What are the different causes of liver failure? Is there a waiting period for transplant? How do I start the evaluation process? What is the workup process like? What are my responsibilities while waiting for transplant? What is the process like when a liver is found for me? What happens when I get to the hospital? What information do I need to bring on the day of surgery? How long will I be in surgery? How long will I be in the hospital after my surgery? What is my expected follow up care after hospital discharge? What medications will I be on after transplant? Why would I not be eligible for a liver transplant at BSLMC?


Question:

What are the different causes of liver failure? 

Answer

Liver failure may be caused by one or more of the following:

  • Hepatitis B & C
  • Autoimmune Hepatitis
  • Cirrhosis
  •  Alcoholic Cirrhosis
  • Primary Biliary Cirrhosis
  • Cryptogenic Cirrohosis
  • Primary Sclerosing Choalangitis
  • Hepatocellular Carcinoma
  • Wilson’s Disease
  • Primary Hemochromatosis
  • Non Alcoholic Steatohepatitis (NASH)
  • Budd- Chiari Syndrome
  • Acute Liver Failure
  • Metabolic Disease

Question:

Is there a waiting period for transplant? 

Answer

If you are accepted for transplantation, you will be placed on a national computer list of active candidates waiting for a donor.  Recipients are chosen according to a complex set of criteria, including MELD Score (Model for End Stage Liver Disease) blood type, and length of time on the waiting list. Recipients are chosen primarily on the basis of medical urgency within each ABO blood group. Waiting time is only a factor when patients have the same MELD score.   The United Network for Organ Sharing (UNOS) coordinates the equitable sharing of organs throughout the United States and oversees all donor centers and procurement agencies.

MELD SCORE -  is a numerical scale used for adult liver transplant candidates. The range is from 6 (less ill) to 40 (gravely ill). The individual score determines how urgently a patient needs a liver transplant. The number is calculated using your most recent laboratory tests. For additional information please log on to www.unos.org.
Lab values used in the MELD calculation:

  • Bilirubin, which measures how effectively the liver excretes bile;
  • INR (formally known as the prothrombin time), measures the liver’s ability to make blood clotting factors;
  • Creatinine, which measures kidney function. Impaired kidney function is often associated with severe liver disease.

Question:

How do I start the evaluation process? 

Answer

The evaluation process begins with an appointment with the hepatologist (liver disease specialist). The hepatologist determines the medical appropriateness of an individual’s need for a liver transplant. You will also meet with the liver transplant surgeon. The surgeon will discuss the risks and benefits of liver transplantation, possible complications after liver transplant, and types of liver donors available. You will meet with the financial counselor to discuss the costs of a liver transplant as well as the costs related to caring for your liver transplant. They will discuss your insurance coverage as well as costs not covered by your insurance. They will discuss options such as fund raising to help cover the costs not covered by your insurance company. You will also meet with the transplant coordinator. This meeting includes education regarding the transplant and listing process and the pre transplant and post-transplant responsibilities of the patient. The transplant coordinator is your primary contact person. The dietician will review your current diet habits and recommend any needed changes. They will also assist you in maintaining proper nutrition and weight. You will also meet with a social worker to evaluate your ability to deal with the transplant regimen while waiting for a transplant and after you receive your transplant. They will also assist you in identifying your support group.

Question:

What is the workup process like? 

Answer

There are many different tests and consults that will be performed to determine if you are a suitable candidate for liver transplantation. Below is a list of some of the tests that will be ordered as part of your evaluation. Other tests or consults may be ordered based on the results of these tests.

  • Blood/Urine/Stool tests - Blood tests and specimen collection to help assess your overall physical condition.
  • Colonoscopy – A procedure to screen your colon.
  • Endoscopy- A procedure to screen your upper gastrointestinal tract.
  • Chest X-ray - The test assesses the size of your heart and any lung abnormalities
  • MRI or CT Scan of Abdomen - Examines the kidneys, liver, and gallbladder for the presence of cysts, stones, lesions, portal vein patency, ascites, and or other abnormalities.
  • TB Skin testing - A small amount of solution is injected under the skin on your forearm to determine if you have been exposed to tuberculosis.
  •  
  • Gynecological exam – All women will need a gynecological exam within the last year. Mammograms are also required for all women over age 40.
  • Pulmonary function studies - If you have a history of lung disease or tobacco use, your transplant work-up may include pulmonary (lung) function studies.
  • Cardiac tests – These tests will assess your heart function and will include an echocardiogram, and electrocardiogram (EKG or ECG).  A stress test and a cardiac catheterization are done if indicated.
  • Physical examination (gives the doctor an overall picture of the patient’s condition).

Everyone is different; therefore, every evaluation will be tailored to evaluate specific patient’s needs. Medical Review Board: When your evaluation is complete, your case will be presented to the Medical Review Board (the MRB).  The MRB consists of a multidisciplinary team of hepatologists, transplant surgeons, transplant coordinators, a dietician, social workers, financial counselor and consulting physicians.  The purpose of the MRB is to discuss each evaluant case by case and to determine possible candidacy. Recommendations may be made by the MRB prior to making a final decision for transplant eligibility. All evaluants will be notified via certified mail and contacted by their assigned coordinator of the MRB outcomes and recommendations.

Question:

What are my responsibilities while waiting for transplant? 

Answer

While on the transplant list, you must maintain active medical insurance.  Failure to do so may impact your ability to receive a transplant. You must notify the transplant center if there are any changes in:

  • Insurance
  • Address or phone number
  • Support Team
  • Medical condition
  • Infections/ fevers
  • Surgeries/hospitalization
  • Medical deterioration

All patients must follow prescribed treatment regimen (diet, medication, clinic appointments and lab work and scheduled testing)

Question

What is the process like when a liver is found for me? 

Answer

When a potential donor is found, the coordinator will call you (it is very important to keep us aware of any change in address, phone number). When we call you, the coordinator will give specific instructions and notify you of a timeline for your care and transplant. When you are instructed to come to the hospital the coordinator will give you a time and place to report and will let you know when to stop eating and drinking.

Question:

What happens when I get to the hospital? 

Answer

After admission, the patient will have a thorough physical examination, including blood work, chest x-ray, and EKG. Unfortunately, in some cases, the surgery must be postponed and the patient sent home again.  We cannot always predict these cases, but postponing the transplant in these instances are in your best interest.  Some cases may include:

  • Infection
  • Additional medical problems
  • The donor liver shows signs of poor function
  • A problem is identified with match between the donor and recipient

Question:

What kind of information do I need to bring on the day of surgery?

Answer

  • A current medication list
  • A list of your drug allergies
  • Current health insurance information (your most recent insurance cards)

Question:

How long will I be in surgery? 

Answer

The surgery normally takes 3-5 hours.

Question:

How long will I be in the hospital after my surgery? 

Answer

After your transplant, you are typically in the hospital for 5 to 7 days. After discharged from the hospital you will be seen in the Transplant Clinic for follow up care. If you live out of the Houston area, you are typically required to stay near St. Luke’s for one month post-transplant. This way, we can monitor your new liver function and medication levels closely.

Question:

What is my expected follow up care after hospital discharge? (Clinics and labwork) 

Answer

You will have to follow up with your liver transplant team after your transplant to make sure that your new liver remains healthy. Typically, patients are seen every week for the first month post-transplant, and then will reduce in frequency over time. Please expect to have frequent lab work done. Any additional testing to monitor your health and liver function will vary from patient to patient. Tests may include abdominal scans, ultrasounds, and liver biopsies.

Question:

What medications will I be on after transplant? 

Answer

Post-transplant, you will be on several different medications.

  • Immunosuppression medications – These medications will keep your body from fighting off your new organ. These may include: Neoral, Prograf, Cellcept, Rapamune, and Prednisone.
  • You may be on other medications to control blood pressure, Insulin, antibiotics and antivirals, diuretics, and vitamins. You may also go back on any pre-transplant medications to manage any other preexisting conditions.

Question:

Why would I not be eligible for a liver transplant at BSLMC?

Answer

  • Significant or advanced cardiac, pulmonary, nervous system or other systemic diseases, except where dual organ transplants are being considered (i.e. liver/lung, liver/kidney, liver/heart)
  • Systemic infection
  • Hepatocellular carincoma with extrahepatic (outside the liver) spread or vascular involvement
  • Presence of malignancies outside the liver with the exception of special cases such as neuroendocrine tumors
  • Acute severe hemodynamic compromise at the time of transplantation if accompanied by compromise or failure of one or more vital organs. Severe compromise is defined by the requirement of inotropic agents to maintain systolic blood pressure >90 mm Hg or pulmonary hypertension with a mean of >33 mm Hg
  • Active alcohol or drug abuse
  • History of behavior pattern or psychiatric illness considered likely to interfere significantly with compliance
  • Lack of sufficient social support to allow 24 hour care
  • Portal vein thrombosis
  • Patients with uncontrolled severe comorbid medical conditions
  • Obesity (BMI >40), which may result in technical or medical complications in the peri-operative and post-operative periods

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