Transplant Center

Liver Transplant Program

Clinical Management

Evaluation Process

Each candidate will be seen by a multi-disciplinary group of consultants comprising the liver transplant screening committee. Each member of the consultant group interviews patients and offers suggestions from their unique perspective concerning any pre-transplant concerns or post-op management issues that may affect the outcome from liver transplantation.

These consultants include:

transplantation surgery
hepatology, transplant medicine
transplant nurse coordinator
financial counseling
social service
psychiatry
anesthesiology
nutrition

Additional consultants as indicated by medical condition or co-existing diseases include:

infectious disease
cardiology
nephrology
pulmonary
blood bank/hematology
oncology

After the evaluation process is completed, the screening committee members will meet and review the cumulative data and render a decision as to the appropriateness and timing of liver transplantation for each patient. Decisions include:

accepted for transplant
deferred, pending supplemental data
rejected for transplant

A formal letter will be sent to each patient and the referring physician relaying the decision of the committee. If a patient is deferred, the patient and referring physician will be notified of the additional required data. If a patient is rejected, the reasons for rejection will be explained along with an offer to facilitate referral to another transplant center for additional consideration.

In addition to the consultant interviews, radiologic and laboratory investigations are performed to elucidate the cause and nature of their liver disease, assess functional capacity, determine patency of hepatic vascular supply, and to exclude co-existing medical conditions that would compromise patient or graft survival.

Complete biochemical and liver profile, hepatitis serologies, virology studies (including CMV, EBV, HIV), complete blood count and coagulation profile.
Assessment of blood type and presence of any special transfusion related problems.
Duplex ultrasound and MRI/MRA of liver to determine portal vein patency and exclude liver masses.
Pulmonary and cardiac functional studies. (If indicated)
Routine cancer screening

Some patients will require inpatient evaluation due to decompensated cirrhosis or acute hepatic failure. Their pre-transplant management and evaluation will be led by Transplant Hepatology. Patients may require therapeutic, as well as, diagnostic measures to improve their clinical and functional status. Patients with fulminant hepatic failure will require expedited evaluation and ongoing joint assessment by transplant hepatology and surgery as to the appropriateness and timing for transplantation.

Pre-Transplant Management

Hepatology/Transplant Surgery follow-up: liaison with patient's primary physician and gastroenterologist
Management of TIPS
Management of Complications of End State Liver Disease
Vaccines
Signing of Patient's Substance Abuse Policy
Ongoing substance treatment reports and random screening

Patient Education

Pre-transplant patients are educated about and provided with information regarding:

The normal functions of the liver
Common symptoms of liver disease
Dietary issues
UNOS and the waiting list
Organ Donation Process
The Surgical Procedure
Medications post-transplant
Post-transplant follow-up

Post-transplant patients are educated about and provided with information regarding:

Infection and Rejection
Dietary issues
Vital sign monitoring
Medications and side effects
Care of the T-tube and wound
Liver biopsy indications and protocols
Hygiene and Dental Care
Activity and Exercise
Discharge plan and long-term follow-up

Outpatient Post-Transplant Management

Patients are discharged from the hospital eight to fourteen days following liver transplantation. After initial discharge, until three months post-transplant, patients are seen in the transplant surgery clinic. After three months post-transplant, patients transition to the transplant hepatology clinic for continued management. The frequency of clinic visits in the transplant hepatology clinic are as follows:

Once a month (months 3-6)
Once every three months (months 6-12)
Once every six months (months 12-24)
Once a year after 24 months

Transplant hepatology clinic is designed to do a comprehensive review of laboratory data and diagnostic studies reflective of liver function, manage the immunosuppressive regimen that each patient is following, and monitor for recurrence of viral hepatitis. Each patient will be referred back to the primary care physician or gastroenterologist for routine health maintenance. As collaborative physical groups are caring for these patients, referral physicians should expect to regularly communicate with transplant center physicians and/or nurse coordinators. This communication is integral in formulating an overall plan of management for transplant recipients.

Routine Outpatient Laboratory Testing

Routine laboratory tests are necessary to monitor for the following: drug toxicity, graft rejection, infection secondary to immunosuppression, and the response of liver enzymes after treatment for graft rejection or after a change in the immunosuppressive regimen. Infection and graft rejection most often occur within six months following transplantation. In the event that one or both of these situations occurs, the frequency for laboratory testing will increase in order to closely monitor the patient's overall response. Our current protocol for laboratory testing is:

3-6 months post-transplant - labs every two weeks
after 6 months - labs every month

Routine laboratory tests include: CBC with differential, standard chemistries with a liver profile (ALT, AST, Alkaline Phosphatase, and bilirubin) and a Cyclosporin (Neoral) or FK506/Tacrolimus (Prograf) level. Patients can have laboratory testing done at Associates in Pathology Laboratory located at University of Maryland Hospital, at a preferred diagnostic center that is designated by a HMO, or at the referring physician's office.

This page was last updated on: September 2, 2008.

If you would like to make an appointment or talk to someone about our services, please call 410-328-5408 or 1-800-492-5538.