Before patients become liver transplant candidates, the Penn Transplant Institute performs an extensive evaluation of their liver disease and general health to determine if transplant is the right option.
The evaluation process at Penn Medicine is a one-day visit where the potential recipient and their family meet all the members of the multidisciplinary team. Medical records from the patient's community physicians are reviewed, and we provide a comprehensive list of testing needed to complete the transplant evaluation. Those tests can, for the most part, be completed locally, closer to home.
Penn Medicine is currently offering transplant evaluations in person at our Philadelphia location, as well as our satellite locations in Lancaster and Lehigh Valley.
Meeting the Liver Transplant Team
At Penn Medicine, we use a multidisciplinary approach to care. When seen for a transplant evaluation, the potential recipient will meet a:
- Transplant hepatologist—medical physician who specializes in liver disease
- Liver transplant surgeon—examines patient and weighs the risks and benefits of transplant to determine whether it is the best treatment option by looking for any surgical contraindications to transplant
- Transplant nurse coordinator—acts as the patient’s primary contact throughout the transplant process. In this role, they assure testing is up to date and are available to answer questions and concerns while educating the patient and their support system through the transplant process
- Transplant social worker--focuses on the psychosocial nature of end stage liver disease and how the patient is coping with their diagnosis-- offering mental health support as needed
- Transplant nutritionist--appraises patient’s nutritional status like weight patterns (both gains and losses) and dietary intake, and provides recommendations for an ideal diet
- Financial coordinator—reviews medical insurance (primary, secondary, supplemental and prescription) to ensure the patient has adequate coverage to support a transplant, along with providing resources and information about obtaining sufficient coverage
- Transplant pharmacist--examines the medication list for any contraindications prior to transplant and delivers comprehensive discharge teaching after the transplant for any new medications
Liver Transplant Tests
Patients whose livers do not function well due to life-threatening problems may be candidates for a liver transplant. At the Penn Transplant Institute, we do a number of studies throughout the evaluation process to determine eligibility.
A pre-liver transplant coordinator will review the medical records sent to the office prior to the appointment and compile a list of the testing needed to complete the evaluation.
We do not require the patient to complete these tests before we first meet. Instead, our physicians will provide prescriptions and orders for the necessary tests. However, it is important we have comprehensive records from the local GI physicians prior to the first visit, so we don’t order tests that have already been done, unless repeating is medically necessary.
These liver transplant tests include:
- Imaging: MRI of the abdomen with contrast or CT Abdomen with contrast
- Chest X-ray
- Chest CT (for patients who carry a diagnosis of hepatocellular carcinoma or cholangiocarcinoma- two types of cancer that we transplant for)
- Pap smear and mammogram (for female patients)
- Colonoscopy (age appropriate)
- Blood work, including:
- Complete Blood Count (CBC), Basic Metabolic Panel, Hepatic Function Panel, INR (clotting factors)
- Labs to rule out underlying causes of liver disease
- Transplant Viral Workup (to check immunity and exposure to multiple viruses including CMV, EBV, Herpes 1 and 2, Hepatitis A, B, and C; Varicella, Measles/Mumps/Rubella, Syphilis, HIV)
- Tuberculosis Screening: Quantiferon Gold
- Health Maintenance Labs: Hemoglobin A1C, Lipid Screening, Thyroid Levels, PSA
- Cardiac evaluation, including an echocardiogram and stress tests as determined by cardiologist
What to Expect During the Liver Transplant Evaluation
During the evaluation visit, patients and their families meet with members of the transplant team. A YouTube Video is sent to all patients prior to evaluation for review that details the evaluation process, the listing process, and the transplant process. Blood work is also completed at the time of the visit.
The liver transplant team meets weekly to determine whether transplant is the best treatment option for every patient evaluated. A member of the transplant team then contacts the patient with the results of this discussion. If the transplant team decides that liver transplant is the best option and the patient agrees, they can complete any additional tests required and be listed for transplant.
We encourage patients to complete their testing within 30 to 90 days from the initial date of evaluation. In many instances, the evaluation can be completed in much less than 30 days. Most testing can be done locally in the community, and patients should communicate frequently with their transplant coordinator as they complete testing, so we can stay up to date on the results and overall evaluation status.