Liver Transplant Evaluation
Candidates for liver transplant require a comprehensive evaluation. The process includes patient education, medical records review, and patient examination. The patient meets with several members of the transplant team, including a transplant coordinator, hepatologist, surgeon, social worker and a nurse educator. The evaluation appointment involves a variety of tests, such as blood tests, chest x-ray, urinalysis, drug screening, and Alpha Fetoprotein (to check for liver cancer). The case is then reviewed by our multidisciplinary transplant team and a decision about the patient's suitability for an organ is made. For liver transplant, multi-listing is available, allowing patients to be listed at more than one center, usually in a different state, to improve chances of getting a donor liver. Patients must have the ability to travel, have the financial means and may have to go through the entire evaluation process at each center. For patients who get sick very quickly, we can evaluate on an emergency basis as an inpatient. And our Survival Flight (air transport) allows us to reach people from all over the state and region, 24 hours a day.
Diagnostics for Liver Transplant
Each member of the multidisciplinary team at the University of Michigan Transplant Center is a specialized expert dedicated to transplant patients, including our subspecialist radiologists. We have the largest concentration of liver MRI radiologists in the regions – experts who only read MRIs. We also maintain the latest equipment for the best possible imaging.
The Transplant Coordinator – Your Partner in Care
Our dedicated transplant coordinators are the first contact for patients. Each patient is assigned a specific coordinator who will be your point person for anything regarding your care, all the way from pre- to post-transplant. Their responsibilities include answering questions, completing everything needed for you to be listed, ensuring all periodic testing is scheduled, helping with medications, and alerting your medical team if you are having treatment for any other health issue. They also serve as your liaison to the doctors.
Supporting Liver Transplant Patients and Their Families
One of our greatest priorities is to provide education and support to our patients and the people who will be supporting them before and after transplant. We provide a Patient Education Guide and offer a weekly support group where patients and families can learn more about the process and engage with other patients. We also offer peer mentoring by former liver transplant recipients. For patients who live outside the area, we connect them with transplant recipients located closer to their homes for peer mentoring. Family members have several options for housing while in Ann Arbor for the operation and hospitalizations. These options include a hotel located on the medical campus (Med Inn, 800-544-8684) and the nearby Transplant House, for which reservations need to be arranged through our social workers ahead of time. The social workers can also provide additional information regarding temporary housing and local hotels in the area.
Medical Care for Liver Transplant Candidates
Once you’ve been listed, our team will provide ongoing medical care to ensure that you are as healthy as possible for your transplant. This care is individualized to your specific needs, and includes testing as needed, providing treatment for any health issues and communicating with your local hepatologist. Each patient is assigned to a hepatologist (liver specialist), starting with entering the system, while on the transplant list and through the transplant and post-transplant process so there’s continuity of care. Our patients like this personalized approach because they know and trust their doctor. We can provide this to our patients thanks to having seven hepatologists on our team.
What If I Am Not Yet Ready to Be Listed?
Perhaps the transplant team will determine that you aren't ready to be listed, either because you aren’t yet healthy enough to be a good candidate or because of liver disease that we can comprehensively treat – potentially with results that will delay or eliminate the need for a transplant. Our goal is to get our patients in optimal shape, so not only will you qualify for listing, but you will also have better outcomes after transplant. We work to improve nutrition and activity level, help you stop smoking, and optimize medical care.
Delaying Liver Transplant and Prolonging Life
The Michigan Transplant Center offers many unique treatment options for patients with liver disease that can delay the need for a liver transplant and/or prolong life while waiting for a donor liver:
- Medications for various liver diseases, including oral antiviral agents for chronic hepatitis B and C and immunosuppressant drugs for autoimmune disorders.
- Treatment for liver tumors to downstage (make smaller)them so a transplant is possible.
- Bioartificial liver devices, which replicate liver function outside the body to support select patients with acute liver failure. We have access to these devices because of our extensive clinical research program,
- Transjugular Intrahepatic Portosystemic Shunt (TIPS), used as a bridge to transplantation for patients with cirrhosis to eliminate fluid buildup in the belly and chest and for those who have persistent gastrointestinal bleeding.
When a Donor Liver Is Available
Once a donor liver becomes available, the patient heads to the hospital. In the operating room, the recipient’s liver and gallbladder are removed and the new liver is placed into position. Most liver transplants take approximately six hours. Following the operation, the patient goes to surgical intensive care unit for recovery. The average liver transplant recipient stays in the ICU for four days and is on the transplant floor for 10 days, depending on how quickly they recover from the operation. About one quarter of patients require inpatient rehabilitation therapy following transplant. Most patients go home approximately two weeks following the transplant surgery.
After Your Liver Transplant
Patients who have had a liver transplant are seen frequently for the first three months following transplant. An individual plan will be developed for you. Eventually, you will be transitioned to the care of your local hepatologist, who was caring for you before your transplant. At that point you will still need a transplant clinic visit every three or four months at University Hospital but eventually these visits will only be needed once or twice per year. Taking your anti-rejection medicine is critical to the success of the transplant. During your clinic visits, we will draw blood to check your blood chemistries and drug levels to ensure you are getting the proper medication and that the donor liver is performing well. All patients require physical therapy following transplant. We work closely with our colleagues around the state to get our patients into the best rehabilitation facilities near their homes. We also provide visiting nurses if patients need assistance while recovering in their homes.
To make an appointment to evaluate your need for a liver transplant within the Michigan Transplant Center, call a patient care representative at 1-800-333-9013. Find a University of Michigan liver transplant doctor.