Referral for Transplant
Ideally, patients with cirrhosis should be referred to the liver transplant unit when they develop evidence of deteriorating liver function, experience their first major complication e.g. ascites, variceal bleeding, spontaneous bacterial peritonitis (an infection that can develop in the abdominal fluid), encephalopathy or malnutrition.
Patients with hepatocellular cancer (primary liver cancer) and cirrhosis should be referred for assessment by the liver transplant team as soon as the tumour is discovered, so that optimal treatment can be decided.
Transplant Assessment
A detailed assessment is carried out prior to deciding whether a patient is a candidate for liver transplantation.
As a general rule there are four basic requirements, which would indicate that you may be considered suitable for assessment:
irreversible, progressive liver disease
the liver disease fails to respond to all other forms of medical and surgical treatment
absence of other major diseases
ability to understand the nature and risks of liver transplantation
The assessment process
There are a number of tests that will need to be performed while you are undergoing assessment for transplantation. The results of these tests provide an overall assessment of your current state of health and help determine if transplantation is the right option for you.
There are a number of baseline tests that all patients need to undergo; extra tests are tailored to the individual situation.
In most people, these tests are performed on an outpatient basis.
Time: usually 7 - 10 days needed to complete tests.
The assessment period may vary greatly depending on the availability of test procedures, personnel and, in particular, the complexity of the individual case.
An outline of the tests you will need to undergo
Blood tests
A number of tests including:
Biochemistry
Haematology
Blood clotting profile
Cross-matching
Tissue typing
Hormone levels
Hepatitis screening
Screening for exposure to certain viruses, which will help to optimise your post transplant management
A urine collection to assess your renal function
Other tests include:
Chest X-ray, hip X-ray, spine X-ray
ECG and cardiac ECHO
Lung function tests
Abdominal CT scan (This computerised image will show the size and shape of the liver and major blood vessels. At times, this test reveals previously unsuspected liver tumour.)
Bone density scan
Endoscopy
Female patients must have a Mammogram and Pap smear
Other tests as individually indicated
Tissue
typing
Although we perform tissue typing on all patients awaiting transplantation, we do not match donors on the basis of tissue type. There are three reasons:
1.It does not seem to make any difference to the outcome.
2.There is usually insufficient time to accurately tissue type a donor.
3.There is a shortage of donors, so we would never do any liver transplants if we had to wait to have a tissue-type match.
However the donor organ has to be matched with you with regard to blood group and size.
What
else happens?
During the course of the assessment you will have the opportunity to meet one our dietitians who will advise you about your particular dietary requirements.
You will also be able to meet with our social worker, who can advise and help you with any specific issues you may need assistance with in relation to family, employment or financial issues etc, you may be experiencing.
Your doctor will also decide whether you would benefit from a consultation with our psychiatrist or clinical psychologist, or a specialist from Drug Health Services.
Depending on the results obtained from these tests, and the complexity of your case, further tests may be arranged as necessary in order to establish suitability. You may also need to be seen by other specialists, such as a lung specialist or heart specialist. Following review of your tests by your hepatologist, an appointment will then be arranged for you with one of our Transplant Surgeons and our Transplant Anaesthetist.
Following
Assessment
After you have gone through all these various stages, the decision whether to proceed to transplantation is discussed with you and your family.
At this time, possible outcomes include:
You are considered suitable for immediate transplant and your name is placed on the active waiting list.
You are considered as suitable for transplant, but deferred for an indefinite period because you are too well. This may be months, years or never. You return home and remain under the care of your specialist if appropriate, who remains in contact with the Specialists at Royal Prince Alfred Liver Transplant Unit.
There is may be the possibility you are unsuitable for transplant for whatever reason. The main reason may be that that the risks of transplant are too great, and you might not survive the operation. You then have the choice of returning home or, if appropriate remaining at Royal Prince Alfred Hospital for continued hospitalisation or return to your “home” hospital. If you have liver cancer, your doctor may determine that it is not in your best interest to proceed with transplantation, because of a high risk of tumour recurrence after transplantation.
If you are suitable for transplant now or later, you retain the right to decide that you would prefer NOT to undergo transplantation. The team will respect your decision.
Having proceeded through these stages, if it is agreed the timing is right for you to proceed to transplantation, your case gets presented at a meeting of the Liver Transplant Team. If the team are in agreement that there are no valid obstacles to your successful transplantation, you are formally placed onto the Active Waiting List to await a suitable donor organ becoming available for you.
Members
of the Transplant Team at RPAH
Physicians:
Professor Geoff McCaughan, Dr David Koorey, Dr Simone Strasser, Dr Tony Donaghy, and Dr Robert Feller
Surgeons:
Dr Deborah Verran, Dr Graham Stewart, Dr James Gallagher and Dr Michael Crawford
Anaesthetist:
Dr Andrew Watts
Dietitians:
Helen Vidot and Joanne Heyman
Transplant Coordinators:
Graham Kyd
Nick Koutalistras
Ganson Govender
Social Worker:
Lee Bratel/Susan Clare
Psychiatrist:
Dr Rob Gribble
Psychologist:
Ms Suzanne Roche
Drug and Alcohol Specialist:
Prof Paul Haber
Liver Transplant Nursing Staff:
Sr Margaret Gleeson CNC and Sr Fran Coble
Theatre Sister:
Sr Jenny Watson CNC
You will come into contact with many of these people during the course of your assessment and ongoing association with the transplant unit. You may be provided with the opportunity of meeting someone who has already had a liver transplant.