Description
Liver transplant is most often performed for patients with decompensated cirrhosis, but today there are more reasons than ever a patient may need one — including some cases of colorectal cancer that has spread to the liver. In this video, Dr. Katie Rude, hepatologist and transplant hepatologist at UAMS Health, explains what patients can expect during the liver transplant evaluation process. She describes the full medical, social, psychological, and financial evaluations that take place to ensure patients and their caregivers are ready for this life-changing procedure. Dr. Rude also explains how patients are added to the national liver transplant list, how MELD scores determine priority, and what recovery looks like after surgery. With a dedicated, multidisciplinary team of hepatologists, surgeons, nurses, social workers, pharmacists, and psychologists, UAMS Health provides comprehensive support before, during, and after transplant. Patients continue to receive lifelong care and monitoring, ensuring the best possible outcomes with their new liver.
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Transcript
The majority of liver transplants are done for patients with decompensated cirrhosis. However, there are more and more indications for liver transplant.
Now, patients can undergo liver transplant who have colorectal cancer that has metastasized to their liver. So those patients—they have to meet very strict inclusion and exclusion criteria. But considering that colorectal cancer is becoming more common in younger patients, we expect to see that we’ll have more referrals for liver transplant evaluation for patients with metastatic colon cancer.
When patients come into liver transplant clinic, I think at that point it’s really important to have the patient leave the clinic visit with a better understanding of their disease and their disease process—and what to expect.
When someone comes to liver transplant clinic, one of the things we do is determine if they even need a liver transplant evaluation—because sometimes they don’t. They may just have liver disease and need to be on the right medications. But oftentimes they do need a liver transplant evaluation.
And so what that entails—and we try to do it as quickly as we can—is a full medical evaluation. We have to make sure that their heart’s functioning well, that they don’t have breast cancer or colon cancer or something that’s going to exclude them from liver transplant.
We need to do a social evaluation. It is imperative that patients going through liver transplant evaluation—and that get liver transplant—have a good caregiver, or multiple caregivers, because that process is a lot for one person to take on. And they need family and friends that will be there for them while they’re in the hospital and after transplant. And so it’s a big social evaluation.
We even have a transplant psychologist that sees all of our patients who are being evaluated for liver transplant—sees the patient, evaluates the patient, meets their caregiver.
And then it’s also a financial evaluation as well. We want to make sure that patients are going to be able to afford their post-transplant medications that they have to be on for the rest of their life in order to make sure that their graft succeeds.
So again, we really function as a multidisciplinary team in liver transplant, which is something that I’m very proud of.
And then once we have completed that evaluation, then we meet in a large committee. That committee includes the hepatologists, the surgeons, the nurses, psychologists, social workers, pharmacists—really everyone on our team.
And then we determine if we think that patient should be listed for liver transplant based upon all of the testing that we’ve done. And if they are a candidate for liver transplant listing, then we put them on our liver transplant list.
That is a list that you are in a group with patients of your same blood type. And where you are on the list is determined by a score called the MELD score. And this is how it works everywhere in the country.
And that MELD score is determined by your labs. And so the patients with the highest MELD score—and therefore the sickest patients—are at the top of the liver transplant list within their blood type.
And at that point, you never know with transplant. Sometimes people are waiting for months. Sometimes patients are listed and then undergo liver transplant within the next few weeks.
And then after transplant, patients are usually in the hospital anywhere from about four days to maybe 10 days. And then they leave the hospital.
We transplant people from all over the state of Arkansas, but we ask them to stay within an hour or so of Little Rock for the first month after transplant because we really are keeping a close eye on them—sometimes seeing them in clinic twice a week, checking labs twice a week.
And we follow those patients for the rest of their lives, though. They require immunosuppression and monitoring of their new liver for the rest of their lives.
So I’ve been at UAMS for about 10 years now, and I still follow the first patient of mine that underwent a simultaneous liver-kidney transplant about a month after I arrived.
