Living Liver Donor Program
Additional Surgical Services
The liver transplant program at University Health System
- Established in 1992
- Experienced rapid growth
- Excellent outcomes
- Performed over 650 liver transplants
- Patient survival at one year remains an outstanding 90% and at three years an impressive 80%
- New approaches include the use of split-liver transplants
- Living related liver transplants
Symptoms of Liver Disease
- Chronic fatigue
- Encephalopathy (Confusion due to an elevated ammonia level)
- Increasing jaundice (yellowing of skin and/or eyes)
- Ascites (fluid collected in the abdominal area)
- Pruritus (uncontrolled itching)
- Variceal bleeding
- Blood clotting problems
Diagnoses...
A liver transplant may be needed for the following diseases:
- Hepatitis
- Alcoholic liver disease (six months abstinence required)
- Primary Biliary Cirrhosis (PBC)
- Primary Sclerosing Cholangitis (PSC)
- Autoimmune liver disease
- Cirrhosis of unknown origin
- Sudden acute liver failure
Reasons not to transplant
- HIV
- Cancer (not in the liver)
- Gallbladder cancer
- Uncontrolled infection in the body
- Advanced heart or lung disease
- Active drinking or substance abuse
Listing Criteria...
The United Network for Organ Sharing (UNOS) has set national guidelines to classify patients—the MELD scoring system.
All patients are listed according to this national points system and their blood type. Points are determined by the severity of the liver disease based on three blood results: total bilirubin, creatinine and INR.
Patients with alcoholic liver disease will be asked to sign an agreement stating that they will follow our program guidelines, which include random drug and alcohol testing.
Referral of patients...
Patients must have a primary care doctor and must be referred by a doctor.
Referral should be considered in patients with:
- TIPPS or surgical shunts
- Liver tumors
- Uncontrolled ascites
- Uncontrolled encephalopathy
- Frequent variceal bleeds
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Hepatopulmonary syndrome
Once referred, a patient is assigned to a registered nurse transplant coordinator who will assist the patient from referral to transplant.
Evaluation...
Patients must be evaluated to determine their candidacy for transplantation. This process can take a few days to several weeks depending upon the general health of the patient. All patients are required to do the following:
- Blood work
- See our hepatologist (liver specialist)
- Evaluation by transplant surgeon
- Interview with our Social Services
- Radiology exams (CAT scan or MRI of abdomen, chest x-ray)
- Heart and lung tests
- Kidney tests
Transplant Surgery...
Most transplant patients:
- Are in surgery 3-5 hours
- Use an average of 5 units of blood
- Spend two days in the intensive care unit
- Are discharged 6-10 days after their surgery
Follow-up Care..
Patients are followed closely in our clinic the first 3 months after transplant. Medications are quickly lowered during this time. Three to six months after transplant we start sharing responsibility with the referring doctor taking care of the patient. The patient will come back to us for routine visits with blood work every 6 months. We strongly encourage the referring doctor to contact us with any questions or problems.
Results...
The volume of liver transplants at UTHSCSA continue to grow, making us one of the most active transplant centers in the United States.
Other Areas of Expertise...
In addition to multi-organ transplantation, we are surgically helping people with liver disorders who may not require a transplant. These include:
- Liver tumors (malignant and non-malignant)
- resections
- heat ablation therapy
- Gallbladder cancer
- Biliary disorders
- Pancreatic disorders
- Surgery for portal hypertension
