Dr. Jonassaint

Dr. Naudia Jonassaint of the UPMC Center for Liver Diseases discusses the ground breaking and comprehensive care available to patients dealing with not only common but complex liver disease.

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Read The Full Podcast Transcript

Tonia Caruso:
Offering groundbreaking and comprehensive care, the UPMC’s Center for Liver Diseases. Welcome to the UPMC HealthBeat podcast. I’m Tonia Caruso, and joining us right now is Dr. Nadia Jonassaint. She is a gastroenterologist and hepatologist with the UPMC’s Center for Liver Diseases. Doctor, thanks so much for joining us.

Dr. Nadia Jonassaint:
Thank you, Tonia.

Tonia Caruso:
So let’s begin by talking about the center, and it really is sort of the front door for liver care. Talk about some of the cases that you see there.

Dr. Nadia Jonassaint:
So Tonia, I would say in general, probably the thing we see most commonly are things such as viral hepatitis, that includes hepatitis C most commonly, followed by hepatitis B. But in addition to that, we see a fair amount of what we call nonalcoholic fatty liver disease due to the growing prevalence of obesity in this country, and we see a fair amount of alcoholic liver disease.

Tonia Caruso:
And obviously it depends upon the type of liver disease, but are there any common symptoms? How is it normally detected that someone is experiencing problems with their liver?

Dr. Nadia Jonassaint:
The spectrum of liver disease goes from asymptomatic to being on death’s door. Most of the time, we find that most patients come to us in the setting of having gotten some either incidental study, an ultrasound for what was thought to be maybe gallbladder pain and were found to have fatty liver disease, or what’s noticed is kind of a new or longstanding elevation in somebody’s liver function tests.

Tonia Caruso:

 you have a variety of programs in place for a variety of different conditions.

Dr. Naudia Jonassaint:

We do.  I would just like to highlight the clinics. Some of the specialized clinics we have in place. So run by doctor j bahari, is the flow clinic which stands for fatty liver disease obesity and wellness clinic and this really is comprehensive liver disease care for patients suffering from non-alcoholic fatty liver disease. Within this clinic, sits a dietician, a hepatologist, and people who are really committed to making sure patients are able to get to their weight goals in order to avoid advancement of liver disease.

Dr. Nadia Jonassaint:
I would also like to highlight one area of our clinic, which is also our Alcoholic Liver Disease Clinic. So in this clinic, really, the focus is intervening on patients that have long-standing alcoholic liver disease, or even short term alcoholic liver disease, in order to prevent end stage liver disease. Within this clinic sits our chief of hepatology, Dr. Ramon Bataller, who heads the clinic with his physician’s assistant. And in addition to that is a behavioral specialist who really concentrates on the psychosocial portions of alcoholic liver disease.

Dr. Nadia Jonassaint:
Lastly, I’ll say that we also have a Hepatitis C Clinic that is mainly run out of our McGee Clinic, and this is really part of another revolution in liver disease, which is the introduction of direct acting antivirals, has helped us to cure much of hepatitis C in eight to 12 weeks. And in this clinic, we have treated a lot of patients over the last couple of years, and we’re hopeful that those patients never have to return for liver disease care during the course of their life.

Tonia Caruso:
And so when they come to the center, it really is sort of ground zero with evaluation and then figuring out and determining treatment and care?

Dr. Nadia Jonassaint:
That’s correct. So, many times, this is a broad array of things that we really provide from kind of diagnostic studies to understand where people are on the spectrum of liver disease. Some people need very little intervention by us and can return to their primary care physicians for longitudinal care and following, and then other patients can be very ill, and severely so. Some people we see for the very first time are dealing with diagnoses as severe as cancer or end stage liver disease in need of transplantation.

Tonia Caruso:
Your role as a hepatologist, talk about what you do.

Dr. Nadia Jonassaint:
So our job really varies. I’m a transplant hepatologist, but I’m also a general hepatologist. So I may see someone with a benign condition such as fatty liver disease that was incidentally found on an ultrasound that was done for what somebody might’ve thought was gallbladder disease, anywhere from there, to taking care of somebody that has end stage liver disease and really struggling with symptoms of decompensation, ascites, bleeding varices, encephalopathy as they prepare themselves for transplantation and being worked up for that evaluation. We’re also a critical part of obviously the evaluation process and making sure patients are medically fit to undergo transplantation.

Tonia Caruso:
And so transplantation, obviously pioneered in Pittsburgh and at UPMC, and now there is such a big focus on living donor transplants. And why is that so important and so key?

Dr. Nadia Jonassaint:
About 14,000 people per year are awaiting liver transplantation in the United States, and about 8,000 people are transplanted per year. So as you can imagine, 6,000 people are still awaiting transplantation year after year, and about a quarter of those patients will die awaiting transplantation.

Dr. Nadia Jonassaint:
So living donor liver transplantation is really critical because it allows us to increase the donor pool and allows us to take people out of that donor pool before they become very, very ill and are at risk for losing their life.

Tonia Caruso:
And then how much does that contribute to actually better outcomes and better recovery because the patient is not as sick?

Dr. Nadia Jonassaint:
We know from all of the studies done in transplantation, that from that standpoint, living donor transplantation has comparable or slightly better outcomes than deceased donor transplantation because patients tend to, after living donor transplantation, spend less time in the hospital, less time on the ventilator, need less dialysis following surgery. And for that reason, we really feel like this is kind of central and pivotal and is going to be part of the next part of revolutionizing transplantation in the United States.

Tonia Caruso:
And let’s explain to folks what a MELD score is and how that plays into liver transplantation.

Dr. Nadia Jonassaint:
So historically, we used a score starting in 2002 called the MELD score, which was composed of the bilirubin, creatinine, the INR. And that score then turned into the MELD sodium score, which are those three labs with sodium added onto it. That score goes anywhere from six, which is normal, which we would presume our MELD scores to be because we don’t have liver disease, to 40. It can be calculated above 40, but we know that those people who have a MELD score at about 40 are likely to succumb to their liver disease within days to weeks. So we don’t typically calculate the score above 40.

Dr. Nadia Jonassaint:
So that MELD score really helps us to understand how sick patients are, and it also nationally and regionally delineates where you are on the list for transplantation. So your wait in line really deals with what your MELD score is and that MELD score tells us how quickly you would be offered a deceased donor.

Tonia Caruso:
And so, by having living donors, that sort of can give everyone the opportunity to be considered for a liver transplant.

Dr. Nadia Jonassaint:
Exactly. So let me just give you an example that might resonate with you. Someone with a MELD score of 15 and a blood type of O probably would not get an offer for a deceased donor liver transplantation anywhere in the country because the score is essentially just too low for that to happen. For those people who could be offered living donor and have a living donor available, that person could then schedule their surgery, essentially electively, and then again, be essentially saved from the repercussions of advancing in their liver disease and possibly succumbing to death associated with their chronic liver disease.

Tonia Caruso:
Right. So what happens if someone is thinking, “I don’t have a living donor.” How do I go about finding a living donor? Talk about your program here.

Dr. Nadia Jonassaint:
So I would say one of the unique features of the Living Donor Liver Program at the University of Pittsburgh, which is known to be the largest living donor liver transplant program in the United States, is that we have a living donor champion program. And what that essentially is, is that we lead our patients through an educational process and a supportive process that allows them to assign a surrogate in search of a donor.

Dr. Nadia Jonassaint:
As you can imagine, someone suffering from chronic end stage liver disease is very, very ill, and we really do fundamentally believe that their concentration should be on staying as healthy as they possibly can. This champion is someone that values the life of the patient as much as the patient does and is really the person that is going to lead the charge to try to find them a donor. So much of the education that we do with this champion surrounds understanding what the process is like, so as they go out into the community, they can explain to people who might be interested in donating what the process involves.

Tonia Caruso:
And so how has COVID-19 and the emergence of it in our region, how has that impacted care?

Dr. Nadia Jonassaint:
The University of Pittsburgh was one of the transplant programs that continued to stand during COVID-19,

Dr. Nadia Jonassaint:
Here at the University of Pittsburgh and in the city of Pittsburgh and surrounding areas, the prevalence has been fairly low. We do believe that this is a life-saving and life-sustaining surgery, so that people who need transplantation really should be seeking out transplantation and ongoing chronic liver disease care during this time because it’s of the utmost importance.

Tonia Caruso:
Can you talk a little bit about the safety precautions in place when patients do come into the hospital?

Dr. Nadia Jonassaint:
So we have multiple things in place. So when you come into the building itself, obviously you’re going to get a temperature scan, you’re going to get masked, and you’re going to be screened for the likelihood that you would have any suspicion of COVID-19 or having been recently exposed and might be an asymptomatic carrier.

Dr. Nadia Jonassaint:
In addition to that, when you actually come into the physical practice itself, we have social distancing practices. So we actually have kind of walled off some of our chairs to make sure that people who are sitting in the waiting room and waiting for their physician, physician’s assistant or NP are actually distanced appropriately.

Dr. Nadia Jonassaint:
So I think all of the precautions that we know to be effective are being taken. Obviously we have multiple areas where you can use alcohol in order to decontaminate hands, et cetera, and then just being cautious of any type of unnecessary contact with people. So shaking of hands, hugging, things that we might do traditionally in clinic with our patients and others are obviously discouraged during this time.


Tonia Caruso:
What about people who would come to the care center for things not transplant-related, something not that serious?

Dr. Nadia Jonassaint:
So I would say that this is a critical time to return to care. It was very scary because I think that there were multiple reports during the peak of the COVID period about people staying at home when they were having chest pain or when people are becoming jaundice and just kind of chalking these things up to, “Oh, I’m having indigestion.” And unfortunately I think people may have lost their lives and I think that’s always going to be underestimated during this time period because of the scare of not entering the medical system during the COVID-19 pandemic.

Dr. Nadia Jonassaint:
Now, based on where we are, I think it’s really, really important for me to take this opportunity to encourage people to return to care, even for their general care, because as we know, prevention and close monitoring are the things that prevent progression of disease. So as we try to prevent people going down this pathway of decompensation or end stage liver disease, we want to make sure that we’re seeing those patients and monitoring them regularly to make sure that they have the very best outcomes longterm as possible.

Tonia Caruso:
Yeah. Well, Doctor, some great information. Thank you so much for coming in and spending some time with us today.

Dr. Nadia Jonassaint:
Thank you, Tonia. I appreciate it.

Tonia Caruso:
You’re welcome. Thank you for joining us. I’m Tonia Caruso. This is UPMC HealthBeat.

About Center for Liver Diseases

The UPMC Center for Liver Diseases provides complete care for a variety of liver diseases. Our expert hepatologists manage and treat patients using cutting-edge practices and therapies. We research and evaluate new treatments to provide the best care possible. work out of several outpatient locations in western Pennsylvania and a specialty inpatient unit at UPMC Montefiore in Oakland. We manage your care and, if necessary, can help you make the transition to subspecialists, including transplant surgery and oncology.