- 6/30/2025
In this month’s informative Stay Well Health Chat, Andrew Salciunas is joined by Dr. Simona Rossi, a highly respected transplant hepatologist and Administrative Medical Director of Advanced Transplant and Organ Health Services at Virtua Health. Dr. Rossi provides essential insights into liver and kidney diseases, emphasizing prevention, early detection, and the importance of organ donation.
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00:00Hello, everybody. I'm Andrew Salchunas, host of The Morning Show, Kincaid and Salchunas on 97.5 The Fanatic.
00:07And every single month, I love that I get to do these, the virtue of Stay Well Health Chat.
00:11It's my way to continue to learn more about my own body and then also sort of give you information about your own body,
00:18because we should probably all know about our own health so we can live long, happy, healthy lives.
00:23And this week, this month, it's a little bit different.
00:26And I'm excited for this one because it's not something that I can just kind of fix over a checkup.
00:32This is a little bit deeper, and that's why we turn to the specialists.
00:36That's why I turn to Dr. Simona Rossi, who is a transplant hepatologist and administrative medical director of transplant and organ health services,
00:44all with the Virtua team, who I love.
00:47So, doctor, first and foremost, thank you very much for joining me today.
00:51I always love doing these Stay Well Health Chats.
00:53I have a lot of family members and friends who are in the medical field, so it's my chance to try to pretend like I know what they're talking about whenever I have communications with them.
01:01So, you educate me, and then we help educate the audience.
01:05So, thank you.
01:06So, first and foremost, we'd love to sort of get your background.
01:09What got you into this medical field?
01:11Because, you know, transplants, this is a different beast.
01:14We'd love to know what got you here today.
01:16Yes.
01:17So, nice to meet you, and thank you for having me.
01:19What got me into this field is probably it was an evolution of my training that kind of always brought me back to caring with the patient with liver disease.
01:29The road to that was initially internal medicine, then gastroenterology.
01:33And when I was doing my gastroenterology, I gravitated always to the liver patients, enjoyed my liver months the best,
01:39and kind of realized I had caught the bug, and that was where I was going to be.
01:43So, here I am.
01:44Well, I appreciate what you do.
01:46I appreciate everybody in the medical field.
01:47You guys are all very, very important to our lives.
01:50So, transplants, before we even get to the when and where and how, how do we get there?
01:57Obviously, liver disease is something that everybody kind of hears about, and I would love to know what kind of gets us there.
02:04I think there's the – everybody kind of knows that alcohol is a big part of it, but I would love for you to speak on that.
02:11How much alcohol could impact our liver?
02:13What other causes could lead to eventually getting a liver transplant?
02:17So, let's start off with what leads to liver disease.
02:20Well, I'm actually really glad that you mentioned that alcohol everybody thinks of right away because there are so many other causes of liver disease
02:27and so many other causes as to why a patient can end up with cirrhosis, and it's all within various – very much assumed that it was alcohol.
02:35But actually, the most common cause of liver disease and cirrhosis is now fatty liver disease.
02:42So, the person at risk is no longer a stigmatized patient of alcohol, which we should never do.
02:48But it is your mother, our sister, our brothers who have high blood pressure, high cholesterol, diabetes, whose BMI is greater than it should be.
02:57Those patients are at extreme risk of developing liver disease, which then can progress to cirrhosis.
03:03And we know for certain that this is becoming and will become the number one cause for liver transplant in the United States.
03:10So, is there ways to try to obviously prevent it with healthy lifestyles, but maybe your liver levels – I'm speaking at a very low-educated level – low – your liver levels, they get to a certain point where maybe you need to work on it.
03:25Are there things that you can do before we get to the transplant route, or is this something where, all right, it's going to be inevitable, but we can try to sustain it for a certain period of time?
03:34No, absolutely. It requires knowing it way before. You don't want to present with cirrhosis. We want to know – we want to prevent cirrhosis.
03:42So, absolutely, taking good – taking care of yourself, you know, eating a healthy diet, seeing your primary care doctor regularly, and getting liver tests probably once a year if you're an adult.
03:53It was just to make sure that everything is status quo and normal, because the first sign sometimes, but not always, is a liver test that is elevated.
04:01And then the physician looks at your risk factors, and if there are risk factors that suggest possibility of liver disease, it's important that we get that early on so we can stabilize and even now reverse.
04:14We have so many good therapies out there that can prevent progression.
04:18Liver is something – I don't know what the life expectancy is of somebody that has the disease and just opts out of getting a liver transplant.
04:26So, what are some of the necessities for that? And if you don't get the transplant, what could happen?
04:32So, that's a great question. So, the process is pretty much the same for most centers.
04:37I know there are some deviations, but often the patient is recognized – either they come through an emergency room or are very sick,
04:44or a primary care gastroenterologist will refer the patient to one of us.
04:48And what we use is certain lab value results that reflect how well the liver is working or not working to kind of give us a guideline as to whether or not it is time for that patient to go through the process of an evaluation.
05:01If that is all kind of in check, and we do agree that the likelihood of you surviving without a liver transplant is worse than if you get a liver transplant, then we move forward.
05:13Because liver transplant in itself has its own risks and its own complications, and some patients could potentially not survive a transplant.
05:20So, we want to make sure that when we pull that trigger that we're benefiting the patient.
05:25So, once that is done, then we always have the social work on hand.
05:29There's a lot of emotion, as would be expected, when somebody is facing a transplant.
05:34So, social workers are a very valuable part of our program for the fact that, unfortunately, there is still a lot of alcohol abuse and disease in the world.
05:46We have also addiction medicine that helps out because this is a disease that will continue once they have a transplant.
05:53So, these patients, you need to treat the disease of alcohol.
05:57So, we need that as part of it.
05:59And then you have us, the medical doctors, and the surgeons.
06:01The surgeons need to make sure that anatomically, everything will be able to be connected.
06:07We need to make sure your heart's strong enough and your lungs are strong enough to get you off the machines after you have a liver transplant.
06:14And all those moving pieces have to kind of fit perfectly.
06:19And if so, then you are placed on the liver transplant list, and so begins your time.
06:23Now, that was a lot of great information on the liver, and I really appreciate that.
06:27But another thing that we could talk about is the kidney.
06:31So, what leads to kidney disease?
06:34That's one that I honestly don't know about, Doc.
06:37Like, I don't even have, like, a clue.
06:38So, what could lead to kidney disease?
06:41And then sort of the same conversation about the liver when it's time to get a transplant.
06:46When do we know about that?
06:47So, there are multiple causes of kidney disease, and most of patients who have kidney disease that require dialysis are due to high blood pressure, diabetes.
07:00Those are probably the number one causes of kidney dysfunction that lead to dialysis.
07:04There are also, however, kidney diseases that a person is born with, genetic causes that cause ongoing slow progression of kidney failure.
07:14So, there's many things, including medications or an acute illness where a patient is in the hospital, and unfortunately, their kidneys fail because of that illness, and then just don't recover.
07:24So, there's multiple causes.
07:26And I know a lot of people, I think, know this, but not everybody, that you could live with one kidney.
07:33So, when it comes to kidney transplant, is that easier to get than, you know, we were just talking about the liver, and obviously, there's heart transplants, and there's a lot of other transplants.
07:44Is kidney one of the easier ones to maybe find a donor for?
07:47It's not so much that it's easier, but it's also not as much of an emergency.
07:52So, because of the dialysis, a patient can live waiting for a kidney transplant.
07:58It's just a little bit more, or kind of, it's much more pressurized for a liver because there's only so long that a patient can live without their liver.
08:06So, that's the biggest difference.
08:09There is that time buffer, although we know that once patients are on dialysis, their lifespan, their quality of life is significantly impacted.
08:18So, Doc, earlier you mentioned that we could find out about liver disease, kidney disease through blood tests, right?
08:24We do our annual blood test checkups, but this isn't something that I think you get symptoms from.
08:30So, is it imperative to get it checked out every single year, your annual blood work?
08:35And is there other ways to sort of keep in track of your liver, of your kidneys?
08:40You mentioned high blood pressure.
08:42It's not like somebody just goes, oh, I have high blood pressure.
08:44I must have liver disease.
08:46So, what are other things that we can keep an eye on?
08:48So, I think, again, health, being healthy, living a healthy lifestyle is paramount for everything, right?
08:55When you see your physician, you want to be very honest with your physician about potential risk factors that might elicit concern on your physician's part to start to look for things.
09:05Because oftentimes, you know, somebody may have really advanced liver disease and have even developed cirrhosis and have no symptoms whatsoever.
09:13And if you're not being honest with your physician or you're just meeting a physician, they may not appreciate that there's some underlying risk factors that they need to be aware of.
09:24But you're right.
09:27I mean, most cirrhosis is very commonly an asymptomatic disease, I should say, until it's symptomatic.
09:34And that's usually when you have decompensated or advanced cirrhosis.
09:37So, certainly, being in the hands of a physician who is caring for you on a regular basis and monitoring you and assessing risk factors so that they know when to look for liver disease is extremely important, as well as with the kidney.
09:50Now, when you mention honesty, is that like when you get the sheet of paper at the beginning and it's like, how many drinks a week do you have?
09:56And you go, oh, typically six, but I'm going to put down two.
10:02Is that what you mean?
10:02Or what other things can we be honest about with our physician?
10:06I think definitely the alcohol component.
10:08I think, unfortunately, you know, again, there is a stigma with alcohol use disorder and it is a disease.
10:13And from the patient's perspective to everybody else's perspective, we need to kind of change gears and look at it as a disease.
10:21You know, you would say you have high blood pressure.
10:23Hopefully, we'll get to a point where you also say you have an alcohol use disorder, alcohol use disorder, so that we are able to help intervene and also, you know, monitor liver enzymes and liver tests and liver function.
10:35But, you know, it's not just alcohol.
10:38If you're taking a lot of supplements, unusual medications that are not prescribed, that are not FDA regulated, sometimes those are actually very unsafe for patients and can cause liver failure.
10:50So it's really important that you're forthright and honest and just kind of like think of anything and everything that you're doing and taking because it may be relevant.
10:58That unusual supplement that you're taking that is for weight loss or for better liver health, for memory health, that actually could be toxic to your liver or to your kidneys.
11:08So it's really important to think of everything and just be forthright.
11:11Let's get to the transplant process.
11:13Before we even get to the importance of it, I think something that people need to know is that this isn't something that's like, we got you a liver.
11:21Like, this might take some time.
11:23So could you talk to somebody who's listening right now that knows somebody that's going through it or they themselves might go through it that need to know, all right, this isn't going to be an overnight process?
11:33Certainly.
11:33So there is living donor whereby you have control over when and the timing of your transplant.
11:38But the vast majority of patients are getting transplants through donations from family members who are losing other family members through brain trauma, an acute, you know, stroke or heart attack.
11:52And so when those tragic events happen to another patient, if that patient has requested to be an organ donor or their family so chooses that, then that person can carry on life for a recipient.
12:07But a lot goes into that.
12:09Number one is, are they a match?
12:11Do they have the same blood type?
12:12Are they the same size?
12:14And then who else is waiting?
12:16Who is sicker than the patient that you want to be transplanted?
12:21So there's a lot of moving parts.
12:23Our goal is always to save a life.
12:26But unfortunately, the reality is that we do lose patients sometimes on the waiting list.
12:30So you mentioned there's so many different areas of your body on the inside and on the outside that you can donate when it comes to that time where maybe some unfortunate incident happened to you and it's time to donate.
12:42Or maybe you are a living donor, as you mentioned earlier.
12:45What are some of the things that the team at Virtua are really strong with?
12:48Obviously everything.
12:49But what are the things that you specialize when it comes to the donation process?
12:53So at Virtua, Our Lady of Lords, we are doing liver transplants, kidney transplants, pancreas transplants.
13:03Less pancreas transplants is starting to kind of go down across the nation.
13:07But our liver transplant program has tripled in size over the past couple of years.
13:11And our kidney transplant is kind of following the same path.
13:15So we're growing exponentially.
13:17But that's where we concentrate our transplant program.
13:21And that's why I trust the team at Virtua Health.
13:22I mean, you guys just continue to grow and grow.
13:24And it's for good reason.
13:27I mean, you guys are tremendous at everything that you do.
13:30Now, I know this is sort of a heavy question for somebody that might be listening.
13:34And I think about when I was 16 years old getting my driver's license and there's the box.
13:40Do you want to be an organ donor?
13:41Yes or no?
13:42And I, you know, I check yes because if something happens, I would like to try to help somebody else out.
13:46But I'm curious for you if you could speak to the audience if maybe somebody's on the fence or somebody just is worried about it.
13:53Or somebody may have opted out, but they want to change their mind.
13:57The importance of organ donation, if you could talk on that, doctor.
14:01Absolutely.
14:02I can't stress enough how important organ donation is.
14:06It is how we save lives.
14:08And one person who agrees to have organ donation or the family chooses so for them, the amount of lives saved is incredible.
14:19It's not just a liver.
14:20It's not just a kidney.
14:22It is the liver, the pancreas, the kidney, the lungs, the heart.
14:26It's so many life-saving gifts that that donor gives to so many people.
14:34And I can tell you that while it's very anonymous, the gratitude that we see of our recipients for the donor is tremendous.
14:45And it's awesome in the true sense of the word, awesome.
14:48And the donor is never forgotten.
14:52And it's just, I can't, I mean, if you have any reservations or you're on the fence, know that this is a life-saving event for so many people.
15:04Yeah.
15:04Very well said, Doc.
15:06Now, to lighten up the mood, I do want to know a little bit more about you.
15:09What is the most rewarding part about your job?
15:11Because we're talking about saving lives here or changing the direction of somebody's life.
15:15So, for you, with all the work that you put into it, I mean, you talked about your degree and how you got to this part.
15:20I know that wasn't like an overnight class, right?
15:23You've done a lot of work to get to where you're at today.
15:26So, what are some of the most rewarding parts about your job?
15:28The one thing that keeps me going, and this is a very stressful job, it has a lot of really awesome moments.
15:35It has a lot of real sadness.
15:37Being the advocate to a patient who I know needs advocacy, getting them on the list and seeing them on the other side, getting back to life, being with their children, looking healthy.
15:49They walk through the door and you wouldn't even know that they had a transplant.
15:53That is the reward.
15:56That's awesome.
15:57Listen, Dr. Rossi, I really appreciate you taking the time today.
16:00It's wonderful what you do, wonderful what the team at Virtua does.
16:04And obviously, you guys can always look up more information, Virtua.org.
16:07If you want to learn more, you know, we've got all kinds of pages for every part of the body, every sort of health area.
16:13Even when you think about, Virtua.org has it.
16:16And it's been a lot of fun for me to be able to do these on a monthly basis.
16:19And I learned a lot again today, Dr. Rossi.
16:21I really appreciate the time.
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