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    Liver Transplant Evaluation

    When a person reaches a certain stage of advanced liver disease—due to cirrhosis, liver cancer or hepatopulmonary syndrome—a liver transplant may be the only way to extend a person’s life.

    To be added to the liver transplant waiting list at California Pacific Medical Center, you will need to undergo a 2- to 3-day transplant evaluation in San Francisco. To inquire about a transplant evaluation, complete our inquiry form or call 415-600-1020. In most cases, our team can complete the complex process of liver transplant evaluation within one month of your hepatology consultation.

    During your liver transplant evaluation you will meet with a transplant surgeon, nurse coordinator, psychiatrist, social worker, dietitian, financial coordinator and other consultants, as appropriate. You may meet with a transplant hepatologist who is different than the one you see on a regular basis. Your evaluation will include laboratory tests (blood work), imaging studies, and heart tests. These tests will help doctors decide whether liver transplantation is needed and feasible, and if it is your best choice of treatment.

    Imaging Tests

    1. Ultrasound Scan: This test uses sound waves from a microphone passed across your skin. It provides a picture of your liver, bile ducts and the blood vessels to and from your liver. It also screens for liver cancer.

    2. Computed Tomography (CAT or CT) Scan: This scan shows detailed images of your liver and its blood vessels, and other organs and structures such as lymph nodes. A CAT scan also screens for liver cancer.

    3. Magnetic Resonance Imaging (MRI) Scan: Using a powerful magnet, computer and radio waves, an MRI provides detailed pictures of the organs and structures inside your body. It may be used as an alternative to or in conjunction with a CT scan.

    4. Chest X-Ray: This provides a black and white picture of your lungs, heart, ribs and diaphragm.

    5. Endoscopy: An endoscopy helps diagnose and treat enlarged veins (varices), inflammation and/or ulcers in the stomach and small intestine that can be caused by advanced liver disease. Sometimes these varices cause life-threatening bleeding when left untreated. During an endoscopy, you receive anesthetic spray in the back of the throat and intravenous sedation (medicine to make you sleep). Doctors insert a thin, flexible tube is through your mouth, down the throat and into the stomach and upper small intestine.

    6. Colonoscopy: A colonoscopy helps diagnose and treat bleeding, precancerous growths (polyps) and cancer in your colon. During this procedure, you receive intravenous sedation and doctors insert a thin flexible tube through your anus into the rectum and through your colon. If polyps are seen they will typically be removed during the procedure. A colonoscopy may be conducted immediately after the endoscopy so you will only need sedation once.

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    Cardiac Tests

    All liver transplant candidates will have an electrocardiogram and echocardiogram. Transplant candidates over age 50 or candidates with risk factors for heart disease, or a history of heart disease, will undergo cardiology consultation with additional heart studies. These may include a stress test and cardiac catheterization.

    1. Electrocardiogram (EKG or ECG): An ECG is a record of your heart’s electrical activity, including your heart rate. It is used to identify various heart diseases.

    2. Echocardiogram: This shows how well your heart is pumping, examines the heart valves and estimates the blood pressure in different parts of the heart. It is performed by lightly moving a probe across your skin that delivers sound waves to produce an image of your heart. Echocardiogram results provide insight into whether your heart can withstand a liver transplant, and/or whether additional testing or heart treatments are necessary.

    3. Persantine Thallium (Stress Test): An exercise stress test is a special type of ECG that compares the heart’s electrical activity at rest and under exertion. Persantine is given to stress the heart (instead of a treadmill) in conjunction with Thallium, a radioactive substance, to determine if your heart has a healthy blood supply.

    4. Cardiac Catheterization: A heart catheterization enables a cardiologist to directly measure pressures in all four chambers of the heart and, if necessary, examine the heart’s blood vessels for disease.

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    Pulmonary Function Tests

    Pulmonary tests measure how well your lungs work when you breathe in and out. Patients with a history of smoking, asthma or other lung disease will need a pulmonary function test.
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    Liver Biopsy

    A liver biopsy removes a tiny piece of the liver for microscopic examination. Few patients need a liver biopsy before liver transplantation. When performed, it is typically used to identify the type(s) of liver disease you have.
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    Liver Transplant Blood Work

    Two categories of blood tests are used to evaluate liver injury and liver function:

    1. Liver Enzymes: ALT (SGPT), AST (SGOT), Alkaline Phosphatase and Gamma-glutamyl transferase (GGT). High levels reflect cellular injury in different liver compartments.

    2. Liver Function Tests: Prothrombin time and INR (a clotting test), albumin (a protein in the blood) and bilirubin (the substance that makes a person yellow) all indicate a problem with your liver function if abnormal. If the liver is not working properly, you will have an INR >1.2, elevated bilirubin and a low albumin level.
    Your liver team may order additional lab tests to fully evaluate your condition. These include:
    1. Complete Blood Count (CBC): Provides information about your blood cell and platelet count.

    2. Basic Metabolic Panel (BMP): Measures your kidney function (creatinine), key blood salt and glucose levels.

    3. Alpha- fetoprotein (AFP): Rising levels suggest you could have a primary liver cell cancer (HCC).

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    Psychosocial Evaluation

    Your mental health and social circumstances are equally important as your physical health for a successful transplant. Accordingly, your evaluation will include a meeting with a specialized transplant social worker and/or psychiatrist. This evaluation will help your doctors find out how well you handle stress and determine your support system. Our team also meets with your support person(s) or family members to ensure everyone knows what to expect during the transplant process. Your social worker can also help you with financial concerns, connect you to hospital services and provide information on support groups. All patients and families are expected to meet with the social worker, psychiatrist (if scheduled), and attend a support group pre-transplant.
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    Nutritional Evaluation

    A healthy diet and regular exercise are important for maintaining a successful transplant. During your evaluation, a transplant dietitian will review your nutritional status and needs, and help design an eating plan for you. The dietitian will also offer suggestions to help you follow your new diet.

    Often, patients with cirrhosis are malnourished while others are overweight. Both extremes can influence your eligibility for liver transplant and your transplant outcome. Compliance with nutritional recommendations is essential.

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    Evaluation by a Transplant Financial Coordinator

    You will meet with a transplant financial coordinator to review your insurance coverage, including benefits, deductibles and co-payments. The coordinator will also evaluate your prescription coverage, which is critical following your transplant.
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    Liver Transplant Selection Committee

    Following the completion of one’s tests and consultations, our Liver Transplant Selection Committee will review each patient’s medical history and circumstances. This committee is made up of doctors, transplant coordinators, financial coordinators, dietitians, and social workers.

    The committee may immediately accept some patients to the transplant waiting list. Other patients may be considered too ill to survive a transplant. In this instance, the committee will not approve a liver transplant and the patient will be “declined.” Other patients may be declined because they need to complete specific recommendations from the committee such as Alcoholics Anonymous (AA) meeting attendance, smoking cessation, weight loss, or obtaining more social and/or financial support. Such patients will initially be declined for transplantation but will be reconsidered if they satisfy the committee’s recommendations. If the patient is subsequently found to be a good candidate, the committee will approve listing for liver transplantation and will add the individual’s name to the transplant waiting list.

    Some patients may be considered too healthy for a transplant; in this case our team will closely monitor their liver disease. If the disease progresses, we will re-evaluate the patient for transplantation.

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    About California Pacific Medical Center

    San Francisco Center for Liver Disease

    California Pacific Medical Center, part of the Sutter HealthOpens new window network, offers specialized care in liver disease and liver transplant. Our program is based in San Francisco and has outreach locations throughout Northern California and Nevada.

    California Pacific Medical Center
    San Francisco Center for Liver Disease
    2340 Clay Street, 4th Floor
    San Francisco, CA 94115
    Tel: 415-600-1020
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