Liver Transplant

About

Liver transplantation requires a lifelong commitment by the patient and family. This commitment includes taking medications daily, visiting a physician regularly, eating a proper diet, maintaining an exercise program and trying to avoid infections. It is important that transplant candidates meet this commitment.

Evaluation

Liver transplant candidates undergo detailed physical, laboratory and psychological evaluations. The typical evaluation takes up to two weeks and generally includes:

• Extensive testing.
• Meeting with a liver specialist (hepatologist) and a transplant surgeon. The hepatologist will thoroughly investigate your liver disease and underlying medical condition. The surgeon will assess your surgical risk, discuss the transplant procedure and review possible complications and outcomes. You and your family are encouraged to ask questions.
• Social services consultation. Your support system, coping ability and family dynamics will be assessed. Issues such as housing and transportation can be addressed, and an operational plan for the family to use during and after the transplant will be created.
• Nutrition assessment. A dietitian will help you develop an eating plan that provides a balanced diet and appropriate calories before and after the transplant.
• Financial issues. A financial coordinator will help you determine insurance coverage, home health care, long-term housing and other financial issues.

Activation for transplantation

Specialists in hepatology, infectious diseases, anesthesiology and social services, along with the transplant surgeons, meet to review your candidacy for transplant. This process is known as the selection conference. If accepted, you are placed on the UNOS (United Network for Organ Sharing) waiting list, and your MELD score is calculated to determine your priority on the transplantation wait list.

A waiting period of anywhere from a few days to many months can be expected. Throughout the waiting period, checkups at Mayo Clinic will be scheduled. Hepatologists order laboratory tests and cultures at these checkups and may adjust medications while you wait.

Transplant surgery

Once a potential donor is found, a transplant team member will instruct you to come to Mayo Clinic as soon as possible. If you live more than four hours from Mayo Clinic, you may need to stay near the clinic during the waiting period or arrange for air transportation.

Upon arrival at the hospital, you'll have a brief examination as well as blood tests, urine samples, cultures, an electrocardiogram and a chest X-ray.

During this time, the organ procurement team is recovering the donor liver. As you're being prepared for surgery, the donor liver has one final assessment before transplantation. During surgery, your diseased liver is removed and replaced with the donor liver. Typically, the surgery lasts three to five hours.

Post-transplant

Following surgery, liver transplant patients typically spend one to two days in the intensive care unit and remain hospitalized for seven to 10 days. During your hospital stay, nurses and other care providers will provide instructions on post-transplant recovery, care and medications. When it's time to leave the hospital, you'll have a supply of medications, instructions and contact numbers for questions or emergencies.

During the first few weeks after transplant surgery, you'll need to return to the clinic frequently for follow-up visits. If you don't live nearby, you will need to arrange to stay near Mayo Clinic during this time.

Going home

After returning home, you'll be in regular contact with a post-transplant nurse coordinator who will coordinate weekly lab work that's required for the first four months after surgery. The nurse coordinator can also answer questions and order medication refills. Typically you will return to Mayo Clinic at four months after surgery, and then annually for follow-up exams.