Liver Transplant Evaluation

Liver Transplant Evaluation

The purpose of pre-transplant evaluation are several. It checks all body systems with regards to optimal function and presence of unexpected disease. It also reveals presence of occult un-manifested infection or cancer in the body. This process also allows for patient to doctor relationship to mature with development of mutual faith and commitment to the common goal. Being a high morbidity/morality procedure there is a need for greater interaction between the patient, patient's family and the doctor. The family has to understand the gravity of the commitment which is usually not understood until it actually happens. The psychological preparation is as important as the physical and physiological preparation. The tests that are carried out during pre-transplant evaluation are as follows-

1. Chest x-ray - Determines the health of the patient's lungs and lower respiratory tract.
2. Electrocardiogram (EKG + Heart assesment (ECG + Stress Thalium test + Coronary Engiography in some cases ) - Determines how well the patient's heart is working and may reveal heart damage that was previously unsuspected.
3. 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.
4. CT (CAT) scan - This computerized image will show the size and shape of the patient's liver and major blood vessels.
5. MRI (magnetic resonance imaging) - May be used in place of CT scan or ultrasound to see inside the patient's body.
6. Total-body bone scan - If the patient has a liver tumor, ensures that it has not spread to his bones.
7. 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.
8. 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.
9. 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.
10. Cholangiogram - Reveals any obstructions or growths in the patient's bile ducts.
11. Gallium, colloidal gold, or technetium scan - Gives the transplant physician a view of the patient's liver, gallbladder, and pancreas.
12. Peritoneoscopy - By inserting a flexible tube through a tiny incision in the patient's abdomen, the transplant physician will be able to see any structural changes in the liver. Usually done in some patients with liver cancer, just before the proposed transplant.
13. Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free.
14. Lower GI series - Ensures that the patient is free of intestinal abnormalities.
15. 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.
16. DTPA - is otope scan of kidneys to give accurate function of both kidneys.