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| The liver specialist usually suggests this evaluation once he has diagnosed end-stage liver disease. Pretransplant tests, as well as giving a clear picture of the patient's overall health status, help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option. This increases the likelihood of success. |
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| Recipient evaluation is done in three phases and normally takes 5-7 days in hospital. |
- To establish definite diagnosis, determine the severity of liver disease and the urgency of the transplant.
- To determine the fitness of the patient for a transplant. The other systems such as heart, lungs, kidneys, blood counts are tested and the presence of any infection is ruled out. The liver specialist then decides how successful the surgery is likely to be depending on the status of the patient and the cause and severity of liver disease.
- The final phase entails the psychological and mental preparation of the patient. The patient and the family are counseled about the procedure, hospital stay, the likely course after surgery, follow up and aftercare.
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After evaluation, the patient is either placed on the waiting list for cadaveric donation, or , if there is a willing and blood group matched family donor available, he/she is evaluated for donation and a transplant is scheduled.
While on the cadaver waiting list, the patient follows up with the Transplant Team until a suitable liver becomes available. If the patient's condition shows signs of deteriorating, we normally suggest the family to consider living liver donation.
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| The following procedures help in evaluating a patient's health status: |
- Chest x-ray - Determines the health of the patient's lungs and lower respiratory tract.
- Electrocardiogram (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that was previously unsuspected.
- Ultrasound with Doppler examination - Determines the openness of the bile ducts and major vessels. It is commonly done in all liver transplant recipients before and after transplantation.
- CT (CAT) scan - This computerized image will show the size and shape of the patient's liver and major blood vessels.
- MRI (magnetic resonance imaging) - May be used in place of CT scan or ultrasound to see inside the patient's body.
- Total-body bone scan - If the patient has a liver tumor, ensures that it has not spread to his bones.
- Blood tests - The patient's blood count, blood and tissue type, blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed.
- Pulmonary function test - The patient will be asked to breathe into a tube attached to a measuring device, which will reveal how well his lungs are working and determine his blood's capacity to carry oxygen.
- Hepatic angiograph - Dye injected into the patient's arteries will enable the transplant physician to see if there are any abnormalities or blockages in the patient's blood vessels.
- Cholangiogram - Reveals any obstructions or growths in the patient's bile ducts.
- Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free.
- Lower GI series - Ensures that the patient is free of intestinal abnormalities.
- Renal function studies - Urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function.
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| Donor Assessment for LDLT |
The donor should be physically fit for the donor hepatectomy, and the liver should be functioning well, have adequate size, and a suitable anatomy. The donor should have a blood group that is compatible with the recipient, e.g. blood group A donor for a blood group A recipient.
The donor should ideally be related to the recipient by blood relationship (e.g. siblings, children) or by legal relationship e.g. spouse. In the event the family is not suitable for donation for medical reasons, emotionally related donors are permissible after review by the hospital ethics committee to ensure that there is no coercion or financial inducement.
The donor should be above 21 years of age and less than 55 years old. There should not be any significant medical problem. Cardiac assessment would be performed in those with significant risk factors for ischemic heart disease. Hepatitis B and C, and HIV should be negative. Blood test will be performed along with imaging studies to ensure that there is adequate liver volume and the anatomy is normal for donation. Significant fatty liver would be a contraindication.
Patients will be evaluated by a physician for fitness of operation, and if necessary by a cardiologist as well. Occasionally, liver biopsy may be required for those with fatty liver to quantify the amount of fat. Psychiatric assessment is also required to ensure that the donor is mentally prepared for the operation and understands the implication of the surgery.
The donor usually stays in hospital for 7 days after the surgery, and will be able to return to their own country within 2 weeks of the surgery. They will be able to resume work in one month unless they are involved in heavy physical work. The liver will regenerate back to its normal size within a few months. |
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