Recipient Assessment
On the day of your initial transplant clinic appointment, you will meet with several members of the transplant team. Please bring all of your medications (including dosage) and any requested test results with you for the initial visit. During the initial visit, discussion regarding the transplant evaluation process, surgical procedure, complications, medications, and follow up care after transplant will occur.
The following is a list of examinations that will be completed prior to consideration for liver transplantation:
- Complete history and physical
- Blood test
- Chest X-Ray (Pulmonary Function Test if necessary)
- Heart tests (age and history will determine the type of tests that will be ordered)
- Social work evaluation
- MRI of the liver, abdominal organs and vessels & MEVIS study for the donor
- Colonoscopy
- Endoscopy
- Mammogram and Pap smear for women
- Dental Examination
- PPD (test for exposure to TB)
- Evaluation by a Neuropsychologist
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Due to the known damage caused by alcohol and drugs, the expectation for all patients being considered for liver transplantation, is that they will not use these substances. Frequently, we will do blood and urine tests to determine if there is a presence of either alcohol or non-prescribed drugs.
You will meet with one of our transplant Hepatologists on the day of your appointment. This is the time for you to ask specific questions in relation to your medical problem. In some cases your current liver disease may recur in your new transplanted liver. The physician can discuss this aspect with you in more detail.
Once all testing is completed, your evaluation will be presented to the liver team to determine if you are an appropriate candidate for transplant. Once that decision has been made, you will be notified of the results by phone as well as in writing.
Objective Assessment Scoring Systems
In any particular disease there is a need to assess the urgency to transplant. In other words how soon a transplant must be done in a patient. This depends on the cause of liver failure, extent of disease and for how long the disease has been present.
There are three main objective ways to assess how soon a transplant must be done in a particular patient taking into account all of these factors and they are outlined below.
CTP score :
- Child-Pugh Turcotte score
- Based on Albumin, Total Bilirubin, Ascites, PT/INR and encephalopathy
- Score 7 or more regarded as decompensation
| Measure |
1 point |
2 points |
3 points |
Total bilirubin (umol/L) |
<34 (<2) |
34-50 (2-3) |
>50 (>3) |
Serum albumin(gL) |
>35 |
28-35 |
<28 |
INR |
<1.7 |
1.71-2.20 |
> 2.20 |
Ascites |
None |
Suppressed with medication |
Refractory |
Hepatic encephalopathy |
None |
Grade I-II |
Grade III-IV |
| Points |
Class |
One year survival |
Two year survival |
5-6 |
A |
100% |
85% |
7-9 |
B |
81% |
57% |
10-15 |
C |
45% |
35% |
MELD score:
- Model for End-Stage Liver Disease score
- Calculated based on a mathematical model
- 3.8loge (total bilirubin [mg/dl]) + 11.2 loge (INR) + 9.6loge (serum creatinine [mg/dl]) +6.4 (aetiology [cholestatic = 0, otherwise = 1)
- The higher the score, the more severe the liver disease
- Good predictor of non-survival and used widely as criteria for transplant
MELD as a predictor of 3/12 mortality
MELD score |
≤9 |
10-19 |
20-29 |
30-39 |
≥40 |
Hospitalised Patients |
4% |
27% |
76% |
83% |
100% |
Ambulatory Non-PBC |
2% |
5.60% |
50% |
- |
- |
| Ambulatory PBC |
1% |
13% |
0%(0/2) |
- |
- |
| Historical |
8% |
26% |
56% |
66% |
100% |
King’s College Criteria for Transplant in ALF
- For paracetamol overdose
- Assessed at >24 hours after the ingestion of paracetamol
- pH < 7.3 after adequate fluid resuscitation OR
- Creatinine > 300umol/L and
- PT > 100 seconds / INR > 6.5
- For non-paracetamol overdose
- PT > 100s (or INR > 6.5) or
- Any 3 of the followings:
- Age < 10 or >40
- NANB hepatitis, halothane induced hepatitis, idiosyncratic drug reaction
- Duration of jaundice before encephalopathy > 7 days
- PT > 50s (INR>3.5)
- T.Bil > 300 mmol/L
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