Liver Transplantation Patient Guide Evaluation

Transplant Evaluation

The Center for Liver Disease and Transplantation may recommend a liver transplant when all other treatment options are exhausted. Evaluation for transplantation takes place once your evaluation at the CLDT is completed. During your transplant evaluation you will meet with the team to discuss test results and learn if you are physically able to undertake the transplant procedure.

It is important to discuss any and all symptoms with the transplant team. Although there are no medicines to "cure" cirrhosis, there are many drugs that can be used to manage the various manifestations of liver disease. They can make waiting for a transplant more manageable.

Center for Liver Disease and Transplantation Outcomes

During the 2 ½ years January 2004-June 2006, the Center transplanted 267 adults and 43 children with over a 98% survival rate (compared to a 96% survival rate nationally). Of those, eight children and 28 adults received living donor organs.
One-year post-transplant survival for the same period was 88% for adults, compared to 87% nationally, and 94% for pediatric transplants.

What's Involved

Blood Tests

Typically, you will have blood drawn to confirm your blood type, evaluate serum chemistries, screen for clotting factors and hepatitis, and conduct viral studies. If you are being evaluated for liver transplantation, you must consent to testing for HIV, the virus that causes AIDS. This government-mandated testing is performed by all transplant centers; your results are confidential and will not be released without your permission.

Radiologic Testing

You may be required to have one or more of the following tests:

Chest X-Ray to determine if your lungs and lower respiratory tract are healthy.
Ultrasound to examine your liver and other abdominal organs and blood vessels.
CT Scan (computerized tomography) makes an image to show the size and shape of your liver and major blood vessels. A contrast material may be injected into a vein to enhance the quality of the image.
MRI (magnetic resonance imaging) makes a more detailed picture of your abdominal organs and blood vessels.
Endoscopy passes a scope to view the esophagus and stomach to assess for ulcers, inflammation, or varices. You will be sedated for this procedure.
ERCP uses a scope similar to that in endoscopy to take X-ray pictures of your bile ducts
Liver Angiogram images the liver and its anatomy using intravenous dyes.
Liver Biopsy requires taking a sample of liver tissue to help diagnose the type of liver disease you have, and to evaluate the extent of the damage it has caused.

Cardiac Evaluation

The CLDT team may require a cardiac work-up to ensure your heart is strong enough to withstand treatment. Testing includes:

EKG to examine your heart's rhythm and rate.
Echocardiogram uses sound waves to look at your heart's anatomy and assess pressure in the chambers.
Stress Testing examines your heart's response to exercise. There are different types of stress tests, some of which require you to walk on a treadmill and others which use medicines to make your heart feel as if it is exercising. The team will assess which stress testing method is best for you.
Cardiac Angiogram may be necessary if your stress test is abnormal or if you have multiple risk factors for coronary artery disease. Dye is injected into your arteries to help identify any abnormalities or blockages in your heart's vessels.

Pulmonary Evaluation

If you were a smoker or have a lung disorder you may require some of the following tests:

PFT (Pulmonary Function Testing) to assess your lungs' functioning and capacity to determine your blood's ability to carry oxygen.
ABG (Arterial Blood Gas) tests the carbon dioxide and oxygen levels in your blood. Blood for this test is drawn from an artery.

Additional Evaluations

Together with the medical tests, a transplant evaluation requires additional assessments. These include the following:

Psychiatric and Social Work
Consultations are beneficial in helping you and your family cope with the many psychosocial issues that arise during the transplantation process. It is vital that all potential transplant recipients build support systems to provide help throughout the process.
Substance Abuse Screenings
At any time in the transplant process, candidates may be tested at random for the use of alcohol and illicit drugs. Use of these substances will forfeit the patient's eligibility to receive a liver transplant. The social worker may ask you to sign an agreement regarding this matter.

Completion of Evaluation Process

When your evaluation tests are completed, the results will help the team determine which treatment options are best for you. Choices range from medical management, investigational protocols which offer the newest therapies, liver surgery to transplantation.

We will ask you to return to the Center to meet with various team members to discuss your options and allow us to answer your questions.