Skip Navigation
Miami Transplant Institute

Pediatric Liver Transplant

Last Visited »

The Lillian Jean Kaplan Renal Transplant Center at the Miami Transplant Institute

There are many important things to consider when selecting a pancreas transplant center, including experience, survival rates, program longevity, participation in research, and physician and staff credentials.

The Miami Transplant Institute is considered one of the leading transplant centers in the world with a major role in liver and intestinal/multivisceral transplantation.

In 2010, MTI received national recognition for extraordinary performance from the U.S. Department of Health and Human Services.

The liver transplant program was one of only a few transplant programs in the United States to be recognized at the Bronze level of Service.

The awards are presented by the Donation and Transplantation Community of Practice, which was established in 2003 by HHS to ensure best practices at all hospitals performing transplants. The awards are based on performance in three categories: graft survival one year after transplant, transplant rate, and mortality rate after being placed on the transplant list.

MTI is a collaborative endeavor between University of Miami Health System/Leonard M. Miller School of Medicine and Jackson Memorial Hospital.

MTI performs approximately 120-140 liver transplants per year and 15-25 intestinal/multivisceral transplants. A multidisciplinary team of medical professionals and patient advocates work together to increase access to transplantation and improve quality of life.

(SPK) and Pancreas alone transplants per year. A multidisciplinary team of medical professionals and patient advocates work together to increase access to transplantation and improve quality of life.

Criteria for Liver Transplantation

At MTI, you will become partners with your health care team, which consists of s transplant surgeon, transplant nephrologist, transplant nurse coordinator, social worker, pre-transplant secretary, donor team, patient financial services, dietician, and psychologist. Everyone will work together to ensure a successful procedure and good long-term outcome.

The average waiting time for MTI liver transplant patients to receive their new organ is one year for a patients with a MELD score of 15 and usually 2-6 months for those with a MELD of greater than 20; shorter than most centers.


Indications for Transplant

A selection committee composed of transplant surgeons, hepatologists, nurse coordinators, psychiatrists,
social workers, dietitians and other interested individuals meets weekly to determine the suitability of
potential liver transplant candidates and determine the timing and priority for transplantation. General
indications for liver transplantation are as follows:

o Irreversible cirrhosis with at least two signs of liver insufficiency
o Fulminant hepatic failure: coma Grade 2
o Unresectable hepatic malignancy confined to the liver that is less than 5 cm. in diameter
o Metabolic liver disease that would benefit from liver replacement

Factors that are listed below are often the precipitating reason for proceeding with liver transplantation:

o Severe fatigue
o Unacceptable quality of life
o Recurrent variceal bleeding
o Intractable ascites
o Recurrent or severe hepatic encephalopathy
o Spontaneous bacterial peritonitis
o Hepatorenal syndrome
o Development of small hepatocellular carcinoma on hepatic imaging

Indications:

• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Biliary Atresia/Alagille’s Syndrome
• Autoimmune hepatitis
• Fulminant and subfulminant hepatic failure
• Alcohol related cirrhosis as cleared by Addiction team and or completion of rehabilitation with contract
• Hepatitis B
• Hepatitis C
• Cryptogenic cirrhosis
• NASH
• Budd-Chiari
• Hepatic trauma
• Polycystic liver disease
• HCC, unresectable
• Sarcoidosis
• Other: ________________________________________ (specify)          

Inborn errors of metabolism:

  • Alpha 1 antitrypsin
  • Glycogen storage disease
  • Primary hyperoxalosis
  • Wilson’s disease
  • Urea cycle deficiencies
  • Tyrosinemia
  • Erythropoietic - Hemachromatosis
  • Protoporphyria
  • Familial homozygous hypercholesterolemia
  • Cystic fibrosis

High Risk Candidates:
• HIV positive
• Age > 70 yr., or estimated biological age
• ICU bound
• Severe deconditioning, immobile, malnutrition
• Obesity with BMI > 40 kg/m2
• No social support
• Extensive abdominal surgery or anatomical abnormalities hindering liver transplantation
• Hematologic disease:
• Paroxysmal nocturnal hemoglobinuria
• Protein C and S deficiencies
• Anti thrombin III deficiencies
• Other hypercoagulable and myloproliferative states
• Advance cardiac or pulmonary disease
• Portal vein thrombosis, prior portosystemic shunts
• Renal failure
• Active variceal bleeding
• Hepatic hydrothorax
• Re-transplantation

Indications:

• Primary non function
• Hepatic Artery Thrombosis
• Delayed Graft Dysfunction/Failure
• Recurrent Disease *
• Chronic Rejection
• Ischemic Cholangiopathy or Secondary Biliary Cirrhosis
• Other: ________________________________________ (specify)
*Recurrent HCV is a relative contra-indication

Contraindications:

• Active systemic infections (sepsis, SBP, TB, other)
• Neuropsychiatric illness

  • Active substance abuse (alcohol, narcotics)
  • Inability to comply with IS regimen
  • Irreversible brain damage
  • Active psychiatric disease that affects IS regimen compliance

Malignancy (except for localized HCC, skin cancers)
Active extrahepatic malignancies. Must be documented and cleared by Hem/Onc.
Rare exception: indolent malignancies cleared by oncology (ie epithelioid hemangioendothelioma
metastatic neuroendocrine tumors)
Hepatocellular carcinoma with gross vascular invasion.
Cholangiocarcinoma with regional lymph node metastasis
Hemangiosarcoma
• AIDS

Back to Top

Referral Process

Transplant referrals are made by health care professionals. You may also download the physician referral form to give to your primary care physician or gastroenterologist for completion.

Once your referral has been forwarded to our center, you will be processed for financial clearance. Once cleared you will be given an appointment to meet with the surgeon and your pre-transplant coordinator.

We invite you to take the mandatory class. After completing the class, please download the test, complete, and bring to your first appointment. If you do not complete the class and test prior to your visit, you will be required to attend a scheduled class appointment.

Please take the time to review the following informative documents that will be discussed with you at your first appointment.

Please view the checklist and have your physician complete the referral form. Once you have completed all of the forms and collected the necessary medical records, you may e-mail the information to MTILiverinfo@med.miami.edu, fax it to  305-355-5790, or mail to:

Miami Transplant Institute
Liver/GI Referral Area
1801 NW 9th Avenue, Third Floor
Miami, FL 33136

Back to Top

Initial Appointment

You will need to bring any diagnostic testing results (ultrasounds and x-rays) done in the last six months that have not be previously sent to us including the CD’s of the x-rays. 

During your first appointment with the Transplant team most patients will meet with surgeon and pre-transplant coordinator and have labs drawn to determine how quickly your work up needs to be done. Subsequent visits will including meeting with the pediatric gastroenterologist, social worker, dietician, and infectious disease if needed.

Please bring:

  • Any additional medical records and testing done by Pediatric Gastroenterologist, or Pediatrician
  • Copies of driver’s license and all insurance cards (parents)
  • A sweater
  • A snack

Your evaluation will consist of the following tests:

Optional Testing:

  • Doppler ultrasound of the liver
  • Triple phase CT of the abdomen – depending on the age of the child and the underlying disease
  • Cardiac evaluation (annual) including an EKG, 2D echocardiogram, and cardiology clearance
  • Chest x-ray (annual)
  • EGD – depending on the age of the child and the underlying disease
  • TB test (annual)
  • Immunizations – Pneumovax (good for 5 years), Hepatitis A and B vaccine (if you don’t have antibodies against them),
  • Influenza
  • Dental evaluation (annual) – depending on the age of the child
  • Any other testing/consults as directed by your past medical history

Diagnostic testing can be done locally or will be arranged by the Transplant Center to be performed at UM/JMH.

 

Back to Top

Transplant Preparation

Accommodations near the medical campus:

Transplant House
Jackson Towers
1500 NW 12th Avenue, 7th floor West
Miami, FL 33136
Phone: 305-585-1500
E-mail: Dmiller3@med.miami.edu

Marriott SpringHill Suites Miami Arts/Health District
1311 NW 10th Avenue
Miami, FL 33136
Phone: 305-575-5300; toll-free 800-228-9290; fax 305-575-5301
Web: www.MiamiSpringHill.com

Should you require additional housing options, please discuss your needs with your transplant social worker.

Your responsibilities while listed:

1) Keep testing updated every 6 months

Doppler ultrasound of the liver
Triple phase CT of abdomen (this test is sometimes done every 3 months for some patients)

2) Annually
Cardiac – EKG, Stress test, Echocardiogram
Chest x-ray
TB

3) Visit transplant center every 6 months

4) Notify your transplant center if you are hospitalized

5) Notify transplant team of any changes in address, phone, insurance or travel

6) Notify transplant team of any changes in health or medical urgency issues

 

When you are called:

  • You may be called any time of the day or night.
  • Once called, you will have to go to East Tower Holtz Admitting office during working hours (7a-9p) or to the Emergency Room after hours. If you go to the Emergency Room let them know that you are scheduled for a transplant once you check in.If on dialysis, finish your treatment before going to have your labs drawn.
  • You may have multiple “dry-runs” before your actual transplant occurs.

Where to go:

Step 1 LABS:
Located at:
University of Miami Rosenstiel Building (RMSB) Tissue Typing Lab
1600 NW 10th Ave, 8th Floor, Room 8161
Miami, FL 33136
(305) 243- 4556

Parking located next door at:
Park Plaza West
1611 NW 12th Ave
Miami, FL 33136
Accessible through NW 12th Ave and NW 16th Street

Step 2 ADMITTING:
Once confirmed for transplant, proceed to Holtz admitting located at:
1611 NW 12th Ave
Miami, FL 33136
Parking is available at Park Plaza West. Follow side walk East and Northeast to Holtz admitting.

Step 3 ABDOMINAL TRANSPLANT FLOOR:
Once admitted, exit Holtz and enter main hospital to the right in the West Wing. Access elevators to the 15th floor and proceed down hallway to nurses station to check in.

Step 4 OPERATING ROOM
You will be transported to the operating rooms located in the Diagnostic Treatment Center.

View Map 

What to bring:

A "goodie bag" ready with

  • List of meds
  • Essential toiletries
  • PD Supplies
  • If you need financial assistance, bring copy of income tax papers

Don't bring:

  • Valuables
  • Plants or flowers
  • Visitors under the age of 14 years
Back to Top

Your Transplant

Surgery time:

  • Simultaneous Pancreas/Kidney (SPK) 6-12 hours
  • Pancreas 4-6 hours

Time in hospital:

  • Discharge teaching will begin from time of admission for transplant and have support system available.
  • Discharge when medically stable, even if you may not feel ready
  • SPK 7 days

Will your new Pancreas or Kidney/Pancreas work right away?

Most organs work immediately. Some take a period of time to begin functioning. The patient may require a dialysis session(s) for the kidney until kidney function is established and supplemental insulin if pancreas function is delayed

Back to Top

Post Transplant

Complications:
Rejection of the Kidney
Infections

Cytomegalovirus
Diabetes

Outpatient Care:
Discharge Instructions
General Health Considerations
Care for Wounds
Discharge Medicine
Care of a Urinary Catheter at Home

Lab work:
WBCs, Bun, Creatinine

Support groups:
Monthly Support Groups

Back to Top

Kidney Transplant Team

Physician Team:

George W. Burke, III, M.D., F.A.C.S
Chief, Division of Kidney and Pancreas Transplantation
Director, Lillian Jean Kaplan Renal Transplantation Center
Professor of Surgery.

Gaetano Ciancio, M.D., M.B.A., F.A.C.S.
Institute Director, Miami Transplant Institute
Director, Urologic Transplant Surgery
Professor of Surgery and Urology.

Linda Chen, M.D.
Surgical Director Living Donor Program
Assistant Professor of Clinical Surgery

Junichiro Sageshima, M.D.
Director, Abdominal Organ Fellowship Program
Associate Professor of Clinical Surgery

Nephrology (Adult):

David Roth, M.D.
Wm. Way Anderson Professor of Nephrology
Director of Clinical Services
Medical Director, Renal Transplantation

Warren L. Kupin, M.D.
Professor of Clinical Medicine

Giselle Guerra, M.D.
Medical Director, Living Kidney Donor Program
Assistant Professor of Clinical Medicine and Transplant Fellowship Director

Adela Mattiazzi, M.D.
Assistant Professor of Clinical Medicine

Nephrology (Pediatric):

Carolyn L. Abitbol, M.D.
Professor of Pediatrics
Medical Director, Pediatric Dialysis

Gaston E. Zilleruelo, M.D.
Professor of Pediatrics
Division Director and Fellowship Program Director

Jayanthi J. Chandar, M.D.
Associate Professor of Clinical Pediatrics
Division of Pediatric Nephrology

Wacharee Seeherunvong, M.D.
Assistant Professor of Clinical Pediatrics

Anesthesiology:

Ramona E. Nicolau-Raducu, MD, PhD
Chief, Solid Organ Transplantation & Vascular Anesthesia, Miami Transplant Institute
Associate Professor of Clinical Anesthesiology, University of Miami Miller School of Medicine
Jackson Health System

Kyota Fukazawa, M.D.
Associate Professor of Clinical Anesthesiology

Vinaya Manmohansingh, M.D.
Assistant Professor of Clinical Anesthesiology

Vadim B. Shatz, M.D.
Assistant Professor of Clinical Anesthesiology

Todd J. Smaka, M.D
Assistant Professor of Clinical Anesthesiology

Fouad G. Souki, M.D.
Associate Professor of Clinical Anesthesiology


Administration, Nursing, and Support Staff:

Michelle Gascon
Transplant Nurse Manager, Kidney & Pancreas
mgascon@med.miami.edu
Zoila Zoila Chediak
Clinical Program Coordinator
Pre-transplant Patient Scheduling and Appointments
zchediak@med.miami.edu

Pre-Transplant:

Shirlene L. Hazel, RN
Clinical Transplant Coordinator
shazel@jhsmiami.org

Sobeida Jerez, RN
Clinical Transplant Coordinator
Sobeida.Baribeau1@jhsmiami.org
Elaine Llewellynn, R.N, M.S,N,C.N
Clinical Transplant Coordinator
ellewellynn@jhsmiami.org

Suze Petit, RN
Clinical Transplant Coordinator
spetit3@jhsmiami.org

Tamika Hill-Matthie RN
Clinical Transplant Coordinator
thill@jhsmiami.org

Jimmy Herrera RN
Clinical Transplant Coordinator
jherrera@jhsmiami.org

Catherine Dillardscowby RN
Clinical Transplant Coordinator
Catherin.Dillardsco@jhsmiami.org

Yvette Torres, LPN
Clinical Transplant Coordinator
ytorres@med.miami.edu

Post Transplant:

Grethchen Abdulreda, ARNP
Clinical Transplant Nurse Practitioner
gabdulreda@jhsmiami.org
Delvis Jorge, RN, BSN
Clinical Transplant Coordinator
djorge@jhsmiami.org
Ester Montenora-Velarde, RN, BSN
Clinical Transplant Coordinator
evelarde2@jhsmiami.org

Herminia Alvarez, RN
Clinical Transplant Coordinator
halvarez@jhsmiami.org

Living Donor:

Josefina Aixala, RN
Living Donor Coordinator
jaixala@jhsmiami.org

Maria Mithavayani, RN
Living Donor Coordinator
mmithavayani@jhsmiami.org

Social Workers:

Ana Jewett, M.S.W.
Adult Pre and Post Kidney/Pancreas Support
ajewett@med.miami.edu

Adriana Webster, M.S.W.
Adult Pre and Post Kidney/Pancreas Support
adriana.webster@jhsmiami.org

Back to Top
Miami Transplant Institute
ToolsFeedback