Liver Transplant Process at University of Colorado Hospital

Before you receive a liver transplant, you have a series of tests to determine your current health.

After these tests are performed, you have a thorough evaluation with various members of the liver transplant medical team.

Following your tests and evaluation, a hepatologist presents your case to the Patient Selection Committee for Liver Transplantation, which meets on a weekly basis. The committee is made up of transplant experts who determine whether liver transplantation is a safe procedure for you. They also will discuss a plan of care for you after transplant.

Either your hepatologist or your transplant coordinator will inform you of the committee’s decision and plan.

Your coordinator will notify you when you are placed on the active transplantation waiting list or registry.

Random screening of waiting list patients

Please note that every patient on the waiting list may be randomly screened for drugs or alcohol at any time. The screening test may be done using a blood or urine sample. Anyone who has a positive test for alcohol or illegal drugs will be removed from the waiting list.

After you have received a call to come to the hospital for your transplant surgery, you are admitted to the transplant unit. This is where preparation for surgery begins. You may have some preoperative tests done and be given some medications.

Your surgery will not begin until the donor liver:

• Arrives at the Hospital
• Is examined by the transplant surgeon
• Is considered to be acceptable

Once the decision to proceed with the surgery has been made, you will be given an anesthetic to put you to sleep for the surgery.

Liver transplant surgery can be divided into three stages:

• Removal of the old liver
• Replacement with the new liver
• Reconstruction of the biliary tract (bile duct system of the liver)

Although there are several factors that may influence the difficulty of your surgery, the operation should last five to eight hours.

Summary of procedure

An incision or cut shaped like an upside-down T is made on the upper part of your abdomen. Your old liver is removed and replaced with the new organ, leaving major blood vessels in place. The new liver is then attached to these blood vessels and bile ducts.

After surgery some patients stay in the Intensive Care Unit for a short period of time and then return to their rooms for recovery. Others go directly from surgery to their rooms.

The amount of time a patient is in the hospital after liver transplant surgery varies. It can be as little as one week, barring complications.

You may return to work as early as six weeks after surgery. Depending on your condition, however, it may take much longer.

Any complications that might arise from the procedure appear in the first few months. We recommend that you wait six months after transplant surgery before planning a vacation or long-distance trip.

Your liver function will need close monitoring for the first several months after you leave the hospital.

Initially, you will be seen in the University of Colorado Hospital Liver Transplant Clinic twice a week.

You need to have blood tests done at least once a month as long as you have your new liver. Your risk for rejection and infection decreases with time, but is never completely gone. You will need to have these tests at University of Colorado Hospital at first.

Your follow-up clinic visits will become more flexible once your:

• Wound has healed
• Liver function is normal
• Medication doses are adequate

At this time, you may want to have your blood tests done closer to your home.

If you live outside the Denver area, your transplant coordinator will arrange for your follow-up care to be managed by you local doctor and lab facility.

Diet and Exercise After Your Liver Transplant

Exercise and diet after transplant are very important factors in feeling healthy again. Post-transplant patients are encouraged to resume or begin a regular exercise plan when they leave the hospital.

It is very unhealthy for your new liver and your general health to put on excessive weight. The most effective method of maintaining a desired weight is to limit your calories and exercise regularly.

Exercise for transplant patients has been shown to:

• Increase endurance
• Increase muscle strength
• Enhance bone remodeling
• Reduce the need for anti-hypertension medication

Proper nutrition also is critical for post-liver transplant patients. Certain medications you may take will affect the way your body processes food.

Your dietitian at the hospital will help you create meal plans that are both nutritious and low in calories. Your diet is important in the total rehabilitation process and for maintaining a good nutritional status throughout your life with your new liver.