Pre-Transplant Evaluation

What to Expect at the Evaluation

The Liver Transplant office is located:

Ambulatory Care Center, (ACC), 140 Bergen Street, Level D, Suite 1650.

Patients do not need to fast for this office visit and should take all of their prescribed medications.

Upon arrival, patients sign in with the receptionist and complete a form. Patients can complete paperwork before arrival using the “forms” tab on this site. The patient will have a consultation with a hepatologist, that takes approximately one hour and includes a detailed history and physical examination. Patients then meet with a transplant coordinator and may also be seen by a social worker, psychiatrist, nutritionist, or financial coordinator, as determined by individual need.

The following items are needed for the first office visit:

• All medical records, including X-ray films (CT scans, MRI, ultrasound)
• All insurance information and cards
• Address and phone number of the referring physician
• All medications currently being taken
• A list of all drug and food allergies
• A list of all emergency phone numbers, including family members, friends and physicians

After this initial visit, the hepatologists contacts the referring physician, and the transplant work-up will be initiated. This may be accomplished either through the University Hospital complex, or, with the assistance of the referring physician, the work up may be completed closer to the patient’s home. Please be assured that any recent test results will be accepted as part of the transplant work up:

The Medical Assessment

The transplant team will perform a complete evaluation of the patient’s medical history and current health status. The patient may be asked to undergo any of the following procedures:

• A complete laboratory assessment including urine analysis, complete blood count, blood chemistries, liver function tests, and blood and tissue typing. In addition, blood tests for certain infections will be checked.
• Several X-ray tests, including:
  1. Chest X-ray– to tell if the lungs are healthy.
  2. Ultrasound with Doppler– checks the blood flow into and out of the liver looking at the liver’s veins and arteries, as well as the bile ducts.
  3. CT scan– a computerized image of the abdomen, particularly to determine the size of the liver, major blood vessels, and the presence of any tumors.
  4. MRI (magnetic resonance imaging)- may be used in place of a CT scan.
  5. Total-body bone scan– if a liver tumor is present, this test will ensure that it has not spread to the bones.
  6. Hepatic angiogram– dye (contrast) is injected into one of the patient’s arteries to see if there are any abnormalities or blockages in the liver’s blood vessels. This is performed under X-ray and only if the ultrasound detects a serious problem in the liver’s blood vessels.
  7. Cholangiogram– to reveal if there are any blockages or growths in the liver’s bile ducts.
• Some heart function tests, including:
  1. Electrocardiogram (EKG)- to see how well the heart is functioning. It may reveal a previously undetected heart problem.
  2. Echocardiogram– This test is an ultrasound of the heart. It will detect any problem in the heart’s valves and show how well the heart pumps blood.
  3. Persantine thallium stress test– a special type of echocardiogram. It is a stress test performed without the patient walking or running on a treadmill. If there are any special concerns or abnormalities found on the echocardiogram, this test will determine the risk of a heart attack.
  4. Lung (pulmonary) function tests– to reveal how well the lungs are working. A blood sample may be taken from the patient’s wrist to help determine the amount of oxygen in the blood.
• Upper endoscopy– involves passing a tube down the patient’s throat (esophagus) into the stomach to determine if there are varices (varicose veins that may rupture and bleed), ulcers, inflammation, or any other disease.
• Lower endoscopy (colonoscopy)– involves passing a flexible tube into the rectum and colon to determine if there are any rectal or intestinal abnormalities.
• Kidney tests– The patient will be asked to collect urine for 24 hours to determine if the kidneys are working correctly.
• Miscellaneous tests may be necessary, such as: Pap smear and mammogram for women, PSA blood test for men to detect cancer of the prostate, dental X-rays to detect cavities or infections, and a stool test for hidden blood, which may indicate intestinal bleeding.
• A liver biopsy is a small sample of the patient’s liver obtained by a needle. It can be done at the bedside or under the guidance of an ultrasound or CT scan. A local anesthetic is used. The biopsy is obtained by passing a needle into the liver and removing a tiny piece of liver tissue. The specimen allows the doctors to determine the nature and severity of the liver problem. Biopsies are also performed after liver transplant to detect rejection or other post-transplant complications, including infection.

The Psychosocial Assessment

The social worker and a psychiatrist if needed help patients develop coping mechanisms for the stress they will undergo throughout the transplant process. In cases where prior alcohol and substance abuse exist, the psychiatrist and social worker will undertake a detailed analysis of the situation and recommend (within Department of Health guidelines) approaches designed to minimize the chances of the problem recurring after transplant.

The Nutritional Assessment

The nutritional assessment is an integral component of the transplant evaluation process. Studies show that malnutrition can adversely affect patients and their recovery from a liver transplant. The registered dietitian assesses all patients during the evaluation process to identify nutrient deficiencies and educates patients and their families on appropriate diets to meet their nutritional needs. The dietitian reviews the patient’s dietary habits with him or her and family members to help develop and maintain an appropriate diet before and after the transplant. The dietitian can also provide the patient with recipes and helpful hints to reduce health risks.

Financial Counseling

A financial coordinator will meet with the patient, and, if desired, family members, to discuss any financial issues related to his or her medical care, both before and after the transplant.

The financial coordinator contacts the patient’s insurance company to obtain prior authorizations and to determine the level of coverage, as well as the patient’s financial responsibilities. For patients with inadequate health insurance coverage, the coordinator will make referrals to an appropriate agency for eligibility.