Office Hours: Monday through Friday 8:00 a.m. to 4:30 p.m.
Office Phone: 801-581-2634
Office Fax: 801-585-5091
Long Distance: 1-800-824-2073 ext. 1-2634
Liver Transplant Team Length of Surgery 18
Team Members 3, 4
The Liver and how it Works
The Post Transplant Course
How it Works 5
Surgical Intensive Care Unit
End Stage Liver Disease 6 19
When to Seek Medical Attention 6 Visitors
Diseases that Cause Liver Failure 20
Liver Failure Medications 9
Lab Schedules 21
Liver Transplant Evaluation
The Workup 10, 11
Surgical Complications 22
Waiting for Liver Transplant
When to Call the Nurse 23
The Waiting List 13
Waiting Times Medications
13 Immunosuppression 24
UNOS 14 Infection-Fighting Drugs
Transplant List 14 24
Where to Wait 15 Other Medications
Getting the Call for Transplant 15
Medication Refills 25
Organ Selection & Matching
The Liver Transplant Surgery
Your Transplant Surgery 17
The Operating Room Resources 27
17 Glossary of Terms
Tubes, Catheters and Drains 28
As you progress through the transplant process, you will become acquainted with
many members of the transplant team. If you have any questions regarding the
pre-transplant process, the transplant operation itself, or the post-transplant period,
they can be answered by the transplant coordinator. The transplant pharmacist can
answer questions about your medications. Questions about psychosocial issues
should be directed to the Social Worker. Financial questions should be directed to
the financial facilitator. However, please feel free to ask any team member your
Hepatologist: William Hutson, M.D.
Surgeons: John Sorensen, M.D.
Jason Schwartz, M.D.
Tim Gayowski, MD
Physicians Assistant: Triscia Martin, PA
Transplant Coordinator: Alana Edwards, RN, CCTC
Kerin Stevens, RN, CCTC
Social Worker: Susan Gleason, LCSW
Pharmacist: Lonnie Smith, PharmD
Financial Facilitator: Michelle McCardell
Transplant Assistant: Susan Osborne
Transplant Dietician: Riti Bhatnager, MS, R.D., C.D.
Office Hours: Monday through Friday 8:00 a.m. to 4:30 p.m.
Office Phone: 801-581-2634
Fax number: 801-585-5091
Hospital phone number: 801-581-2121
Long Distance: 1-800-824-2073 ext. 1-2634
Hepatologist transplant. The long term goal of the nurse
A hepatologist is a medical doctor who coordinator is to teach you how to take charge
specializes in medical problems of the liver. of your own care and will be available to
The hepatologist works together with the discuss any concerns you may have as you
surgeons to manage your liver disease prior to begin to adapt to life following your transplant.
the surgery. The Hepatologist and the surgeons
will care for you following surgery and will
make decisions together in managing your
treatment. Social Worker
The transplant social worker specializes in
Transplant Surgeon helping patients and families cope with the
This is the doctor skilled in transplant surgery. stresses and challenges of the transplant
He/she will be the one to actually perform your process. They will assist you in housing needs,
transplant operation. After the operation the financial concerns and provide emotional
surgeon will care for you on a daily basis. The support, information and counseling. They can
surgeon and the hepatologist will make changes assist you with referrals to community
in your treatment and order new tests based on agencies.
House Staff The pharmacist assists the transplant team in
The University Of Utah Medical Center is a managing the dose, side effects and interactions
teaching facility. This means that doctors such of your medications. After transplant, the
as interns, residents and hepatology fellows are pharmacist will be involved along with the
also assigned to your care. You may even have nursing staff in providing information about
medical students helping to care for you. They your medications and instructions on how to
work under the supervision of the surgeons and take them.
Primary Care Physician or Referring MD
Nurse Practitioner/Physician Assistant You will need to continue your relationship
The nurse practitioner is a registered nurse with with your referring physician and or primary
an advance medical degree and the physician care physician. You will need to rely on this
assistant has an advanced medical degree as doctor for your general medical needs before
well. They assist the physicians in managing and after transplant. A referral to the liver
your health care. transplant program does not mean a transfer of
total care. This physician will continue to
Transplant Nurse Coordinator (RN, CCTC) provide your medical care. The liver transplant
Transplant coordinators have extensive program will work closely with them to care
experience in the care and management of for you and your liver prior to and after
transplant recipients, both before and after transplant.
Financial Facilitator They can also assist you in scheduling your
The financial facilitator will help you with appointments for procedures, including the
insurance issues for transplant. They help you transplant evaluation and also update you on
understand what your insurance will and will your lab results and lab orders.
not cover, including estimating the cost of the
transplant and transplant medications. Registered Dietitian performs a nutritional
Transplant Assistant assessment and provides nutrition education to
The transplant assistant can assist you in patients
connecting with your transplant coordinator.
The liver is the largest internal organ in your
body. An average adult liver weighs
approximately three to four pounds. The
liver is located in the right side of the
abdomen just beneath the diaphragm and
behind the lower ribs. The liver has a right
and left lobe. The main blood vessels of the
liver are the hepatic and portal veins,
inferior vena cava and the hepatic artery.
Beneath the liver lies the gallbladder, which The liver is responsible for many of the
is the reservoir for bile. The pancreas also body’s metabolic and manufacturing
lies below the liver and produces enzymes functions, including:
that aid in digestion. • The metabolism of carbohydrates
into glucose (sugar) so your body
can use it for energy.
• Detoxification (cleaning) of harmful
substances from the body, this
includes alcohol, drugs and other
byproducts from what you eat and
• Production of bile, a yellow-green
substance that helps your body
• Metabolism of basic proteins (amino
acids) to ensure proper ammonia
levels are maintained.
• Production of proteins, including
proteins that aid in blood clotting.
• Maintenance of normal balance of
• Filtering blood to remove bacteria
and other particles.
• Storage of minerals and vitamins for
your body’s use later on.
• Host defense to assist in fighting
The signs and symptoms of liver disease include:
• Jaundice (yellowing of eyes and skin)
• Pruritus (severe itching)
• Dark urine
• Encephalopathy(mental confusion, forgetfulness, coma)
• Varices (enlarged vessels in throat & stomach)
• Vomiting of blood
• Easy bruising and tendency to bleed
• Gray or clay-colored stools
• Ascites (abnormal buildup of fluid within the abdomen)
• Muscle Wasting
• Fatigue (feeling very tired)
You should seek immediate medial attention if you experience any of the following liver
• Vomiting of blood or coffee ground-like material
• Blood in your stools or black tar-like stools
• Weight gain of more than 4 pounds in a week
• Shortness of breath
• Confused thinking
• Fever over 100° F
Complications associated with end-stage liver disease are challenging and difficult to manage.
The delicate balance of medications, fluid management, nutrition and education of the patient are
best handled by a hepatologist.
MEDICATIONS AND ALCOHOL
If you have liver disease, you should not drink any alcohol. Pain relievers such as Tylenol
(acetaminophen) are safe if you take less than six 325 mg tablets or less than four 500mg tablets
each day (2 Grams). Ibuprofen and aspirin are not safe to take with liver disease. They are
harmful to your kidneys and may cause bleeding. We will review all of your medications during
your evaluation and make recommendations.
Viral Hepatitis transplant is a viable option for treating the
This is a prolonged inflammation of the liver symptoms of hepatitis B. Those
due to viral infection. Patients with chronic transplanted will receive special treatments
hepatitis may develop cirrhosis, portal before and after a transplant to keep the
hypertension and/or cancer. Liver failure virus under better control.
may occur within five years.
Symptoms of chronic viral hepatitis Hepatitis C (HCV)
(Hepatitis A, B and C) can be described as Previously known as non-A , non-B
flu-like symptoms and may include fever, hepatitis. HCV was identified in 1989 and
fatigue, anemia, pruritus (itching) abdominal by 1990 the test was available to identify
pain, jaundice clay colored stools and dark those infected. HCV is transmitted through
colored urine, anorexia, nausea, vomiting, exposure to blood infected with the virus. A
varices, ascites, bruising and prolonged high-risk history includes blood
bleeding. transfusions, IV drug users sharing needles,
tattoos, and multiple sexual partners.
Hepatitis A Interferon and ribavirin are approved for
Drinking water or eating food contaminated treatment of HCV and works for a variable
with fecal matter containing the virus percentage of patients depending on the
transmits this disease. Shellfish is also genotype, viral load, and a number of other
frequently a source of hepatitis A. Most factors.
people recover from the infection within six
months and rarely require a liver transplant. Alcoholic Cirrhosis
Excessive alcohol consumption damages the
Hepatitis B liver cells resulting in cirrhosis. Scar tissue
Transmission of hepatitis B through infected forms and is permanent. Individuals who
blood and other body fluids such as semen, develop liver damage from alcohol should
vaginal secretions, breast milk, saliva and stop using alcohol immediately. In many
open sores. A high-risk history includes cases the liver function will improve within
blood transfusion or exposures through six months even though the cirrhosis will
needle sticks, IV drug use, multiple sex remain. Continued use of alcohol will result
partners, or sexual intercourse with an in further cirrhosis, and increasing
infected person. Most people fight off the symptoms of liver disease and failure. Liver
infection themselves; however 5-10% of damage can develop from alcohol even if a
those infected progress to be a chronic-state person is not an alcoholic. Women are
and may eventually develop liver disease much more sensitive to alcohol, and suffer
with cirrhosis and even liver cancer. Liver the long-term effects of continued drinking
sooner than men. Liver transplant is the Hemochromatosis
only option if liver failure develops from Hemochromatosis is an inherited metabolic
alcoholic cirrhosis. error in which the body absorbs more iron
than the body needs. The iron is stored in
Autoimmune Hepatitis the liver, and cirrhosis can develop.
An abnormality of the immune system can Symptoms include a bronze to slate gray
cause progressive inflammation of the liver. appearing skin. This condition can affect
70% of all patients with autoimmune the heart in the form of abnormal rhythms,
hepatitis are women. Treatment with or congestive failure and can affect the
Prednisone and Imuran has been shown to pancreas resulting in diabetes. A liver
decrease symptoms and frequently prevent biopsy assessed for iron quantity levels can
the development of cirrhosis. also help diagnose hemochromatosis.
Symptoms include fatigue, abdominal
discomfort, jaundice, aching joints, itching,
and spider angiomas on the skin, ascites and
A Hepatoma is a malignant tumor in the
liver. Sometimes it is possible to surgically
remove the tumor. The tumor must be
relatively small for transplant to be a
Primary Biliary Cirrhosis (PBC) successful option. Special treatment to
PBC is a slow progressive destruction of the prevent further growth is necessary prior to
bile ducts that interferes with the excretion liver transplant.
of bile from the liver. Substances normally
excreted in the bile build up in the blood. Alpha-1 Antitrypsin Deficiency
Inflammation results and eventually will Alpha-1 Antitrypsin is a protein made by the
cause scarring and cirrhosis. The initial liver important in prevention the breakdown
cause of PBC is unknown. However, of enzymes in various organs of the body.
disturbances of the immune system and Adults with this deficiency may also suffer
hormones may play a part. Women are from emphysema.
affected 10 times more than men. Symptoms include fatigue, poor appetite,
Symptoms include itching, fatigue, ascites, edema, jaundice, itching,
jaundice, fluid accumulation and darkening nosebleeds, bruising and varices.
Primary Sclerosing Cholangitis (PSC)
In Wilson’s disease the liver fails to rid the
Bile ducts inside and outside the liver
body of copper resulting in excessive
become narrowed due to inflammation and
amounts of copper in the liver, brain and
scarring causing bile to build up in the liver.
other organs. Wilson’s disease is an
The result is damage of the liver cells. PSC
inherited disorder. It has a chronic
is more common in men than women. 70%
progressive state. However, it can cause
of the patients also have inflammatory
acute fulminate hepatitis in which the liver
failure progresses rapidly. Other symptoms
Symptoms include fatigue, itching, jaundice
of Wilson’s disease include mental
and fever and chills from infection in the
difficulties, unsteady walk, kidney damage
and copper in the eyes known as Kayser- This is manifested by the increased
Fleischer rings. accumulation of fat within the liver.
Steatosis is not specific and can be seen in
Steatohepatitis-NASH- Fatty Liver association with diabetes, obesity, total
parenteral nutrition and certain drugs.
Even if you do not have alcoholic cirrhosis, alcohol can increase the effects of your liver
disease. For example, if people with hepatitis C drink alcohol, they will advance to end
stage liver disease faster than those who do not drink.
Persons continuing to drink alcohol are not eligible for transplant.
If you have liver disease and are still drinking. STOP!
Your physicians try to minimize your symptoms of liver failure by prescribing medications
that control specific side effects. The more commonly prescribed medications are outlined
below. If you have any questions regarding these medications, please talk to your
physician or nurse.
Lactulose This is used to decrease the build up of extra
This is a laxative used to prevent and treat fluid without depleting the potassium from
encephalopathy. It decreases the pH in the the blood. Aldactone can cause
colon making it difficult for the intestine to gynecomastia (breast swelling) and
absorb ammonia. This decreases the tenderness. It may also result in high
ammonia circulating in your blood and potassium levels. Both symptoms need to
improves mental function. be reviewed by the physician.
The dose of Lactulose varies by each
individual patient, but is designed to
produce 3-4 soft stools a day.
NOTE: The transplant coordinators and
physicians reserve the right to question
Neomycin anyone with suspected problems with pain
This is an antibiotic, which destroys bacteria medications. Abusive behavior will be cause
and reduces toxins in the intestine. It is This medication decreases the pressure
for investigation by the team and could in
sometimes used to help treat the portal blood vessels and thus as a
potentially inactivate your status prevents
encephalopathy. esophageal varices and gastric varices
(enlarged blood vessels of the esophagus
Furosomide (Lasix) and stomach). This helps to prevent
This is used to decrease the build up of extra hemorrhage of these vessels.
fluid in the feet, ankles, legs and abdomen.
Lasix can deplete potassium from the blood Multivitamin
stream. Your potassium level is monitored A nutritional supplement to replace
when you are on Lasix and you may require important vitamins and minerals in your
a potassium supplement. body. A prenatal vitamin is commonly
prescribed due to the extra minerals it
Spironolactone (Aldactone) contains.
Individuals with liver disease occasionally Herbal Medications
may have medication prescribed for short Do not take any herbal medications without
term pain. Pain medications are closely consulting with our physicians. This
supervised. We require that you receive your includes but is not limited to Echinacea, St.
pain medications from one source, either Johns
your local physician or the liver transplant Wart, kava kava, ma-haung.
program. There are several types of pain
medications used. For any questions you Transplant patients should never take
have regarding your medication please talk medications or herbs intended to boost their
to the physician prescribing the medication. immune system.
The evaluation is usually done on an outpatient basis unless you are critically ill
and require hospitalization. During the evaluation you will have appointments with
many specialists in addition to the members of the liver transplant team. The pre-
transplant tests, as well as giving a clear picture of the patient's overall health
status, helps in identifying potential problems before they occur. They also help in
determining whether transplantation is truly the best option. This increases the
likelihood of success.
The following procedures help in evaluating a patient's health status:
Psychosocial Evaluation- The social Ultrasound with Doppler examination-
worker and/or psychiatrist will meet with This determines the openness of the bile
you to help assess your emotional state. ducts and major vessels to and from the
This evaluation helps your doctors find out liver. It also screens for liver cancer, which
how well you handle stress and determine can occur with cirrhosis.
your support system. The transplant team
will also want to meet with you and your CT(CAT) Scan- A radiology procedure that
support person or family members to ensure will show the size and shape of the patient’s
that everyone knows what to expect during liver and major blood vessels. It can also
the transplant. screen for liver cancer, which can occur with
Blood Tests- The patient’s blood count,
blood and tissue type, blood chemistries, and
immune system function are evaluated. In MRI (Magnetic Resonance Imaging) This
addition, blood tests for certain infectious may be used in place of CT scan or
disease will be performed, including ultrasound to see inside the patient’s body.
tuberculosis and HIV testing.
Echocardiogram- Echo determines the
Chest X-ray- This evaluates the health of health of your heart. Similar to the
the patient’s lungs and lower respiratory ultrasound, the echocardiogram checks the
tract. health of the chambers of your heart, the
valves, vessels and blood flow.
Bone Density- Measures the strength and working correctly. It is important that you
density of your bones. collect the urine correctly. The lab will
provide you with a large plastic jug which
Pulmonary function test- The patient will you can take home and return it to the lab
be asked to breathe into a tube attached to a for testing after collection.
measuring device, which will reveal how
well his lungs are working and determine his Cardiology Consultation- All transplant
blood’s capacity to carry oxygen. candidates will have an echocardiogram.
Those transplant candidates over age 50 or
ERCP-This procedure allows the physicians candidates with risk factors for coronary
to diagnose and treat problems in the liver, artery disease, like diabetes, or a history of
gallbladder, bile ducts and pancreas. The cardiac disease, will undergo cardiology
procedure combines X-ray and the use of an consultation with additional cardiac studies.
endoscope-a long flexible lighted tube. The These may include a stress test and/or
scope is guided through the patients’ mouth cardiac catheterization.
and throat, then through the esophagus,
stomach, and duodenum. The physician can Persantine Thallium (Stress Test)- An
examine the inside of these organs and exercise stress test is a special type of
detect any abnormalities. A tube is then electrocardiogram (EKG) that compares the
passed through the scope, and dye is injected hearts electrical activity at rest and under
which will allow the internal organs to exertion. A radioactive substance is given to
appear on X-ray. stress the heart, instead of a treadmill, in
order to determine which parts of the heart
are healthy and functioning and which are
Endoscopy/EGD- A flexible tube is passed
down your throat into your stomach. The Right Heart Catheterization- A heart
physician will look for enlarged veins or catheterization enables physicians to
ulcers that have been caused by liver measure pressures in all four chambers of
disease. You will be given medicine to help the heart through the insertion of a thin
you relax during this procedure. plastic tube or catheter into a vein in your
neck. Patients receive a local anesthetic
Colonoscopy- A flexible tube is inserted before undergoing the 30-45 minute
into the rectum and colon to assess for catheterization procedure.
bleeding and cancer. You will be given
medicine to help you relax during this Liver Biopsy-a liver biopsy is a test of a
procedure. tiny piece of the liver. The tissue is taken
out with a small needle. Very few patients
Renal Function Tests- Urine will be need a liver biopsy before transplant. If it is
collected from the patient for 24 hours in needed, it is useful in diagnosing what type
order to determine if the kidneys are of liver disease you have.
Addictionology Consult- In the event that a
history of drug or alcohol use is identified, It is important that all of the testing be
you may be requested to meet with our completed as directed by your liver
addictionologist to determine the extent of transplant coordinator.
your addiction and to identify potential road In the event that you are unable to
blocks to your full substance abuse complete any testing this must be
recovery. All patients, regardless of the reported to the transplant coordinator as
liver diagnosis may be requested to have soon as possible.
random blood and urine drug screenings
performed both pre and post transplant.
Depending on your diagnosis, additional
studies may be performed. If any of the
tests reveal a potential problem, the
transplant team may schedule more tests.
After all of the tests and consults are completed, your results will be present to the Liver
Transplant Selection Conference. The conference is held once a week. All the members of the
transplant team are present and your case is discussed in detail. There are two decisions to be
made at this time.
First, it will be determined if you meet the
criteria for liver transplant. The Criteria for
candidacy includes, but is not limited to:
• The presence of end stage liver disease,
which cannot be cured by other medical
• Full understanding of the transplant
• Stable support system, such as family and
• Ability to understand and demonstrate
compliance with the medical care
• No active infections.
• Negative HIV test. Second, the team will decide your candidate
• At least 6 months abstinence from category. Categories of candidacy include:
alcohol and substance abuse with
addictionology treatment. Accepted
• No active cancer, with the exception of The patient meets the criteria for transplant. This
some liver tumors status continues unless something is discovered
• No other medical conditions that will in additional work up that is a contraindication
interfere with your recovery from a for transplant
transplant (such as significant heart and
lung disease). Deferred
The patient does not meet criteria for transplant, financial department, we can then proceed to
further testing and treatment may be necessary. place you on the waiting list.
Examples: a medical problem needs specific We will have you return to the liver
treatment, counseling for psychiatric diagnosis, transplant clinic with your family/support
or treatment for past alcohol or drug abuse. The system to proceed with the liver transplant
patient will be informed in writing of the listing process.
requirements to meet transplant listing and when
they are achieved, the case will be presented at WAITING TIMES
Selection Conference. Waiting times depend on your blood type, the
severity of your illness, body size and the
Declined number of donors available and are therefore
The patient does not meet criteria either due to difficult to predict. If you have questions
medical or psychosocial reasons. Individuals regarding your waiting time once you are listed,
who make the choice not to follow through with please talk to your transplant coordinator.
the recommendations from the Selection
Conference are declined due to poor compliance We realize that waiting for your liver transplant
with the medical care required. can be very stressful. Even though the waiting is
difficult, there are things to do while you are
The selection of a specific patient is based on the • Follow the recommended nutrition and
merit of the individual candidacy. The transplant exercise programs and lose weight if
team will work with patients on an individual recommended.
basis to establish their candidacy. It is important • Continue to live a productive life,
to remember that the team relies on you to continue working if possible and stay
assume responsibility for coming to involved in as many activities as your
appointments and completing all of the health allows.
recommendations from the Selection
Conference. You need to notify your coordinator if you are
hospitalized or if there are any changes to
your medical condition, insurance, address or
THE WAITING LIST
After all of your information has been reviewed
by the Selection Conference and the
Liver transplant patients are listed by the MELD
recommendations have been completed and it
score or Model for End Stage Liver Disease.
has been determined that you are an acceptable
The MELD is a system of prioritizing patients
candidate, we will be able to pursue the financial
waiting for liver transplant. It is a statistical
approval from your insurance company for
formula that determines that the patient with the
authorization for liver transplant. Your
greatest need will have the highest priority for
insurance company will need to review your
the next available liver. The MELD score is
records, confirming that you meet criteria for
used for adults and the PELD score is used for
transplant. When we have received authorization
pediatric patients. The MELD score is
from your insurance company and the hospital
calculated by a formula that uses 3 routine lab
1. Total Bilirubin, measures how effectively UNOS
the liver is excreting bile. All patients are listed through the national
2. INR and prothrombin time, which transplant data base which is governed by the
measures the liver’s ability to make blood United Network of Organ Sharing or UNOS.
3. Creatinine, measures kidney function. UNOS is the governing body of all solid organ
Impaired kidney function is often allocation. Currently there are over 18,000
associated with severe liver disease. patients who are actively waiting for liver
transplantation. Out of the 18,000 patients,
MELD scores range from 6(less ill) to 40 (the approximately one third will be transplanted; one
most ill). third will transition to waiting the following year
Patients with MELD scores of 15 or greater are and one third, unfortunately, will die while
considered for active liver transplant listing. waiting for liver transplantation.
One can be listed with a MELD score lower than
15, but cannot be transplanted due to UNOS Patients are listed by ABO (blood type), MELD
rules. Score and body size.
The MELD/PELD will vary with each lab draw. When you are listed on our local list, you will be
It is mandatory for patients to have lab work put into your blood type subgroup: O, A, B, AB.
done at least every 3 months, or sooner if your Within that group you will be placed according
MELD score is greater than 18. Failure to do so to the severity of your liver disease.
will result in your score reverting to an inactive Blood Type Compatibility
status and you could be bypassed for liver Blood Type
transplant. We must receive your current lab O O, A2
work within the time constraints that have been A A
dictated by your current MELD score. B B, O
It is important for you to understand that during
your wait for transplant, your condition could
deteriorate to the point that you would no longer
survive transplantation, and therefore would no The United States is divided into 11 different
longer be a candidate. The Liver Transplant team regions. In Utah, we are in region number 5 and
will do everything possible to keep your status we share our organ allocation with Nevada,
active. California, Arizona and New Mexico.
The organs are allocated by specific listing
1. Status 1 – these patients take first
priority. These are patients who are
identified as having acute fulminant liver
failure, who have been deemed as 3. Should a match not be found then the
having less than 7 days to live. organ is offered to the Regional patients
2. Local (meaning those patients listed in who are listed with MELD scores from
the state of Utah) with a MELD score 40(most ill) to 15 who have been waiting
>15. for the longest amount of time.
Name Blood MELD Score Body Size List Date
Jaundice Janice O Status 1 5’5” 125 lbs 12/15/04
Ascites Andy O 18 5’10” 180 lbs 07/01/05
Encephalopathy O 16 5’8” 150 lbs 6/04/05
Bruising Barney O 12 5’6” 160 lbs 5/06/04
Coma Corey A 32 6’2” 225 lbs 09/05/05
Confused Callie A 18 5’3” 160 lbs 2/04/05
Muscle Wasting B 22 5’8” 175 lbs 01/01/05
Stable Sam B 16 5’7” 125 lbs 01/01/04
Unique Iris AB 16 5’7” 125 lbs 04/15/05
WHERE TO WAIT Our social worker can give you suggestions
If you do not live in Utah, it may be for low cost housing.
necessary for you to come to Salt Lake City
and wait for your transplant. You must be
able to arrive at the transplant center within
6 hours from the time you are called in for GETTING THE CALL FOR
transplant. You are responsible to assess TRANSPLANT
your ability to provide appropriate
transportation to the transplant center. This While you wait for your transplant, you will
can be arranged by private car, private carry a beeper or a cell phone. If you live in
airline services or commercial airlines. If the state of Utah, we will provide you with a
you cannot be here within that amount of beeper, otherwise you will need to acquire a
time, your may need to make arrangements beeper that will reach you in the area that
to temporarily move to the Salt Lake City you live. Whenever the beeper does go off,
area. call the number received on the pager. If you
are unable to contact the number received,
Transplant candidates who need to stay in call the hospital operator at the University
the Salt Lake City area while waiting for Hospital immediately and ask for the liver
transplant should plan for housing for transplant coordinator on call.
approximately 2 or more months prior to
transplant. You should also plan on staying
approximately 2 months post transplant.
• There is always a chance that the
transplant may be canceled if the
donor liver is inadequate.
• Take the antibiotics prescribed for
Liver Transplant Office you and given to you during your
801-581-2634 listing visit.
Toll Free 800-824-2073 ext.1-2634
When the time comes for you to receive
your transplant, the nurse coordinators will
first call your home. If we do not reach you,
we will use your beeper number. You will
experience many feelings of excitement,
relief, anxiety and/or fear. We recommend
that you have someone drive you to the
hospital. Check in at the University
Hospital admitting office on the first floor of
the hospital. You will be admitted to the
SICU (Surgical Intensive Care Unit).
Some important facts to remember are:
• Nothing to eat or drink once you
have received that call to come to the
ORGAN SELECTION AND MATCHING
The surgeons are particular about what organs they use for transplant. Any time during the day
or night the surgeons may receive a call to notify them of a potential donor. At this time the
donor is worked up with several blood studies, diagnostic studies, and an extensive medical and
social history. If the donor meets the criteria as a safe candidate for donation, the surgeons will
procure (remove/retrieve) the organ. This is the operation the surgeons perform to remove the
organ from the donor and prepare it for liver transplant.
The final decision to use the organ takes place during the procurement when the surgeon
has the opportunity to actually see the liver. If at any time during the procurement process
the organ appears to be unsuitable, the surgeons will not use it for transplantation.
Matching for liver transplantation is dependent on two factors.
1. Blood Type
The vast majority of transplants are done by matching the donor blood type to the recipient’s
blood type. In very rare cases compatible non-identical transplants are done to save the life of a
critically ill patient. This is a rare exception.
2. Body Size
It is very difficult to put a liver of a very large person into the body of a small person and vice
versa. The surgeons will look at the body size of the donor and try to match that closely to the
body size of the recipient.
Unlike kidney and bone marrow transplant, liver transplantation does not require tissue typing
for a successful transplant.
Due to the matching process for the liver, the candidate first on the list is not always the one to
receive the transplant. Therefore, we do not number the candidates on the list. We can only tell
you when you are getting closer to the top, and estimate when your transplant may occur. As
discussed previously, expect to wait some time to receive your transplant.
All members of the transplant team are working hard to get you on the transplant list and get you
transplanted as quickly as possible. Take this time to promote physical and emotional health. If
possible, do not turn your back on your favorite hobbies or activities. You may want to consider
starting a new hobby or restarting old ones.
Walking is an excellent way to promote your physical well being. Talk to your physicians
regarding additional information on physical activity and emotional wellness.
You have finally been called in for your Finally, you will need to scrub with a special
liver antibacterial soap prior to going to the
transplant surgery. You will need to go to operating room.
the admitting office located on the first floor
of the hospital. The admitting office will THE OPERATING ROOM
direct you to the Surgical Intensive Care When it is time, the nurses will take you to
Unit on the second floor. The doctors and the operating room on the 3rd floor. Once
nurses will prepare you for the surgery. The you are placed under anesthesia the
time before the surgery is very busy. A transplant team goes to work.
resident or intern will perform a physical
examination and take a complete history. TUBES, CATHETERS AND
Please bring a complete list of all your DRAINS
medications. At this time you will be asked
to sign one or more consent forms giving Several lines will be placed to prepare you
your permission to the surgeons to perform for surgery. Some of these lines are:
In addition to the physical examination, you Endotracheal Tube (ET tube)
will receive a chest x-ray, EKG, and blood This is a tube placed in the airway (trachea)
tests. The nurses will start an intravenous that is connected to the ventilator. The
line (IV) for antibiotics to prevent infection. ventilator breathes for you while you are
under the effects of the anesthesia. Your attached large clear bulbs, which catch the
throat may be sore after transplant. blood and fluid that is collecting around
Central Venous Catheter (CVC) the surgical site and liver. Draining this fluid
This is a large IV line that is placed in one helps to prevent swelling and infection.
of the vessels in your neck. This line is used
for giving you medication, fluids and blood Bile Drainage Tube
products. This is used to drain bile from the biliary
tree. This drainage tube is connected to a
Urinary Catheter collection container immediately after
This is a drainage tube that is inserted into surgery. Once the drainage slows down and
your urinary bladder. It drains your urine you are stable the tube is capped. This
into a bag. This helps the doctors and tube stays in for weeks and will be removed
nurses evaluate your fluid status, during one of you clinic visits.
electrolytes and kidney function.
Nasogastric Tube (NG tube)
This tube is passed through one of your
nostrils, down your throat and into your
stomach. It is used for keeping air out of While you are in surgery, your family will
your stomach while you are on the wait for you in the family surgical waiting
ventilator. We also use it to keep the room. It will take up to an hour to prepare
acidity of your stomach balanced. The you for the surgical procedure. We ask that
nurses can also give medications down this a member of the family remain available in
tube. the waiting room at all times.
Jackson Pratt Drains (JP drains)
The surgeons place these drains around
your surgical site when they have completed
the transplant surgery. The drains have
The surgical incision for liver transplant is
very large. It goes across your abdomen in a
boomerang shape, and may extend up
towards your chest. Once the incision is
made the surgeon will proceed with
removing your old liver, leaving parts of
your major blood vessels and bile ducts.
The new liver is inserted and attached to
the vessels and ducts. During the surgery
you will receive transfusions of blood,
platelets, and fresh frozen plasma. You are
placed on a monitor that tracks your heart
rate, arterial and venous pressure, and
respiratory rate. In addition, your blood is
sent to the lab frequently to monitor your
chemistries, blood counts and clotting
LENGTH OF SURGERY
The average length of time for a liver
transplant is 9 hours. This is never the
same for each patient, and may vary from
less than 6 hours, to greater than 15 hours.
The length of time does not predict the
success of the surgery. Patients with a past
history of abdominal surgery usually takes
longer during liver transplant because of old
scar tissue present in the abdominal cavity.
When the surgery is complete, the surgeons
close your incision. The incision is closed
on the outside with staples. The staples
stay in place for approximately two to three weeks
and are removed during one of your clinic
visits. After the incision is closed and you
are stable you will be taken back to the ICU.
When your surgery is finished the transplant surgeon will talk to your family in the waiting room
on the 3rd floor. They will then be directed to go to the SICU family waiting room. If an hour
has passed since you have spoken with the surgeon and you have not heard from the SICU
nursing staff, we ask that your family call into the unit to see if they can visit you. The SICU
allows two visitors at a time.
The SICU phone number is: 581-2124
SICU Family Waiting Room: 801-587-3677
POST TRANSPLANT COURSE SURGICAL INTENSIVE CARE UNIT (SICU)
You will wake up from the transplant operation in the Surgical Intensive Care Unit. The
sights and sounds may seem strange to you. You will wake up with all the tubes, IV
lines, and monitors as described in the previous chapter. The average length of stay in the SICU
is 2-3 days. This will vary depending on how you respond to the surgery, how quickly you
recover from the anesthetic, and how sick you were prior to the transplant. When you wake up
you may experience some confusion due to the anesthetic. Nights and days can begin to blend
together. It is not uncommon for your sleep pattern to be interrupted. When you are stable, the
doctors will remove some of the monitors and tubes.
Endotracheal Tube (ET tube)
As soon as your body has metabolized the anesthetic, and you are able to breathe on your own
the ET tube will be removed, this usually only takes 12-48 hours. It is common to have a sore
throat after this tube is taken out.
This might be removed in the SICU if the surgeons feel your kidneys are working well. The
nurses will continue to measure your urine until you go home from the hospital.
Once your medical condition has stabilized you will be transferred to the transplant unit located
on 6 South. The average length of stay on the Transplant Unit is 7-10 days. This makes your total
hospitalization stay approximately 14 days. This varies depending on your overall post transplant
recovery course. After your surgery you may feel many different emotions. Many people feel
that it is over. It is not uncommon to feel depressed or anxious after the surgery. All these
emotions are common and most people feel a little of each. While you are on the Transplant Unit
you have some important responsibilities before you can be discharged.
When you are permitted to eat you will start with clear liquids. If that is tolerated, you will move
slowly to solid foods.
The nurses will expect you to take part in your own care such as brushing your teeth, bathing,
combing your hair, shaving, etc. These activities will help make you feel better.
You will need help at first, but your strength will increase gradually. Walking helps your body
get back into shape, and heal faster.
Coughing and Deep Breathing
Your nurse will show you how to perform coughing and deep breathing exercises. These
exercises aid in preventing pneumonia and will speed your recovery.
You will begin learning all about your new liver, how to take care of it, how to prevent infection,
your medications, and your clinic and lab schedule. The coordinators, pharmacists and nurses
will teach you how to take care of yourself now that you have your new liver. You will receive a
Post Transplant Manual. THIS IS YOUR LIFE LONG GUIDE. The transplant team expects you
to read the manual during your hospital stay. The Transplant Coordinator will come to your room
review the content of the manual, answer questions, and review your medications.
Prior to your discharge, you will need to complete a worksheet on the information you learned.
Tubes and IV lines
As you continue to improve the tubes and IV’s will be removed:
Nasogastric Tube (NG tube)
As soon as your stomach and bowels begin working, and you are able to pass gas, this tube will
be removed from your nose.
Jackson Pratt Drains (JP Drains)
These drainage tubes are removed as the amount of fluid draining into them decreases to a very
Central Venous Catheter (CVC)
This is usually the last line to be removed. It may be removed on the day of your
VISITORS follow up and frequent lab work. It is
important for you to be nearby in case of
The liver transplant team encourages visits complications after the surgery.
from your family and friends. Because of the
risk of infection, you should caution your
friends and family not to visit if they have a The transplant team also wants you to get
cold, flu or some other infectious disease. your lab work done at the University
For the family and friends that cannot visit it Medical Center. This helps the team keep
is helpful to have a your medication doses stable.
spokesperson for the group. The The Transplant Team will discharge
spokesperson is the one who gets the current you when:
updates and passes the information along. You are physically stable.
This helps keep the nursing staff from You know your medications and
having to take time away from your can set up each dose.
care to answer a number of phone calls. You know your clinic and lab
You pass the discharge review
worksheet (checked by the
You have arrangements for a place to
stay when leaving the hospital.
Out of Area Patients
The Transplant Team expects you to stay in
DISCHARGE the Salt Lake city area for up to 2 months
after your transplant. During that time the
As you can imagine there is a lot to pull physicians will decide when you are stable
together. The Transplant Team will work enough to go home. The social worker will
very hard to get you discharged, but we assist you in arranging your housing needs.
depend on you to do your part as well. You
need to study your manual, practice with LAB SCHEDULE
your medications, and follow the medical
orders from the physician and nurses. Post Transplant Lab Work
Upon discharge if you do not live in the 1 month Monday, Wednesday,
Salt Lake City area you will need to make Friday
arrangements to stay. This is because your
2-4 months Every Monday & Thursday
progress requires close supervision. Even
then decreasing to Mondays
though you may be stable enough to leave
the hospital, you will still need frequent
5-6 months Every other Monday
>6 months One Monday a month We can only diagnose rejection with a liver
biopsy. If you do experience rejection we
Due to the nature of your transplant surgery have medications that we use to stop the
and the medications you will take after process, and resolve the rejection. You may
transplant you are at risk for potential need to come to Salt Lake City for the
complications. Getting your lab work on biopsy
time and coming to clinic helps us to and treatment, depending on how far out
recognize signs and symptoms of from transplant you are.
complications early. The sooner we are able
to diagnose a complication, the sooner and
easier we can treat it. It is important for
you to notify the Transplant Coordinators if
you are experiencing signs of complications.
Rejection is the process by which your body INFECTION
recognizes your transplanted liver as being a
foreign protein (not part of the original The desired effect of the anti-rejection
equipment). The body responds with the drugs is immunosuppression to prevent
immune system, its natural defense against organ rejection. Immunosuppression is the
foreign proteins. The immune system weakening of or suppression of your
attacks your transplanted liver. There are immune system. However, because your
medications that can help prevent your immune system is suppressed you are at
body from beginning a rejection episode. greater risk for infection. There are certain
These medications are your anti-rejection or things you can do to help prevent infection
immunosuppression drugs. (These are including washing your hands regularly,
discussed in the next section.) avoiding visits from sick family or friends,
wearing a mask when in large crowds or
Signs and Symptoms of Rejection around construction sites, and taking your
infection-fighting medications. You will be
You may experience abdominal pain, fever, on some of these medications for the first 6
increasing weakness or fatigue, changes in months after transplant.
the color of your stool and urine or jaundice
(yellow). However, if you are getting your Signs and Symptoms of Infection
lab work on time, it is possible you will not • You may experience: fever (≥100.5),
be feeling any symptoms, in fact most • Body chills and/or a productive
people have no symptoms. We usually see cough with greenish mucous,
changes in your liver function tests even • Fluid retention and/or weight gain.
before you experience symptoms. • Diarrhea or painful urination.
Sometimes symptoms of infection can be as
Treatment for Rejection vague as simply not feeling well.
Treatment for Infection Treatment for Surgical Complications
• You first need to have your blood, You would first need to have the suspected
urine and possibly stool cultured to site looked at through ultrasound,
see where the infection might be. angiogram (blood vessel dye test) or ERCP
(a type of endoscopic procedure to look at
If the infection proves sensitive to this bile ducts). Once the problem site is
antibiotics, you will be treated with known the doctors may be able to correct it
antibiotics either by mouth or through with a simple stent that keeps the
intravenous infusion. Sometimes the connection open. The site may require
infection is viral and just has to run its surgical repair.
Surgical complications can be related to:
• leaking at the sites of connection, or
• narrowing or obstruction at those
These sites of connection are at the bile
ducts and blood vessels.
Signs and Symptoms
You may experience abdominal pain,
nausea, fever, jaundice and an overall
feeling of illness.
It is important to remember that if you experience any signs and symptoms of complications you
should call your Transplant Coordinator.
Appropriate times to call the on call nurse coordinator after hours:
You should call the on call coordinator if you think you need to see a doctor immediately or need
to be hospitalized.
Some examples are:
Fever of >100.5 degrees F.
Severe abdominal pain.
Vomiting that prevents you from taking your medications, food, or fluids.
Blood in your stools, or vomiting blood.
Examples of inappropriate calls to the on- call nurse coordinator after hours:
Not being able to sleep.
Medication refills. Medications are not refilled after office hours.
Lab and study results. The coordinators do not have your chart at home when they are
Waiting several days when you are sick, and finally calling after office hours.
Call as soon as you feel the symptoms.
Please remember that the coordinators are not in the office when they are on
Call appropriately when you are having a medical emergency.
If you have issues that require attention please call during office hours.
Liver Transplant Office
Hospital Phone number: 801-581-2121
Toll Free 800-824-2073 ext.1-2634
After your transplant, the Transplant Team will place you on several medications. The
medications serve many functions, including prevention of rejection and infection, nutritional
support, and other medical needs you may have.
In order to prevent rejection the doctors will prescribe medications that you will take every day
for the rest of your life. These medications are given to keep you alive. Some anti-rejection
medications you may receive are listed below.
Prograf (Tacrolimus or FK506)
This medication is used to prevent acute liver rejection and is taken twice a day. The dose may
adjust based on your blood level.
Side effects include but are not limited to high blood sugar, tremors, kidney problems, and
This medication is used to prevent and treat acute liver rejection. You will be started on an IV
form of prednisone called Solumedrol immediately after transplant. You will change to oral
tablets when you tolerate food. You will receive a taper that will tell you how much prednisone
to take on a given day. That taper will begin at different times in different patients depending on
the disease of transplant, diabetes, the presence of rejection, and other factors.
Side effects include but are not limited to mood swings, trouble sleeping, fluid and sodium
retention, high blood sugar, muscle weakness, bone loss, stomach ulcers, impaired wound
healing, acne, cataracts, and glaucoma.
Mycophenolate Mofetil (MMF or Cellcept)
It is used to prevent acute rejection or to sometimes treat chronic rejection. The dose is twice a
Side effects include but are not limited to diarrhea, nausea, vomiting, reduced white blood cells
The anti-rejection medications suppress your immune system, which weakens the body’s ability
to fight infection. You will be given medications to help prevent infection for about 6 months.
The following are 3 examples of medications you may be taking after transplant to prevent
Known as Bactrim, Septra or Cotrim, this is a sulfa type drug used to help prevent bacterial
infections such as Pneumocystis carinii pneumonia, PCP for short. You will take TMP/SMX
once a day by mouth. If you are allergic to sulfa drugs you will receive either Dapsone daily or
Pentamidine once a month instead.
Side effects include but are not limited to nausea, vomiting, rash, itching, or loss of appetite.
This medication is used to prevent viral infections such as CMV, and herpes simplex I & II.
Side effects include but are not limited to headache, nausea, decreased white blood cells and
Mycelex Troche or Nystatin Liquid
This medication is given to prevent fungal infections such as thrush. You will take one of these
preparations 4 - 5 times a day after meals and before bedtime. Women may also need to use
vaginal suppositories once a day at bed time.
Side effects include but are not limited to nausea, vomiting, diarrhea, unpleasant mouth
You will be on other medications to protect your stomach from acids and ulceration. Some
patients may need insulin or oral hypoglycemic drugs; others may require high blood pressure
medication. You will need to take drugs to prevent bone loss. It is not possible to know ahead of
time what your needs will be. You will have your own medication list prepared for you by the
pharmacist prior to being discharged from the hospital. You will have time during your hospital
stay to learn about your drugs and practice taking them as if you were at home. Your nurse will
supervise this while in the hospital.
There are many medications that interact adversely with your transplant medications. If new
medications are started by physicians other than the transplant physicians, you should check with
the transplant coordinator or pharmacist prior to starting them. In addition, there are many
“alternative” or herbal medications that are available over the counter. Many of these are not
safe to take with your transplant medications and should never be started without consulting your
When your care returns to your primary care physician you will continue to have your
immunosuppression medications filled by the transplant team. All other medications should be
refilled through your local doctor.
Allow at least 2 working days for the refill request to be completed. Remember the
coordinators do not refill medications after office hours.
It is important for you to have a full understanding of what your insurance benefits cover and
what expenses are your responsibility. Terms and coverage for transplant vary widely among
companies. Read your policy and talk to the insurance company benefits office to understand
your coverage. Many insurance companies have a co-payment for services or a deductible. Some
insurance companies have a lifetime maximum on transplant benefits and caps on medication
Medications can create a financial strain on the patient after transplant. These medications are
required for the rest of your life. It is very important that you understand what kind of medication
coverage your insurance benefits supply. Have a clear understanding of what medication costs is
Some insurance packages do not have adequate transplant benefits to cover the cost of the
surgery. If this applies to you, you will need to plan to pay for your transplant in other ways.
Some options are to arrange a payment system, fund raising, private funds, or by selling some of
Other costs to consider are food and lodging for distant patients and their families when here in
Salt Lake and transportation to and from the transplant center. Also consider ‘lost time’ that your
employer does not pay for when you are away from work. The transplant social worker and
financial counselors will help you with any questions you have regarding the costs of transplant.
American Association for the Study of Liver Diseases
American Organ Transplant Association
American Liver Foundation
Children’s Liver Alliance
Children’s Liver Association for Support Services
Children’s Organ Transplant Association (COTA)
Coalition on Donation
Fujisawa Healthcare, Inc.
International Transplant Nurses Society
Minority Organ Tissue Transplant Education Program
National Council on Patient Information and Education
National Foundation for Transplant
National Transplant Assistance Fund
Transplant Patient Partnering Program
Transplant Recipients’ International
Transplant Speakers International
United Network of Organ Sharing
Albumin is a protein made by the liver that
A helps maintain fluid balance in the body.
ABO Testing Acute
Blood tests that classify human blood into Short, relatively severe. Symptoms appear,
one of four groups: O, A, B, or AB change or worsen suddenly. The opposite
Albumin of chronic.
Anemia B cells are a type of lymphocyte, or white
Decreased capability of the red blood cells blood cell, that develop in the spleen and are
to deliver enough oxygen to the body responsible for the body’s immunity. B
tissues. It may be caused by a low number cells produce antibodies which help fight
of red blood cells, decreased amount of infection and foreign substances.
hemoglobin or decreased volume of red Bacteria
blood cells. Small organism (germs) that can cause
Alkaline Phosphatase disease or infection.
An enzyme produced by the liver (and Bile
other) cells; elevated blood levels of this A fluid produced by the liver, stored in
substance may indicate abnormal function the gallbladder, and released into the
of the liver or other organs. small intestine to help absorb dietary fats.
Antacid Bile Ducts
A drug that aids in protecting the digestive The tubes through which bile flows.
system and relieves heartburn and digestive Bile Leak
discomfort. A hole in the bile-duct system that causes
Antibody bile to spill into the abdominal cavity.
A protein produced by the body to Biliary Stenosis
eliminate foreign substances, such as Narrowing or constriction of a bile duct.
bacteria. Biliary Tree
Antigen All passageways inside and outside the
An antigen is a substance, usually found on liver that carry bile to the intestines.
the surface of cells, that identifies the cell as Bilirubin
“self” or “non-self”. The antigen causes the An orange colored substance in bile
immune response through antibody produced by the breakdown of red blood
production against the antigen. cells.
Medication that reduces pain by dulling
An arteriogram is a radiologic study (x-ray)
or picture of the arteries in an organ system
that is visualized through a special dye that
is infused in the blood stream.
An abnormal accumulation of fluid in the Biopsy
abdomen A biopsy is a procedure that provides a
Atherosclerosis small amount of tissue from an organ,
A buildup of fats in the lining of the tumor, bone or other body tissue to find out
arteries that may interfere with the flow of more information about that organ or tissue.
blood. A core needle biopsy is usually performed to
examine liver tissue. A tiny cylinder of
tissue, showing liver cells and how they are
B arranged, is removed through puncture with
B Cells this needle. This tissue is examined under
the microscope by a pathologist to determine Cholestasis is an accumulation of bile in the
the cause of liver disease, or to look for any liver. This can be caused by medications, an
evidence of rejection or infection. injury to the liver, total parenteral nutrition
Blood Urea Nitrogen (BUN) (TPN), or gallstones and may resolve over
A byproduct of protein breakdown in the time or when the medications or TPN are
body. discontinued. Cholestasis may also occur as
a symptom of many liver diseases.
C A form of fat that performs necessary
Cadaveric Donor functions in the body, but can also cause
A recently deceased organ donor. heart disease. Cholesterol is found in
Calcium animal foods such as meat, fish, poultry,
A mineral measured in the blood that is eggs, and dairy products.
required for bone growth and for blood Cholangiogram
clotting. It is also needed for the heart and A test that examines the bile ducts in the
nerves to function. liver for any leaks or blockages. A dye is
Catheter injected into the bile ducts and then the liver
A flexible tube that enters or exits the body. is examined through an x-ray.
Catheters may be used to drain body fluids Chronic
(a Foley catheter drains urine) or to Persisting over a long period of time.
administer fluids or medications through a Cirrhosis
vein (a Broviac Catheter) A disease causing irreversible scarring of the
The existence of more than one genetic CMV (Cytomegalovirus)
background within one person. Transplant A virus infection that is common in
recipients show chimerism through genetic transplant recipients; it can affect the lungs
markers since they have cells from the donor and other organs as well; a member of the
organ in their bodies. family of herpes viruses.
A bacterial infection in the bile ducts of the Blood clotting.
liver. Cholangitis can occur if bile flow is Coagulopathy
obstructed due to scarring of the duct or an Abnormal blood clotting.
obstruction of the duct. It can also occur in Corticosteroids
patients who had bile duct reconstruction or A category of immunosuppressive
the Kasai procedure when bacteria from the medications that includes prednisone and
intestine can invade the liver. Symptoms of prednisolone.
cholangitis may include fever, an elevated
bilirubin level, jaundice, and low blood
pressure. Antibiotics are used to treat Creatinine
cholangitis. Patients with recurrent A substance found in blood and urine; it
cholangitis may be prescribed a preventative results from normal body chemical
dose of antibiotic daily. Treatment of the reactions; such as muscle metabolism. High
obstruction through surgery or blood creatinine levels are a sign of
transplantation will ultimately resolve depressed kidney function.
This is a test that examines how well the metabolized by the liver. Ammonia builds
transplant recipient’s blood matches with up in the brain and interfered with oxygen
that of the donor. A high positive getting into the tissue, causing confusion
crossmatch may indicate the need for higher and tiredness. Medications such as
levels of immunosuppression for the liver lactulose, and a low protein diet can help
recipient. A negative crossmatch means that decrease the ammonia level so that the
there is no reaction between the donor’s and patient does not develop encephalopathy.
recipient’s blood. Electrocardiogram (EKG/ECG)
CT Scan A noninvasive test that records the electrical
A 3-dimensional x-ray of internal organs. activity of the heart.
A dissolved mineral such as sodium,
D potassium, magnesium, etc.
To change a harmful substance into a safer A small telescope-like instrument that is
form. used to examine the esophagus, stomach
Diabetes and small intestine.
A disease characterized by high levels of Endotracheal Tube
blood sugar. A tube inserted through the mouth and
Diabetic Nephropathy into the windpipe to aid a person in
Kidney failure as a result of diabetes. breathing.
A process by which blood is cleaned to A protein made in the body and capable of
restore chemical balance. changing a substance from one form to
This is the “bottom number” of blood ERCP
pressure measurement when the heart Endoscopic retrograde
muscle is at rest, expanding and filling with cholangiopancreatogram
blood. A test that examines the drainage system or
Diuretic ducts of the gallbladder, pancreas, and liver
A medicine that helps remove excess fluid (the biliary tree).
from the body tissue causing the body to
excrete sodium. Furosomide (Lasix) and
sprinolactone (Aldactone) are diuretics. F
These medications will increase urine Fibrosis
output. The presence of fibrous tissue in the liver
that causes scarring and liver dysfunction.
Fibrosis develops into cirrhosis.
E Fulminant Liver Failure
Edema A severe form of liver disease that starts
Excess fluid in body tissues; swelling of the then progresses very rapidly.
ankles, for example, are a sign of edema.
Confusion or an altered mental status. G
Encephalopathy may be seen in patients Gallbladder
with end stage liver disease. Due to liver A muscular sac attached to the liver; stores
dysfunction, ammonia can not be bile.
Gastroesophageal Varices The blood vessel that carries deoxygenated
Enlarged veins of the esophagus and blood fro the liver to the heart.
stomach due to scarring in the liver that Hepatitis
obstructs the normal flow of blood through Liver inflammation, may be caused by a
the liver. virus or chemical such as alcohol.
Gastrointestinal (GI) Hepatologist
The tract between the mouth and the A physician who studies the liver and treats
rectum, including the intestines and liver disease.
Glomerular Filtration Rate (GFR) An enlarged liver.
A test that determines the level of kidney Herpes
function. A family of viruses that infect humans:
Glucose herpes simplex causes lip and genital sores;
A type of sugar in the blood that supplies herpes zoster causes chickenpox and
energy to the cell. Glucose levels may vary shingles.
with diet, medications, stress and organ Hirsutism
dysfunction. Excessive hair growth. Hirsutism is a
Graft common side effect of cyclosporine.
A transplanted tissue or organ, such as a Histology
liver or kidney. The study of living tissue. The histology of
liver disease, for example, would be
determined by examining a piece of liver
H tissue from a biopsy under the microscope.
Helper T-cell Hyperlipidemia
The white blood cell that tells the immune A high level of fats (triglycerides or
system to fight infection or foreign cholesterol) in the blood. This can be
substances, such as transplanted tissue. caused by diet, genetic disorders, or
The measure of the number of red blood Human Leukocyte Antigens (HLA)
cells in the blood. Genetic marker, inherited from one’s
A bruise; swelling caused by the Human Leukocyte Antigen (HLA)
accumulation of blood in tissue. Compatibility
Hemoglobin (HGB) A test done on the donor and the potential
A substance in red blood cells that gives recipient to determine how actively the
blood its characteristic red color and recipient’s cells would attack the graft.
contains iron and protein. Hemoglobin Hypertension
carries oxygen from the lungs to the tissues High blood pressure.
and carbon dioxide from the tissues to the Hypotension
lungs. Low blood pressure.
Relating to the liver.
Hepatic Artery I
The blood vessel that carries oxygenated Immune System
blood to the liver from the heart. The system that protects the body from
Hepatic Vein invasion by foreign substances, such as
bacteria and viruses, and from cancer cells.
Immunity released into the blood; these are measured
A condition of being able to resist a to assess liver function.
particular infectious disease. Liver Function Tests (LFT’s)
Immunization Blood tests used to determine how well the
Providing the body with protection from liver is functioning. These include the ALT,
certain diseases through vaccinations. AST, GGTP, Bilirubin, and alkaline
Decrease of the body’s immune response, Lymphocytes
accomplished through the use of certain Cells produced by the lymph glands that are
drugs in order to help prevent or control a responsible for immunity. They defend the
rejection following a transplant. body against infection and foreign
Immunosuppressive Agents substances by producing antibodies and
Medications taken to prevent rejection of a other substances.
Organisms such as bacteria, fungi, and
viruses that invade the body and reproduce Magnesium
causing a variety of symptoms. A mineral required for normal bodily
Insulin function. Magnesium is involved in nerve,
A hormone produced by the pancreas that skeletal muscle, heart and cell function. It is
regulates blood sugar levels. Insulin helps also involved in blood clotting and the
the body use sugar and other carbohydrates. breakdown of carbohydrates and proteins.
As insulin is released in the body, the blood
glucose level decreases. N
Intravenous (IV) Nephrologist
Refers to fluids or medications administered A physician who specializes in diagnosing
to patients directly into a vein (blood and treating kidney disease.
stream) via a needle or catheter. Nephrotoxicity
Kidney damage, usually a result of
J medications or other substances.
Yellowing of the skin and eyes caused by A type of white blood cell.
excess bile products in the blood. Noncompliance/Nonadherence
Failure to follow health care instructions
regarding taking mediations and treatments,
K getting tests on time, etc. Noncompliance
Kidney Failure – Chronic often shortens the lifetime of the
Diminished kidney function over time that transplanted organ(s).
Leukocyte By mouth.
A white blood cell that helps fight infection.
Substances produced by the liver and
patients who are at higher risk for these
A small blood cell needed for normal blood Itching. Patients with liver disease may
clotting. have increased itching due to liver
Pneumocystis Carinii Pneumonia (PCP) dysfunction since there is an accumulation
A type of pneumonia seen primarily in of bile salts in their skin.
patients whose immune systems are PTLD
suppressed. Post-transplant lymphoproliferative disease;
Transplant patients are usually prescribed an a wide spread spectrum of viral disorders
antibiotic (Bactrim/Septra) to prevent this associated with the Epstein Barr Virus
type of pneumonia. (EBV) that may range from a self-limiting
Portal Hypertension mononucleosis (“mono”, glandular fever) to
This term describes increased pressure in the a type of lymphoma, or cancer of the lymph
veins that collect blood from the stomach, nodes. PTLD is complication of a
spleen, pancreas, and intestines (the portal suppressed immune system and occurs in
system). The blood from all the veins of only a small percentage of patients.
these organs is collected into the portal vein, Treatment includes lower
which drains into the liver. In a diseased immunosuppression and administering
liver that has fibrosis or cirrhosis, the blood antiviral medication.
from the portal vein may not be able to flow
easily through the liver.
Increased pressure then develops in the R
portal vein and can cause an enlarged Red Blood Cells
spleen, fluid in the abdomen (ascites), and/or The part of the blood that transports
enlarged veins in the stomach or esophagus oxygen to body tissues.
Portal Vein A term that refers to the kidney or having to
The vein that collects blood from the do with the kidney.
stomach, spleen, pancreas, and intestines Rejection
and carries that blood to the liver. When the immune system attacks the
Potassium transplant organ (liver, kidney, etc.) to rid
Potassium is a mineral essential for normal the body of it because it is recognized at a
body function. Potassium is important in foreign object. Can result in damage to that
helping the heart, nerves, and muscles organ.
function properly. Potassium also helps
change carbohydrate into energy and in
forming proteins. The kidneys excrete any
extra potassium in the body. It is important Sepsis
to follow potassium levels after transplant A severe infection that has spread to the
because some anti-rejection medications can bloodstream.
cause an increase in the potassium level. Shingles
Prophylactic Medication A herpes virus infection (herpes zoster)
Medications that are prescribed to prevent causing painful blistering skin eruptions
certain infections in a specific group of along a nerve track in one area of the body.
The lesions are commonly seen on the neck,
abdomen and legs. The virus can also affect
the nerves of the eye.
Signs T Cells
Things you or someone else can see that are T Cells are a type of lymphocyte, or white
determined by measurement, such as an blood cell, which develops in the thymus
increase in temperature or blood pressure. gland which is located in the upper chest in
Sodium front of the heart.
A type of salt found in the blood and T cells are associated with acquired
required by the body to maintain the balance immunity or the ability of the body to fight
between electrolytes and water. an infection or foreign substance that is was
Spleen exposed to in the past. T Cells play a major
An organ located under the rib cage on the role in the rejection process.
left side of the abdomen. The spleen Thrombosis
removes old or deformed red blood cells, The development of a blood clot.
white blood cells, and platelets. It also Thrush
makes lymphocytes, a type of white blood Thrush is a fungal infection that looks like
cell that helps produce antibodies. The white plaques or spots in the mouth (oral
spleen may enlarge (splenomegaly) in mucous), throat, and on the tongue. Patients
patients with liver disease. who are immunosuppressed are more at risk
Splenomegaly for developing thrush.
Splenomegaly is a term used to describe an Tissue Typing
enlarged spleen. In patients with liver Identifying a person’s major antigens used
disease, splenomegaly results from portal to
hypertension. Splenomegaly can cause a evaluate the match between a donated
low platelet count that may increase the risk organ and a potential recipient via a blood
of bleeding. test.
Stricture or Stenosis Toxins
Narrowing of a passage in the body. Waste products in the blood that are
Systolic Blood Pressure poisonous to the body in high
The top number when the blood pressure is concentrations.
measured. This is the pressure when the
heart muscle contracts.
Things you feel, such as pain, dizziness or Ultrasound
fatigue. A method of picturing internal organs using
sound waves. Often used to detect masses,
abscesses, organ size, or blood flow to a
T transplanted organ.
T-Tube Urinary Catheter
A flexible tube may be placed inside the A soft rubber tube that is inserted into the
common bile duct to drain bile from the bladder to drain urine.
liver to the outside of the body into a Urinary Tract
drainage bag. Sometimes liver transplant The body system that produces, transport,
recipients have this drainage bag for a few stores and eliminates urine. The urinary
weeks after transplant to insure that bile is tract includes the kidneys, ureters, bladder
draining well from the transplanted liver. and urethra.
Urinary Tract Infection (UTI)
An infection of one or more parts of the
United Network for Organ Sharing
The national body that sets policies for
organ allocation in order to ensure fairness.
UNOS also maintains statistics on different
transplant programs and collects scientific
data on transplant recipients and donors.
Enlarged blood vessels, particularly in the
stomach and esophagus
A machine that helps a patient breathe.
A very small agent (germ) that causes
The measurement of temperature, blood
pressure, heart rate, and respiratory
To slowly withdraw or reduce;
Immunosuppression, particularly steroids,
may be weaned slowly over time in patients
who do not reject the transplanted liver.
White Blood Cells
Cells in the blood that fight infection; part
of the immune system.