Carolinas HealthCare System

Liver Transplant Information for Patients

CMC Liver Transplant

The liver is one of the largest and most complex organs in the body.  Made up of spongy wedge-shaped lobes, the liver weighs about one pound in adults and performs many vital functions.

As part of the digestive system, the liver helps the body process carbohydrates, fats and proteins as well as storing vitamins. It processes nutrients absorbed from food in the intestines and turns them into materials that the body needs to survive. For example, it makes the factors that the blood needs for clotting. The liver also secretes bile to help digest fats, break down toxic substances in the blood such as drugs and alcohol and is also responsible for the metabolism of most medications.

For patients with advanced liver disease, the liver does not function normally and may not be able to carry out many of these functions. For these patients, the liver may need to be replaced in order to help the patient live a healthy life.

Common Diseases That May Lead to Transplantation

Each year, nearly 7,000 liver transplants are performed in the United States. (This information courtesy of Transplant Living)

Patient Requirements

Deciding to receive a transplant is a difficult decision and one that requires a strong commitment by the patient and their family members. Patients are required to schedule Evaluation Teaching visits with the Transplant Center.

In order to ensure the best outcomes for our transplant patients, all patients will be required to submit to drug, alcohol and nicotine screens.

If the patient has a history of substance abuse, they may be required to complete an intensive outpatient treatment program along with continuing sobriety support. It is required that the patient successfully complete the treatment program before undergoing the transplant evaluation. To receive a liver transplant, the patient must permanently abstain from nicotine, alcohol and drug use, both before and after transplant.

To ensure compliance, random screenings may be done by the transplant team both before and after liver transplant. Information on smoking cessation and alcohol and drug treatment will be made available to patients that need assistance.

Psychosocial Evaluation

Each patient is required to undergo a psychosocial evaluation by the Transplant Social Worker. The purpose of this evaluation is to help determine if the transplant candidate has the psychological and financial stability, motivation, and adequate social support to be successful long term with transplantation. You will need to bring your primary support person/team for your psychosocial assessment. This is required in order to be considered for liver transplant. Each patient will need to develop a post transplant plan of care which will include primary and backup support availability. If the transplant candidate lives two or more hours away, a specific plan for short term housing will also need to be developed.

In order to ensure the best outcomes, all patients will be required to submit to nicotine, alcohol and drug screens.

If you have a history of substance abuse, you may be required to complete an intensive outpatient treatment program. You will be required to successfully complete this treatment program before undergoing a transplant procedure. To receive a liver transplant, the patient must permanently abstain from nicotine, alcohol and drug use, both before and after transplant.

To ensure compliance, random screenings may be done by the transplant team both before and after liver transplant. Information on smoking cessation and alcohol and drug treatment will be made available to patients that need assistance.

Evaluation Process

Once a referral for liver transplant has been received, the patient is seen initially by a hepatologist (a physician that specializes in diseases of the liver) at the Transplant Center and the patient’s information is then sent to the transplant financial coordinator and transplant insurance benefits are verified.

The transplant evaluation consists of a medical, surgical, social, and financial evaluation. The purpose of these visits is to ensure the patient can benefit from a liver transplant. The Transplant Center will then contact the patient to schedule Transplant Education and Evaluation visits. These Educational visits will include both group and one-on-one meetings with the following healthcare providers:

  • Certified RN Transplant Coordinator
  • Transplant Social Worker (psychosocial evaluation)
  • Registered Dietitian
  • Transplant Financial Counselor

Patients are required to bring their primary support person(s) to the group education session as well as one on one visits with the Transplant Social Worker and RN Transplant Coordinator. A support person is a relative or friend who is committed to helping the transplant candidate throughout the evaluation process and in the months following transplant. The primary support team will be the support person(s) most involved in providing the care needed. Backup support is required in case the primary support becomes unable to perform necessary duties. Reliable transportation and availability to assist the patient with their care needs is required of support team members.

Patients are required to complete diagnostic testing to determine transplant candidacy. Testing will be scheduled by the transplant center and may include, but is not limited to:

The following are the responsibility of the patient:

  • Mammogram within 12 months for females over the age of 40
  • Pap smear within 12 months for females over the age of 18
  • PSA within 12 months for males over the age of 50
  • Colonoscopy for patients over the age of 50
  • EGD
  • Dental evaluation within 12 months

At the completion of the evaluation, patients are discussed in a multidisciplinary transplant conference where their acceptance as a candidate for transplantation is determined. If accepted as a candidate, authorization for transplantation is then requested from their insurance carrier. Once this is received, the patient is placed on the United Network for Organ Sharing national waiting list.

Waiting for a Transplant

Patients on the waiting list will be scheduled for periodic re-evaluation including diagnostic testing and/or clinic visits. It is important for the transplant candidate to keep the transplant center informed of changes in medical condition, support, and insurance while on the transplant waitlist. Patients should follow a healthy diet and stay active to the best of their ability while awaiting a transplant as this will help improve post transplant outcomes.

In the United States liver transplants are allocated by MELD score. MELD score is determined by blood work and determine how advanced the patient's cirrhosis is with a higher score indicating more advanced cirrhosis. The MELD score ranges from 6 to 40. The patient with the highest MELD score within a blood group received a liver transplant before patients with lower MELD scores.

After Liver Transplant

A liver transplant operation may take anywhere from 6-12 hours. This is dependent upon the patient's medical condition at the time of transplant and history of abdominal surgeries. The average hospital stay after transplant is approximately 8-10 days which may vary dependent upon any post-operative complications. Getting out of bed and walking several times a day during the hospital stay is vital in the recovery of the transplant patient. Patients who are more debilitated from their disease prior to transplant may have a more complicated post-transplant stay and may require physical therapy.

Many patients after they are released from the hospital are able to return to their home; however, a small population of our patients may require physical rehabilitation before they are able to return home. These patients will be discharged to a local rehabilitation facility that will be able to provide more concentrated physical therapy in order for the patient to be able to carry on with normal activities of daily living such as bathing, dressing, walking, etc.

After liver transplant, patients will have frequent follow-up care at the transplant center due to the potential for complications with their new liver. Visits start at about 2-3 times per week and will decrease to monthly over the first six months after transplant with more frequent bloodwork in between. Patients who live greater than two hours from the transplant center are strongly encouraged to make local housing arrangements for the first 2-4 weeks after transplant due to the frequency of follow-up visits.

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