no need to take out the stitches afterward because they will dissolve.  If you have surgical staples, these will need to be removed by your doctor approximately 5-15 days after the surgery.  Taking out the staples is painless for most patients!

    Surgical staples
    Surgical Staples


    When Can I Shower after Ablation?

    We prefer that you shower after ablation, and that can be done as soon as the first day after ablation!  We recommend against baths, jacuzzis, or submerged water.  You do not need to cover your incision when you shower.



    When Can I Resume Exercise after Ablation?

    It will be safe to resume full exercise by about six weeks postoperatively.  Between 1-6 weeks you are at high risk for a hernia developing in your incision, so please do not lift anything heavy (anything more than a milk jug!)  Please discuss with your doctor before resuming activity.

  • What to Expect During Your Hospital Stay

    What to Expect During Your Hospital Stay

    After your operation, you will need to recover in the hospital anywhere between 1-3 days depending on the extent of your ablation.  During this time, we will repeatedly encourage and assist you with walking and deep breathing exercises.


    What Room Will I Be In?

    Patients are typically send to the Med/Surg unit after the procedure to continue the recovery process.



    Will I Have A Private Room?

    All rooms at St Vincent are private and you will not share your room with another patient (???? Don’t know if this is correct)



    Can My Family Stay With Me?

    Yes, we encourage family to visit and keep patients company during the day.  Family are not discouraged to stay overnight, however, so that patients can receive adequate sleep.



    Am I Allowed to Eat Food From Home?

    Yes, once approved by your care team it is allowed and encouraged to bring home-cooked meals.  However, if you are on a special restricted diet (for example, low sodium), we ask that family do not bring food from home.



    Am I Allowed to Smoke/Vape While in the Hospital?

    Unfortunately since smoking has been shown to inhibit wound healing, we prohibit smoking in our patients.  Additionally, because of the fire danger with smoking and oxygen cannulas (which most of our patients have!) any smoking is prohibited. We will prescribe you nicotine patches or gum when appropriate.



    How Will You Control My Pain?

    All patients will have their pain controlled after the operation.  This is typically achieved by using a combination of oral medications, epidural pumps, and patient controlled anesthesia (PCA) pumps.   Be aware though:  narcotic medications can cause constipation and if your bowels are not moving after surgery, then sometimes it is necessary to decrease the amount of pain medications we give you.

    pain control pump
    Patient Controlled Anesthesia (PCA) Pump


    How Will I know I am Ready for Discharge?

    The goals for discharge include:

    • Eating and drinking adequately with bowel function
    • Able to walk and carry out basic functions independently
    • Appropriate pain control and no longer needing IV medications
    • No signs of untreated infection or bleeding

    Sometimes patients will require the assistance of physical therapy at home or may even need to be discharged to a rehabilitation facility.  Our social workers will work with you to arrange this care.



    Can I Stay Extra Days in the Hospital to Recover?

    Once you are cleared to go home, the safest option for you is to leave the hospital.  Because the hospital is full of other sick patients, you have a greater chance of exposure the longer you stay.

  • Discharge and Follow-Up

    Discharge and Follow-Up

    On the day of discharge, a member of your care team will review your discharge paperwork, medications, and follow-up instructions with you and your family.  In the case you Have questions or would like to Speak to a member of the team, Please call 213-484-5551.  If you feel the emergency is life-threatening, please call 911!


    Common Reasons to Call your Care Team

    • Fevers of Chills higher than 101°F (38.3 °C)
    • Drainage of fluid from your incision (especially if foul smelling)
    • Swelling, warmth, or increased redness around your incision
    • Any sudden increase in abdominal pain
    • Inability to eat and drink or persistent nausea or vomiting
    • Your skin or eyes turn yellow, or your urine becomes dark
    • Constipation or inability to pass gas for longer than 3 days

    Can I Drive After Ablation?

    Driving a car or operating heavy machinery is safe when you are no longer taking pain medications and are able to have appropriate reaction times.


    Can I Drink Alcohol after Ablation?

    Drinking alcohol after liver ablation is not advised, because your liver is still healing.



Liver Surgery

  • About Liver Surgery

    Depending on the size and location of your tumor, you may need a “wedge resection” (or removal of a small part of your liver) or a “lobectomy” (or removal of a large part of your liver). In most patients, it is safe to remove up to 60-80% of the liver because the liver can regenerate! Liver surgery can be performed using an open incision or sometimes Laparoscopically.

    wedge resection
    lobectomy
    Laparoscopic Liver Surgery


    How big will my incision be for open surgery?

    In order to safely get to your liver, your surgeon typically makes incisions under the ribcage on the right side. Sometimes it is necessary to make a “Chevron” or “Mercedes-Benz” incision if your tumor is in a hard to reach spot!

    chevron incision
    Chevron Incision

    How big will my incision be for laparoscopic or robotic surgery?

    Since these surgeries are performed “minimally invasively,” your incisions are oftentimes smaller and located lower in your abdomen.   You may have one incision that is larger than the others because that is used to remove the tumor specimen from the body.

    laparoscopic surgery
    Laparoscopic surgery scar


  • What to Expect During Your Hospital Stay

    What to Expect During Your Hospital Stay

    After your operation, you will need to recover in the hospital anywhere between 2-7 days depending on the extent of your operation.  During this time we will repeatedly encourage and assist you with walking and deep breathing exercises.


    What Room Will I Be In?

    Some patients will be transferred immediately to the Intensive Care Unit (ICU) for recovery.  Usually after 1-2 days they will be transferred to the inpatient floor to continue the recovery process.



    Will I Have A Private Room?

    All rooms at St Vincent are private and you will not share your room with another patient.



    Can My Family Stay With Me?

    Yes, we encourage family to visit and keep patients company during the day.  Family are not discouraged to stay overnight, however, so that patients can receive adequate sleep.



    Am I Allowed to Eat Food From Home?

    Yes, once approved by your care team it is allowed and encouraged to bring home-cooked meals.  However, if you are on a special restricted diet (for example, low sodium), we ask that family do not bring food from home.



    Am I Allowed to Smoke/Vape While in the Hospital?

    Unfortunately since smoking has been shown to inhibit wound healing, we prohibit smoking in our patients.  Additionally, because of the fire danger with smoking and oxygen cannulas (which most of our patients have!) any smoking is prohibited. We will prescribe you nicotine patches or gum when appropriate.



    How Will You Control My Pain?

    All patients will have their pain controlled after the operation.  This is typically achieved by using a combination of oral medications, epidural pumps, and patient controlled anesthesia (PCA) pumps.   Be aware though:  narcotic medications can cause constipation and if your bowels are not moving after surgery, then sometimes it is necessary to decrease the amount of pain medications we give you.

    pain control pump
    Patient Controlled Anesthesia (PCA) Pump


    How Will I know I am Ready for Discharge?

    The goals for discharge include:

    • Eating and drinking adequately with bowel function
    • Able to walk and carry out basic functions independently
    • Appropriate pain control and no longer needing IV medications
    • No signs of untreated infection or bleeding

    Sometimes patients will require the assistance of physical therapy at home or may even need to be discharged to a rehabilitation facility.  Our social workers will work with you to arrange this care.



    Can I Stay Extra Days in the Hospital to Recover?

    Once you are cleared to go home, the safest option for you is to leave the hospital.  Because the hospital is full of other sick patients, you have a greater chance of exposure the longer you stay.

  • Discharge and Follow-Up

    Discharge and Follow-Up

    On the day of discharge, a member of your care team will review your discharge paperwork, medications, and follow-up instructions with you and your family.  In the case of emergencies, please call (213) 484-5551.  If you feel the emergency is life-threatening, please call 911!


    Common Reasons to Call your Care Team

    • Fevers of Chills higher than 101°F (38.3 °C)
    • Drainage of fluid from your incision (especially if foul smelling)
    • Swelling, warmth, or increased redness around your incision
    • Any sudden increase in abdominal pain
    • Inability to eat and drink or persistent nausea or vomiting
    • Your skin or eyes turn yellow, or your urine becomes dark
    • Constipation or inability to pass gas for longer than 3 days

    Do I need to remove stitches after surgery?  Is it painful?

    Typically, stitches and medical “Super-Glue” will be used to close your incisions, and there is no need to take out the stitches afterward because they will dissolve.  If you have surgical staples, these will need to be removed by your doctor approximately 5-15 days after the surgery.  Taking out the staples is painless for most patients!

    surgical staples
    Surgical Staples
    stitch removal
    Stitch Removal


    When Can I Shower after Surgery?

    We prefer that you shower after surgery, and that can be done as soon as the first day after surgery!  We recommend against baths, jacuzzis, or submerged water.  You do not need to cover your incision when you shower.



    When Can I Resume Exercise after Surgery?

    It will be safe to resume full exercise by about six weeks postoperatively.  Between 1-6 weeks you are at high risk for a hernia developing in your incision, so please do not lift anything heavy (anything more than a milk jug!)  Please discuss with your doctor before resuming activity.



    Can I Drive After Surgery?

    Driving a car or operating heavy machinery is safe when you are no longer taking pain medications and are able to have appropriate reaction times.


    Can I Drink Alcohol after Surgery?

    Drinking alcohol after liver surgery is not advised, because your liver is still healing.



Hepatitis C

What is Hepatitis C?

Hepatitis C is a viral infection that affects the liver. We believe that 5 million Americans have been exposed the virus through blood transfusions before 1992, tattoos and sharing needles. There may be no symptoms of hepatitis C, and patient would not know they had it unless they were specifically checked for it.

Who should get tested for Hepatitis C?

The virus is spread through contact or contamination of blood. All persons born between 1945 and 1965 should get checked since they have the highest risk. Anyone who had a blood transfusion before 1992, received medical care in Mexico, has a tattoo or history of sharing needles should get checked. In some cases, we do not know how a person was infected.

How is Hepatitis C diagnosed?

Hepatitis C is first suspected if a patient has a positive hepatitis C antibody. This may be checked if liver tests are abnormal or if a patient has risk for HCV infection. The test is confirmed by measuring the amount of virus in the blood. This test is known as the HCV RNA. The next important test to know is the genotype of the virus, and there are 6 different strains of the virus. The most common genotype in the US is genotype 1a. An additional test known as “resistance testing” can be done to see how the new Hepatitis C medications will work best against the patient’s virus.

How can my doctor tell how much damage has been done to my liver?

A liver biopsy is the best test to determine the amount of damage to my liver. When examined under a microscope, the biopsy can be graded for the amount of scar tissue. Stage 1 and 2 indicates mild amounts of scar tissue. The highest amount of scar tissue is stage 4, which indicates cirrhosis of the liver. Cirrhosis is a very serious medical diagnosis. In some cases we can determine the stage of liver damage with a picture of the liver known as the fibroscan.

Can Hepatitis C be treated?

Yes, Hepatitis C is highly treatable! There are a number of FDA approved medications for hepatitis C and none of them require injections or interferon. New hepatitis C medications are all-oral and have low side effects with short durations of therapy. After taking these medications, more than 95% of people are cured for life.

Hepatitis B

What is hepatitis B?

Hepatitis B is a virus that can lead to liver damage, cancer and even death. Hepatitis B can be transmitted from birth or person-to-person, for example from sex or sharing needles.

How would I know if I have hepatitis B?

If you are concerned that you may have hepatitis B you may be referred to a hepatologist. The first sign might be flu-like or from yellowing of the skin and eyes (jaundice). In some cases no symptoms might be noted.   If the disease has been left untreated for many years, cirrhosis can develop.

Is there a test for hepatitis B?

Yes blood tests are recommended and your doctor may also recommend a liver biopsy. All patients with hepatitis B infection should be assessed for their risk of liver cancer.   Some may need an ultrasound of the liver every 6 months.

How can my doctor tell how much damage has been done to my liver?

A liver biopsy is the best test to determine the amount of damage to the liver.  When examined under a microscope, the biopsy can be graded for the amount of scar tissue.  Stage 1 and 2 indicates mild amounts of scar tissue.  The highest amount of scar tissue is stage 4, which indicates cirrhosis of the liver.  Cirrhosis is a very serious medical diagnosis. In some cases we can determine the stage of liver damage with a picture of the liver known as the fibroscan.

Can I be treated for hepatitis B?

Medicines for hepatitis B are available in pill form or shots.  Your doctor can discuss which are right for you.  Additionally, patients with hepatitis B should avoid alcohol and receive vaccinations for hepatitis A.  Sexual partners and other household members should receive the hepatitis B vaccine.

Hepatocellular Carcinoma (HCC)

 

What is HCC?

When a cancer starts in the liver, it is most commonly a type of cancer known as hepatocellular carcinoma (HCC). Unfortunately, this is the 3rd most frequent cause of cancer in the United States. Liver cancer is a highly treatable form of cancer and can be controlled with different types of procedures performed by interventional radiologist and special medicines. In some patients with early cancer, it can be cured with a liver transplant.

 

Who gets liver cancer?

The reason patient get liver cancer is cirrhosis. As chronic damage happens in the liver that leads to cirrhosis, it also causes changes in the cells that lead to cancer. In the United States, the most common causes of cirrhosis that can lead to liver cancer are hepatitis C, hepatitis B and fatty liver.

 

How do I know I have liver cancer?

Unfortunately, liver cancer does not cause many symptoms until it is very advanced. In those cases, it may cause pain on the right side or yellowing of the eyes and skin or jaundice. Since liver cancer is highly treatable and there are no warning signs, it is recommended that patients with advanced liver disease or cirrhosis get a picture of the liver with ultrasound, MRI or CT every 6 months. Doctors know that finding a liver tumor early can save lives.

How is a liver cancer evaluated?

Once it is suspected that a patient has a liver tumor, a special MRI or CT scan is done to understand the quality, number and size of the tumors. There are also blood tests that can be done that sometimes detect liver cancer as well. The most common blood test used is the alpha-fetoprotein (AFP). All patients with cancer of the liver should be seen by a hepatologist and then referred to a special team of doctors that review the patient’s case together known as a tumor board. This expert panel of doctors includes liver doctors, liver surgeons, cancer doctors, and radiologists. The team will evaluate the patient’s case together and come up with an expert recommendation about the plan of care.

Can liver cancer be treated?

Yes, there are many treatment options for liver cancer. The best way to way to decide on a treatment plan is to review the patient’s case at tumor board. Most often, the first line treatment is to perform a locoregional therapy. A locoregional treatment is when a special kind of doctor known as an interventional radiologist delivers a treatment to the cancer either by bringing the chemotherapy right to it or burns it with microwave. The medicines that these doctors use include chemotherapy or radiation therapy, known as a TACE or Y90.

 

Some patients cannot get locoregional therapy and they are better candidates for medicines like sorafenib, regorafenib, or nivoluminab. Occassionally, there are limited options for a patient, and in those cases we offer clinical trials.

On the other hand, if the tumors are able to be controlled and are not too big the patient may be a candidate for liver transplantation, which is a cure for cancer.

What is the bottom line for liver cancer?

If you have liver cancer, we are equipped to quickly evaluate your case with state of the art technology in a multidisciplinary approach. Liver cancer is highly treatable and even curable. If you don’t have liver cancer but think you are at risk, then ask.

Tara Seery, MD

Seery's photo

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

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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

Shinde's photo

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

Request an appointment

 

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

Request an appointment

 

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

no photo

Brian Van Ness PA-C
Anesthesia/Critical Care

Request an appointment

 

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

 

 

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