Liver Work – up
Liver transplant has been the choice of treatment for end stage liver disease (ESLD) and complications associated with it such as acute liver failure (ALF) , primary liver cancer ( HCC) and some metabolic diseases.
Patients referred for transplant are evaluated typically in about two or three days. These tests are designed to assess the patient's need for transplantation and the urgency. They include blood tests, imaging tests, evaluation of the heart and lung function along with psycho/social evaluation followed by an extensive interview. A liver transplant workup is performed by a well trained team of physicians, nurses, social workers, dieticians and also includes consultation with various specialists based on each individual patient’s need, several imaging studies and a battery of laboratory tests. Prior to presentation to the Liver Transplant Committee, all patients are expected to undergo the following procedures: 

  1. Consultations
  2. Radiology
  3. Laboratory investigations
  4. Other procedures
  • Consultations 

The hepatologist screens the patient for liver transplant and work up is initiated in association with liver transplant team. The patient and his family members are counseled by the transplant co-ordinator. These patients undergo screening wrt heart, lung and other organs. These include tests such as ECG, Echocardiogram, Pulmonary function tests, kidney profile.  Patients with liver cancer are also screened by Oncologists, interventional radiology specialists.

  • Radiological investigations

Evaluation by X- ray, ultrasound, CT Scan of the abdomen, Doppler study of the portal vein are done. MRI of liver will be advised if necessary. Patients who are diagnosed of cancer are advised CT lungs, brain, nuclear bone scans to locate potential metastatic disease. Chest X-ray, sinus X-ray and X-ray of teeth are also obtained. MR angiography and cholangiography is advised to rule out certain conditions.

  • Laboratory studies

Tests are performed that are basic and advanced. It includes liver function tests, hematological parameters, bio-chemical parameters, cancer markers, autoimmune markers etc.

  • Other procedures:

Esophago-gastro-duodenoscopy (EGD): to screen for esophageal / gastric varices to determine the extent of portal hypertensive gastropathy (PHG). 
Colonoscopy: All patients with cirrhosis older than age 40, or younger patients with higher risk (history of colitis or family history of early colon cancer), undergo screening colonoscopy with prostate digital exam being performed in men at the same time. Polyps are identified and endoscopically removed. Patients with precancerous  polyps and with history of colitis or PSC, will require further screening colonoscopies every few years following liver transplant.
Endocopic retrograde cholangio- pancreatography (ERCP): Patients with PSC or history of colitis will require this procedure to identify the biliary strictures and potential cholangiocarcinoma. Biliary  brushings are routinely obtained to rule out malignancy
 Liver biopsy is not required for the work up. In rare instances, if it is indicated it will be performed by the hepatologist or the interventional radiologist.
Paracentesis:  When severe ascites -- swelling in the belly from liver failure -- causes discomfort, a needle can be inserted through the skin to drain fluid from the abdomen
Mammography & Pap Smear : Female patients will require to rule out / detect breast / cervical cancer.
Nuclear cardiac stress test / coronary angiogram are done to detect blood vessel blocks in the heart.

After the full preparation period, patient is evaluated by the liver transplant surgeon, before being officially presented to the selection committee. 

The selection committee consists of the above mentioned group of physicians and liver transplant Anesthesiologists, as well as pre and post- liver transplant nurses and nurse coordinators, financial coordinators and a transplant co-ordinator recording the session.


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