The Recanati/Miller Transplantation Institute

Programs

Liver Transplantation

Adult Liver: Evaluation

Introduction | Referrals | Evaluation | Preoperative Experience |
Postoperative Experience | Retransplants/Recurrent Diseases |
Transplantation for Liver Tumors | Research

eople with liver disease may experience many of the following signs and symptoms:

• Jaundice (yellowing of the skin and eyes)
• Itching
• Ascites (an abnormal accumulation of fluid in the abdomen)
• Forgetfulness, Confusion
• Dark, tea-colored urine
• Gray or clay-colored bowel movements
• Vomiting of blood
• Tendency to bleed
• Muscle wasting

Initial Consultations and Tests

Evaluation for liver transplantation is an ongoing process, which continues even after you have been accepted onto the waiting list. The two main goals of the evaluation process are to determine 1) whether you have a liver disease for which transplantation is the best treatment and 2) whether your overall condition is such that you can safely undergo transplantation.

The evaluation process begins with an initial visit with the Transplant Hepatologist, Clinical Coordinator and Transplant Social Worker. We will take a complete medical history from you, conduct a physical exam, and review all the outside records, tests and consultations that you have had done previously. The Social Worker will conduct a full evaluation including an assessment of your personal support system. (Liver transplantation is a major undertaking and one key to a successful transplant is the commitment to health and well-being that you receive from supportive friends and family) The Clinical Coordinator will explain the evaluation process, selection process and listing process. Based on the urgency of your condition, you may also be given information about the transplant procedure, immediate post-operative complications and care, medication and follow-up care at this time.

Although you will have the opportunity to meet the transplant surgeons during these early visits, your case will be managed by the hepatologists until the time of surgery. Depending on your age and medical history, you may need to see additional specialists as well.

Routine Testing for the Transplant Evaluation:

1. Cardiology
2. Chest X-Ray
3. Abdominal CT / MRI
   This is a computerized imaging study of the liver, which enables us to determine the size of the liver and identify any abnormalities that may interfere with the success of your transplant.
4. Blood Tests
   It is important that we have your blood type, blood count, blood chemistries and viral studies in addition to other specialty blood tests.
5. Dental Clearance
   You will be given a form at your initial visit to be filled out by your regular dentist describing the health of your teeth and gums.
6. GYN
   All female patients 18 and older will be given a form to be completed by your gynecologist and returned to our office.
7. Mammogram
   Required for all female patients 50 and older.
8. Colonoscopy
   Required for all patients over the age of 50 years
9. PPD Skin Test
   This is a skin test placed on your arm to determine if you have ever been exposed to Tuberculosis.

(Depending on the specifics of your condition, you may need additional testing such as a bone scan, chest CT and upper endoscopy)

All additional consultations or procedures will be discussed with you at the initial visit. Pending clearance from the insurance company, your assigned Coordinator Assistant will contact you to arrange all following appointments. As much as possible, these appointments are scheduled together to avoid unnecessary travel, but you should realize that there are many different departments involved so a completely convenient appointment schedule may not always be possible. If you cannot make an appointment for any reason, please notify our office.

Once the evaluation is complete, your case will be presented before our Recipient Review Committee Meeting. This group includes our Transplant Hepatologists, Surgeons, Clinical Transplant Coordinators, Social Workers, Ethicists and various clinicians from other departments involved with the transplant team. When your case has been reviewed, you will be notified of your rejection or acceptance to the program. If you are accepted and your condition is severe, you will immediately be placed on the UNOS Waiting List. If you're accepted and your condition is not severe, we will wait until your disease has progressed to place you on the UNOS Waiting List. (Waiting to place non-critical patients on the list does not affect overall wait time because the recently implemented MELD system for organ allocation eliminates waiting time as a factor in determining your level of priority for liver offers.)

Some Things to Keep in Mind

The evaluation period gives you and your family the opportunity to meet with us and decide if you want to pursue transplantation at Mount Sinai. Please remember that the ultimate decision to undergo surgery belongs to you, and you may withdraw from the program at any time before the actual procedure.

It is also important to remember that we as a transplant team are consultants; you will remain in the care of your referring physician even if you are accepted as a transplant candidate. If you don't have a primary care physician, you may want to identify one at this time. It is helpful to have someone who is familiar with your medical history because once you are stable after transplant (approximately 3 months) you will be returned to the care of your primary physician.