Liver Transplant

Liver Transplant Patient Evaluation

Being selected as a good transplant candidate is based on a thorough review of the child’s:

• Current health condition
• Past medical history
• Psychosocial history
• Lab results
• Medical testing
• Financial status

Before being given an “Active Status” on the United Network for Organ Sharing (UNOS) list, children will undergo an extensive medical examination of body systems and corresponding tests to determine their ability to have a transplant. Tests include:

• Blood work, including blood typing
• Urine testing, including a 24-hour collection for kidney function
• EKG – electrocardiogram to assess heart condition
• Ultrasound of the abdomen to look a liver and blood vessels that connect to the liver
• Skin tuberculosis test (TB)
• Other types of x-rays, such as CT scans, MRI, heart and lung tests
• Possible liver biopsy

Children are not good transplant candidates if they have:

• Malignancy within two years (other than skin and certain renal tumors)
• Severe cardiovascular or pulmonary disease
• A positive HIV test
• Active infection
• Body Mass Index (BMI) is greater than 40
• Active alcohol or substance abuse
• Sickle cell disease
• Unstable psychiatric disorder
• Moderate to severe social deprivation
• Absence of funding for any part of the transplant process

Liver Transplant Waiting Times

After the evaluation, eligible patients are placed on the UNOS transplant waiting list. The MUSC Health Transplant Center’s wait times for an available liver are among the shortest in the nation. UNOS has a pre-determined process for prioritizing candidates waiting for liver transplants based on statistical formulas that are very accurate in predicting who needs a liver transplant most urgently. The MELD (Model for End Stage Liver Disease) is used for patients age 12 and older. The PELD (Pediatric End Stage Liver Disease Model) is used for patients age 11 and younger. MUSC physicians do not decide who is next to receive a liver from the transplant waiting list.

Liver Transplant Planning

Planning for a liver transplant includes the following:

• Determining what clothing and personal items will be needed at the hospital. A list is helpful to avoid last-minute stress.
• Deciding who will come to the hospital with the child. Write down phone numbers so they are readily available.
• Having directions to the MUSC Health Transplant Center. Write these down and call us in advance to verify.
• Stay in touch with the MUSC Health Transplant Center, especially if:

Liver Transplant – What To Expect

When the time comes for the liver transplant, children and families can expect:

• An abdominal scar
• Six days in the hospital – our length of stay is among the shortest, designed to reduce the risk of infection
• Five to seven days in a local hotel with a caregiver, visiting the MUSC transplant clinic daily
• Thorough post-transplant education

Our goal at MUSC Transplant Center is to provide the patient and family with key information about the pre-transplant evaluation and listing process, transplant surgery and post-transplant care so the patient can make an informed decision about transplant and successfully participate in their post-transplant care.

The information will be provided before wait list placement and again before transplant surgery. Patients are asked to review and sign a Patient Acknowledgement Form, indicating they have reviewed and understand all of the key information.

After the being sent home, patients can receive monthly care here at MUSC or at our outreach clinic in Greenville. Once at home, patients increase the chances of their transplant being successful by:

• Taking new medications daily
• Washing hands frequently
• Avoiding sick people
• Avoiding playing in the dirt

Families across the state and throughout the Southeast turn to us when their children’s lives are threatened by liver disease in four major categories:

• Cholestatic disease
• Metabolic disease
• Fulminant liver failure
• Chronic active hepatitis

A liver transplant may also be performed to treat:

• Malignancy
• Budd Chiari syndrome
• Parenteral nutrition induced cirrhosis
• Trauma
• Caroli’s disease