Liver Transplant Evaluation

Overview

Those who have liver failure or severe liver damage due to issues like cirrhosis, nonalcoholic steatohepatitis (NASH), chronic hepatitis, liver cancer or other conditions may be candidates for a liver transplant, in which a patient’s damaged or poorly-functioning liver is surgically replaced with a healthy liver from an organ donor.

Because healthy donor livers are in very short supply, those in need of a liver transplant are usually asked to undergo a detailed Liver Transplant Evaluation to see if they are a good candidate to receive a liver transplant. Suitability for a liver transplant is determined through medical examinations, tests and interviews. The process is designed to evaluate each prospective transplant patient on a number of factors, including:

• Whether the patient has an incurable liver disease that is likely to be fatal soon without a transplant
• Whether a transplant is likely to give the patient a significantly longer life and better quality of life
• Any medical conditions the patient has that might lead to organ rejection or otherwise prevent the transplant from being a success long term
• Overall mental and physical health, including whether the patient is healthy enough to recover from surgery and will be able to stick to demanding post-transplant requirements for the rest of their life
• Their willingness and ability to take all medications as directed and strictly follow the recommendations of the transplant team

Once these consultations and tests are completed, the Hoag transplant center selection committee will meet to discuss your case, determine the likelihood of your liver transplant being successful long term and decide whether a liver transplant is the best treatment path for you.

If it is determined that you are a good candidate for a liver transplant, you will be placed on the liver transplant waiting list.

Model for End-Stage Liver Disease (MELD) Score

If you are placed on the waiting list for a liver transplant, your treatment team will assign you what’s called a Model for End-Stage Liver Disease (MELD) score between six and 40.

A MELD score is based on several factors, including whether your liver is producing sufficient blood clotting proteins, how much sodium you have in your blood, how well your liver is regulating bile and how well your kidneys are functioning.

In general, the higher the MELD score, the shorter the projected life expectancy and more urgent the need for a liver transplant. The MELD score of those on the waiting list is sometimes used to determine priority when donor livers become available. Because a transplant candidate’s health can change quickly, each patient’s MELD score should be re-evaluated often.

Why Hoag for Liver Evaluation and Transplant?

Hoag’s unique, fully-integrated Liver Program is Orange County’s leader in next-generation treatment for conditions involving the liver, including advanced robotic-assisted surgeries, minimally-invasive procedures and liver transplants. Read more about advanced robotic surgery at Hoag.

Facing acute liver failure and in need of a transplant? Don’t wait. Get an evaluation for liver transplant from the center that sees you as more than just your condition. Get the advice and diagnosis you can count on, at Hoag. Meet Hoag’s dedicated Liver Program Team.

Tests Related to Liver Transplant Evaluation

At Hoag, our liver transplant evaluations are very detailed, delving into every aspect of a patient’s medical history and health to make evidence-based determinations as to which patients are right for liver transplant and are most likely to benefit from the procedure.

These tests may include:

• A thorough medical exam, potentially including cancer screenings to make sure you are healthy enough for a transplant
• Blood and urine tests to assess the function of your kidneys, lungs, heart and other organs
• Imaging tests, including scans of the abdomen and an ultrasound of the liver to look for damage or issues that might demonstrate the need for a transplant or make someone a less-than-ideal candidate
• Cardiovascular tests of the heart, arteries, veins and capillaries to make sure they’re working properly and healthy enough for transplant surgery and recovery
• Bone-density testing
• Blood testing for certain diseases, including hepatitis A, B and C, Epstein-Barr virus (EBV), HIV, varicella zoster virus (VZV), rapid plasma reagin (RPR) and cytomegalovirus (CMV)
• Screening for tuberculosis
• Nutrition counseling with Hoag’s on-staff dietitians to assess your weight and diet, evaluate whether you can stick to any required weight loss and weight-maintenance requirements, and make dietary recommendations on what you should eat prior to the transplant and afterward
• Financial counseling to help you and your family understand the cost of a transplant and post-transplant care and to help you determine which costs will be fully or partially covered by your insurance
• Psychological evaluation to assess mental issues like depression or anxiety, and to make sure you fully understand the ramifications and risks associated with seeking a liver transplant
• Meetings with social workers to assess your family/friend support network and determine whether you have people willing to help care for you during the recovery period following the transplant
• Addiction counseling to assess your use of alcohol, drugs, tobacco and other harmful substances, and to help you quit if those issues might impact the success of a transplant.

Factors that May Limit Your Ability to get a Liver Transplant

Absolute Contraindications

Absolute contraindications are issues that are very likely to prevent a patient from being considered for a transplant. These may include:

• Severe cardiopulmonary disease, impacting the heart and lungs
• Uncontrolled sepsis, which is a widespread infection in the body
• Active extrahepatic cancer
• Being brain dead, with no brain function
• Having AIDS
• Ongoing alcohol addiction or illegal drug abuse (though many transplant programs will accept a specific period of confirmed sobriety as proof you can achieve long-term, post-transplant sobriety)

Relative Contraindications

Relative contraindications are issues with a patient’s overall health that might make it less likely a liver transplant will be successful. Each patient is evaluated on a case-by-case basis, so the following factors should not be taken as definitely prohibiting a liver transplant for every patient. Relative contraindications that can prevent you from receiving a liver transplant may include:

• Advanced age
• Extensive portal vein thrombosis (PVT), which is narrowing or blockage of the portal vein, which delivers blood to the liver from the intestines, spleen, pancreas and gallbladder
• A history or likelihood of medical noncompliance, which means a demonstrated inability or unwillingness to follow a doctor’s orders, take medication as directed for the rest of your life, etc.
• Being HIV positive
• Obesity, particularly if the patient can’t stick to a weight loss program before transplant

Advanced Diagnosis of Liver Conditions at Hoag

As Orange County’s recognized leader in the accurate diagnosis and treatment of conditions involving the liver, the Hoag Digestive Health Institute has a host of advanced diagnostic techniques for those facing serious conditions of the liver, including cirrhosis, portal hypertension and chronic liver disease. At Hoag, advanced diagnostics for conditions of the liver include:

• FibroScan®, (AKA transient elastography), which is the first FDA-approved device in the U.S. that provides a painless, non-invasive method of testing for liver scarring without the side effects and complications of a needle biopsy. Learn more about FibroScan®
• Hepatobiliary iminodiacetic acid (HIDA) scanning, which is an advanced imaging technique which utilizes an injected radioactive tracer to diagnose issues with the liver, gallbladder and bile ducts
• Attenuation Imaging (ATI) for Fat Quantification, which is an imaging technique used to quantify fat deposits that may cause inflammation in the liver.
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the liver and bile ducts for disease, without the use of ionizing radiation
• Magnetic Resonance Elastography (MRE), which is used to detect stiffening of the liver caused by scarring and inflammation. This technology combines MRI imaging with low-frequency vibrations to create a visual map called an elastogram that shows the degree of stiffness of body tissues.
• Magnetic Resonance Multi-Echo Dixon Vibe Liver Iron Quantification, which is a 3D imaging technique used to simultaneously assess fatty liver disease (AKA steatosis) and abnormal iron levels in patients with chronic liver disease.
• Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), which is an emerging imaging technique that accurately measures the amount of fat in liver tissue by correcting for factors that can degrade or skew magnetic resonance signal intensity

Suggestions for those Seeking a Liver Transplant

Not everyone who needs a liver transplant is able to receive one. But for those who need a liver transplant, there are certain steps you can take to stay healthy while being considered or waiting for a transplant.

• Manage your expectations, understanding that not every patient is right for a successful liver transplant, and even those that are good candidates sometimes don’t receive a liver.
• Follow your physician’s instructions exactly, including taking all medications as suggested and keeping all medical appointments
• If you are overweight or obese, lose weight and take whatever steps you can to maintain a healthy weight, including eating a healthy, balanced diet that’s low in fats and salt
• Stop smoking, drinking and/or taking illegal drugs. Seek treatment for alcohol or drug abuse if needed

Treatment for Alcoholism at Hoag

For those with alcohol addiction that may be contributing to cirrhosis or liver disease, Hoag is here for you. The longest-standing addiction treatment option in Orange County, Hoag Addiction Treatment Centers is an accredited program within the Pickup Family Neurosciences Institute that offers help, hope and healing for people facing addiction to alcohol and other drugs. For more information, visit this link, or call (949)764-6883.