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Transplantation and Treatment of Liver Disease at Einstein

docs3The Liver Disease and Transplantation Center at Albert Einstein Medical Center employs an evaluation and treatment approach for patients with liver disease that puts the patient’s needs first. We spoke with Victor Araya, MD, FACG, AGAF, Chairman of the Division of Hepatology and Medical Director of the Liver Transplant Program and Jorge Ortiz, MD, Section Chief, Liver Transplantation and Hepatobiliary Surgery to discover what makes the Einstein Center for Liver Disease and Transplantation unique.

The Transplantation Center

The evaluation process at Einstein is remarkable for the speed and efficiency with which patients who are referred to Einstein for a transplantation workup are seen and placed on the United Network for Organ Sharing (UNOS) waiting list. Initial appointments with a board-certified hepatologist are made within one week of the referral for elective patients and within 24 to 48 hours for more urgent cases. In the week following the initial visit, patients complete the full range of evaluations, including meetings with the surgeon, social worker, and facilitator, imaging studies, and stress testing.  Throughout this process, a coordinator manages the patient’s schedule. During the evaluation week, patients who live some distance away can often stay in Einstein’s York House across the street from the hospital, which provides a comfortable lodging at reasonable rates.

If the patient is placed on the UNOS waiting list, the doctors at Einstein stay actively involved. “We aggressively pursue donor organs to reduce wait times for our transplant recipients,” says Dr. Ortiz. “We also offer cutting-edge post transplant care, including clinical trials of anti-rejection and anti-hepatitis medications.”

Einstein’s Comprehensive Cancer Treatment Program

Einstein’s Comprehensive Liver Cancer program is led by a team of hepatologists, hepatobiliary surgeons, oncologists, interventional radiologists and radiologists, and other healthcare professionals who handle the medical and surgical management of primary and metastatic liver cancers. Uniquely, Einstein has achieved their goal of screening 100% of their patients with cirrhosis for hepatocellular carcinoma, in accordance with the guidelines issued by the American Association for the Study of Liver Diseases,1 Dr. Ortiz noted.  Improved screening efforts such as theirs have contributed to the tremendous increase in the detection of liver cancer in recent years.

Because hepatocellular carcinoma represents cancer in an already diseased (cirrhotic) organ, treatment is extremely delicate and requires an integrated multidisciplinary approach. The Liver Cancer team, in addition to fellows and residents, meets once a week to design treatment plans for patients new to the program, based on input from all of the physicians involved in their care, and to review the results of ongoing cases. Each patient’s situation is considered individually, and treatment and care plans are tailored to their needs.

As with the pre-transplant evaluation, the evaluation process of patients in Einstein’s Cancer Treatment Program is streamlined to expedite the patient’s care with minimal inconvenience. This process is completed promptly—sometimes in one day. Coordinating the entire evaluation so patients can see every doctor and other health care professional involved in their care in as few visits as possible is advantageous for patients and their families, especially those who come from out of the area or need to take time off from work.

A Culture of Communication

Whether physician-to-patient or physician-to-physician, the Einstein team is committed to access and communication.

In the treatment of liver disease and the management of liver transplantation, Dr. Araya is particularly dedicated to treating each patient as a whole person. This is evident in his insistence that adequate time be given for each physician to spend with the patient during his or her evaluation. “That’s get-to-know time,” he explains, refusing to rush either the patient or the physician through their discussions. Moreover, throughout the treatment and post-surgical periods, the doctors at Einstein remain in constant contact with the patients. Perhaps most remarkable is the fact that liver transplant patients have direct access to their Einstein doctors, by Blackberry or email, rather than having their concerns fielded by a coordinator or physician’s assistant.

At every step along the way, Einstein doctors efficiently communicate with their patients’ primary care physicians. For example, within a day of the initial visit with a transplant candidate, the hepatologist contacts the referring physician to provide an update—by phone in urgent cases and by letter in elective cases. Referring physicians also can reach an attending hepatologist 24 hours a day, seven days a week by phone via a dedicated physician-to-physician “Liver Line.”

“Communication with patients and referring physicians is a top priority,” comments Dr. Ortiz. “But we don’t stop there. At Einstein, we doctors communicate with each other.”

  1. Bruix J, Sherman M for the Practice Guidelines Committee, American Association for the Study of Liver Diseases. AASLD Practice Guideline. Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208-1236.      



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