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Becoming a Candidate for a Liver Transplant There are several common problems that occur in patients with chronic liver disease and liver failure. Some of these problems can be treated with medical therapy and others are an indication that the liver is beyond repair and a liver transplant should be considered. The staff at The University Hospital will work closely with your physicians to determine the best treatment for you. Because the results of liver transplantation have improved during the last decade, transplants are often considered as an excellent form of therapy early on in the course of liver disease. The evaluation process includes a number of tests that will examine various aspects of your health. These tests will be completed on an outpatient basis and will be reviewed with you and the physician during the evaluation phase. Listed below are a few of the tests you will be required to have for your evaluation. Blood Tests Blood tests are done to help us evaluate your nutritional status and the condition of your heart, liver, blood, kidneys and other organs. Tests will be conducted to determine your previous contact to many common viruses including various kinds of hepatitis, chicken pox and mononucleosis. You will also be asked to sign a consent form to be tested for the HIV virus. Urine Tests Urine tests will be conducted to evaluate your kidney function. Electrocardiogram (EKG) An EKG will be conducted to evaluate your heart. If this test shows certain abnormalities or if you have a history of heart problems, you will need to be further evaluated by a cardiologist. Echocardiogram (Echo) An echocardiogram involves taking a picture of your heart using ultrasound. A paddle is rubbed on your chest and sound waves take pictures of your heart to measures its function. Dipyridamole Thallium (Optional) This nuclear medicine scan takes a closer look at the pumping motion of the heart and the blood flow through the coronary arteries. Right Heart Catheterization (Optional) If your EKG or Echo shows signs of high blood pressure in the blood vessels leading from your heart to your lungs (a possible finding that makes liver transplant more dangerous), cardiologists may perform a catheterization study by passing a long tube through a vein and into your heart and pulmonary artery to measure the pressure directly. Chest X-ray A chest x-ray will help evaluate the condition of your lungs. Pulmonary Function Tests (PFTs) Pulmonary Function Tests are breathing tests that measure the health and capacity of your lungs. These tests involve having your blood drawn to measure the amount of oxygen in your blood and are especially important if you have a history of smoking or lung disease. If the results of these tests are not favorable, you may be referred to a lung specialist, also known as a pulmonologist. Magnetic Resonance Imaging (MRI)
Please let us know if you have a fear of being in small spaces. If so, we can notify the radiologist that you will need medication to help you relax. An MRI will show if there are any lesions in the liver. It will show the blood vessels in and around your liver and measure your liver size. Knowing your liver size will help us choose the appropriate donor liver for you. Because the MRI system contains large magnets, you need to inform us if you have any metal internal devices such as artificial joints or pacemakers. We will determine whether or not you can have the MRI. If you are unable to undergo an MRI, a CT scan and Doppler will be conducted instead (see below). CT Scan (CAT Scan; computerized tomography) (Optional) A CAT scan is performed in the Radiology (x-ray) Department. The purpose of this test is to visualize your abdominal organs, detect any abnormalities and to calculate the exact size of your liver. Even if you have had a CT scan done recently at another hospital, it may need to be repeated. The size of your liver may be helpful in determining the extent of your liver disease and also in choosing the appropriate size donor liver for you. Abdominal Ultrasound with Doppler The Doppler ultrasound uses sound waves to show the size, shape and exact position of your liver including whether or not the blood vessels to and from the liver are open and flowing properly. Liver Biopsy (Optional) During a liver biopsy, the skin is numbed, and you are given a sedative. A needle is inserted into the liver and a small piece of liver is removed for evaluation. Paracentesis (Optional) Paracentesis is the removal of fluid (ascites) from your abdomen. It is usually performed under a local anesthetic. Esophago gastroduodenoscopy (EGD) During an EGD, a small, lighted scope is passed through the mouth into the esophagus and down to the stomach to explore any abnormalities. Sedation will be given prior to this test, which is part of your nutritional evaluation. Colonoscopy (Optional) During a colonoscopy, a small, lighted scope is inserted into the rectum and colon to check for any abnormalities in the lower part of the colon. Sedation will be given prior to this test. Endoscopic Retrograde Cholangiopancreatography (ERCP) (Optional) During an ERCP, a lighted tube is passed through the mouth and down to the duodenum. The outlet of the common bile duct and pancreatic duct is then identified. A small catheter is inserted into the outlet. Dye is injected to outline the common bile duct and pancreatic duct. If an obstruction is found, further procedures may be necessary. Sedation will be given prior to this test. Nutritional evaluation The transplant dietitian will first review the results of several blood tests that measure proteins in your blood along with the results of many other tests. He or she will use your height, weight and blood test results to determine the best dietary plan for you. Dental evaluation Transplant candidates are required to have a recent x-ray of their teeth to rule out infection. Any major dental work must be completed and healed before you are placed on the transplant waiting list. We will also need a letter from your dentist stating that any needed dental work is complete. It is important that you brush and floss your teeth daily. See your dentist for a thorough examination every six months to keep your teeth and gums in good condition, both before and after transplant. Barium Enema or Colonoscopy According to American Cancer Society guidelines, all patients over the age of 50 must be checked for cancer lesions. To be sure your colon (the lower bowels) are cancer free, either a barium enema or colonoscopy is necessary. The colonoscopy is performed by inserting a small tube into your rectum so the doctor can see if there are any abnormal lesions in your colon. A barium enema is performed by inserting a white material called barium into the colon and taking x-rays. For both of these tests, you will be required to take laxatives to ensure your bowel is clean. Men over the age of 50 -
Women over the age of 50 -
Physician Consults Anesthesiology We work with an excellent anesthesia team that has experience and expertise in caring for critically ill patients and for liver transplant recipients. The anesthesiologist will be responsible for keeping you asleep while the liver transplant procedure is being performed. He or she will also be responsible for administering blood and blood products and for maintenance of all of your vital organ functions during the liver transplant operation. The anesthesiologist and the surgeon will work closely throughout the procedure to be certain that you receive optimal care. Operating room nurses and technicians work with the surgeon and anesthesiologist. Before and after your transplant, the anesthesiologist will visit you to discuss with you the risks of anesthesia administration. Cardiology Consult Any patient with a history of heart disease, diabetes or an abnormal cardiac test will need to see a cardiologist after the EKG and/or echocardiogram is completed. The cardiologist will determine if your heart is healthy enough to withstand a transplant operation. The cardiologist may order additional tests to evaluate your heart such as a stress test or arteriogram. If these additional tests are needed, the cardiologist will explain what the tests are and how to prepare for them. Pulmonary Consult Any patient with abnormal pulmonary function tests or a history of lung disease will need to see a pulmonologist. Smoking will increase your risk of lung infections, including pneumonia, after the transplant. For this reason, all transplant candidates must stop smoking and using any tobacco products. National public health studies show that primary lung cancer is linked to smoking and secondary smoke. If necessary, find a group in your area that supports those trying to break the habit. Hematology Consult Hematologists are experts in disorders of the blood and clotting systems. They are consulted as necessary to assist us in managing any clotting abnormalities that you may have before and/or after transplant. Nephrology Consult A nephrologist, or kidney specialist, will speak with you if you have decreased kidney function. Following your transplant, a nephrologist is consulted if your kidneys are not functioning properly. Some patients require dialysis temporarily until their kidneys function properly again. Infectious Disease Consult The staff in the Infectious Disease department has a great deal of experience managing opportunistic infections, infections that occur in people with weakened immune systems. If you develop any infections after your transplant, the infectious disease staff will be available to assist in your care and participate in the diagnosis and treatment of these infections.
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Magnetic Resonance Imaging is a technique that allows physicians to see inside the human body without entering the body. The system contains powerful electromagnets in the shape of a large tube. This tube surrounds you and produces images of your internal organs including your liver blood vessels.
