Liver disease can be genetic or caused by a variety of factors that damage the liver, such as viruses, alcohol use and obesity. Since your liver is essential for digesting food and ridding your body of toxic substances, it can be life threatening when it gets damaged or stops functioning properly. Over time, conditions that damage the liver can lead to scarring (cirrhosis), which can lead to liver failure, a life-threatening condition.
A liver transplant is an option when the liver can no longer perform vital functions and when the liver disease cannot be corrected in any other way. UofL Health – Trager Transplant Center has been serving liver transplant patients from Kentucky, Indiana, Tennessee and Ohio since 1990. Our team even performed Kentucky’s first adult liver transplant.
Most patients qualifying for a liver transplant suffer from some form of liver cancer, often caused by cirrhosis or Hepatocellular Carcinoma, the most common form of liver cancer. However, liver failure can also result from other diseases or, in rare cases, certain types of medications.
The Liver Transplant Program has a comprehensive team of liver experts who work together closely to provide personalized and high-quality patient care. From the time we are introduced to potential liver transplant patients and their families, through their transition to life outside the hospital, our focus is on easing that journey for all involved.
Start here to learn more about different stages of liver transplant:
- Consultation & Evaluation
- Preparing and Waiting for Transplant
- The Transplant
- Life After Transplant
Consultation & Evaluation
Our Liver Transplant Program uses a multidisciplinary approach to patient care, meaning our team is made up of experts who have different backgrounds. During the liver transplant evaluation phase, you will be seen by our medical, surgical, dietary and psychosocial teams. Their shared goal is to do a complete and thorough analysis of each individual patient to determine if he/she is a candidate for transplantation.
The pre-transplant evaluation consists of:
- Initial phone interview/medical history questionnaire
- Complete medical testing that includes:
- Lab work
- Abdominal ultrasound to look at the organs in the abdomen, such as the liver
- CT or MRI of abdomen to study the issue causing your liver disease
- Electrocardiogram (EKG or ECG) that checks for electrical problems in your heart
- Chest x-ray to look at the structures in and around your chest
- Stress test to monitor your heart rhythm, blood pressure and breathing during exercise
- Pulmonary function tests that measure how well your lungs take in and exhale air
- Appointments with social worker and dietitian
- Education class
When you are referred for a possible liver transplant, we must obtain insurance approval before any appointments can be scheduled. Insurance is needed not only to cover the actual transplant, but also for the anti-rejection medications you will be on for the remainder of your life after transplant. Once your pre-transplant evaluation tests and appointments are complete, the team will review your results and determine if you are a candidate for a liver transplant.
Preparing and Waiting for Transplant
Candidates for liver transplant are ranked on the wait list by their model for end-stage liver disease (MELD) score. The MELD score is calculated from four lab tests and ranges from six (healthy liver) to 40 (critically ill) and helps determine which liver transplant candidates are at the highest need for a new liver. The four lab tests used are:
- Bilirubin (measurement of liver function)
- Creatinine (measurement of kidney function)
- Sodium (assesses body’s ability to manage fluids and electrolytes)
- International Normalised Ratio – INR (test that checks how long it takes blood to clot)
Once you are placed on the liver transplant wait list, you will need to update certain labs/tests every six months to ensure that you are still an appropriate candidate for transplantation. Those appointments must be completed at UofL Health – Trager Transplant Center.
It is extremely important our transplant coordinators can contact you at any time, day or night, while you are on the waitlist. When a suitable liver becomes available for you, the transplant coordinator will call you and discuss the potential transplant. They will ask you about your current health status and if there have been any changes in your insurance, and you will be given instructions on where and when you should come to UofL Health – Trager Transplant Center.
Once you arrive at UofL Health – Jewish Hospital, you will be taken to your room to be prepared for surgery. Lab work, EKG and Chest x-ray will be performed to ensure that you are well enough for surgery.
The transplant incision will extend from the sternum to the umbilical area and then out several inches on either side of the umbilicus. This type of incision is commonly referred to as a “chevron incision.” The liver transplant operation itself takes around six to eight hours, and you will also need to be monitored for a few hours following the surgery.
Your family should stay with you until you go to the operating room and remain at the hospital while you are in surgery. While in the surgery waiting area, they will receive periodic updates on your status.
Patients are then transferred to UofL Health – Jewish Hospital’s intensive care unit (ICU) to recover. Visitation is open within the ICU, but families may be asked to step out periodically for various bedside procedures. Each patient will come out of surgery on a ventilator, have multiple abdominal drains (to help prevent fluid buildup and potential infections), a drain coming out of their nose, several IV sites and a catheter in their bladder.
Life After Transplant
When you return home, you will be expected to see your primary care physician (PCP). It is essential that you have a primary physician who can assist us in your long-term care. It is very important that you notify your transplant coordinator immediately if your PCP changes your medications or adds a medication. Any changes to your medication may interfere with your transplant medications.
You will meet with your transplant team including a surgeon, transplant coordinator and/or a hepatologist every week for one month. After approximately one month your appointments will change once monthly for a year. You will be obtaining lab work often, and this can be done at your local facility.
- If another physician prescribes medication for you, check with your transplant doctor or transplant nurse before taking it.
- Do not take over the counter medication unless you have checked with your liver doctor or transplant coordinator. This includes herbal preparations.
- Never take aspirin or other medications containing aspirin (such as Alka-Seltzer) unless directed by your physician. Aspirin is irritating to the stomach and can cause bleeding ulcers. Tylenol is acceptable for occasional aches and pains. Do not exceed six regular strength Tylenol in 24 hours.
- Never change or stop any medication that has been prescribed for you without checking with your doctor first.
- DO NOT EAT GRAPEFRUIT in any form.
- Do not take Tums, Rolaids, Mylanta, or Pepto-Bismol at the same time as your medicines.
- Do not take your medications with chocolate milk.
- Always take your medications as prescribed. Call the transplant center if you miss a dose, are unsure if you took a dose, or if you have vomiting.
- Remember to take your medications with you if you go on vacation or travel frequently.
- Know the name, address and phone number of the nearest hospital and pharmacy when you plan to be away from home.
- Your doctor may put you on a special diet or may have counseled you to eat a “low salt” diet after your transplant. Either way, we recommend that you follow certain guidelines after your transplant surgery.
- The reason for the specialized diet is that the drugs used to prevent rejection (steroids) cause a “puffiness” or fat deposits in the face and across the upper back, called the “cushingoid effect.” Reducing carbohydrates and increasing protein intake for three to six months seems to decrease this side effect of the medicine. If you have this diet, the hospital dietitian will explain exactly how you can plan your meals.
- The drugs you take to prevent rejection also cause an increase in appetite. We recommend you follow the list below during your transplant period.
- No driving for two to four weeks after transplant. You must have stopped taking pain pills before you will be allowed to drive. You must be cleared to drive by either the transplant doctors or nurse coordinators.
- No heavy lifting, straining or pulling of stomach muscles with sit-ups for three months. No lifting anything over 10 lbs.
- No contact sports (football, soccer, etc.)
- No swimming in fresh water and no swimming in pools or hot tubs until the incision has healed.
- Sometimes you will find your muscles are weak, especially in your legs. This could be a side effect of prednisone. Walking, bike riding, swimming, and aerobics are an excellent way to improve the strength of your leg muscles. After approval from your doctors, you should exercise a minimum of three days a week for 30 minutes each day.
- It is extremely important that you practice good dental and oral hygiene after your transplant. Brush your teeth twice per day and floss daily. You should see you dentist every six months.
- The mouth contains many harmful types of bacteria. These bacteria can enter your bloodstream during a dental procedure. To protect your body from infection, you will need to take an antibiotic before each dental visit.
- Consult your physician for the proper antibiotic regimen.
- You should only have emergency dental care for the first 3 to 6 months after your transplant.
- You should have your eyes examined on a yearly basis, or if you notice any changes in your vision. Prednisone can cause blurred vision or cataracts, and these conditions should be treated.
- You should not plan to travel for at least three months after transplant or until the transplant team has cleared you medically. Complications are most common during the first three months, and you may require hospitalizations to treat them. You must discuss travel plans with the transplant team.
- When traveling to a foreign country, drink bottled water and avoid ice in drinks. Brush your teeth and rinse your mouth with bottled water.
- Always carry more medications than you will need for your trip. Immunosuppressants may not be readily available in other countries. If your return to the USA is delayed, you may not be able to obtain the medications that you need. Always carry medication in your purse or carry-on baggage. DO NOT pack your medications in your check-in luggage.
- You must always receive appropriate vaccinations before you travel.
- Transplant recipients often ask about their pets at home. There is no need to give away a pet, although there are some guidelines.
- It is recommended that the transplant recipient avoids cleaning up after the pet. This includes, but is not limited to, hamster, gerbil or bird cages, as well as fish tanks.
Immunizations & Shots
- It is recommended that you receive a flu vaccine every year unless the transplant doctors or nurse coordinators tell you otherwise.
- You should NEVER receive the nasal spray flu vaccine. You can get a flu shot from either your primary care doctor or at a pharmacy that is providing them. The transplant center does not give out flu shots.
- You must never receive immunizations for smallpox, measles, rubella, or any vaccine containing a live virus. You should be separated from any infants or small children who have received the polio vaccine or any live virus vaccine for at least three weeks. Also stay away from anyone with these diseases for at least three weeks.
- If you plan a trip to a foreign country that requires any of these, please contact us. We will write a letter to the passport bureau stating that you cannot receive these vaccines.