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Liver Transplant Journey

Liver Transplant Outcomes   Access FAQs

A liver transplantation truly is a journey, with distinct steps before, during and after the surgical procedure. Though each patient case is unique, the key steps in the transplant process typically include patient evaluation, preparation for transplant surgery and post-surgical care.

A detailed patient evaluation helps our team of experts decide whether a liver transplant is right for you. Your evaluation will:

  • Establish the need for liver transplant at this time
  • Evaluate your health to ensure transplant viability and recovery
  • Measure emotional, financial and social well being that will establish a positive path for life after transplant

Typically, several medical tests are needed to make sure the rest of your body is healthy enough to undergo major surgery. Testing includes (but is not limited to):

  • A physical exam by the hepatologist and surgeon
  • Blood tests to measure liver and kidney function, infection and blood type
  • A chest X-ray to look at your lung health
  • An EKG
  • An MRI or CT scan of your liver
  • Pulmonary (lung) function tests
  • A heart ultrasound (echocardiogram)
  • A heart stress test
  • A bone density test to look for possible osteoporosis (brittle bones)
  • An endoscopy to look for blocked or swollen vessels (varices) in the esophagus
  • A colonoscopy to look for colon polyps or colon cancer
  • Routine medical and dental check-ups
  • A TB skin test or blood test for TB
  • A Pap smear and mammogram for women

After reviewing your blood work certain vaccinations may also be required.

During your visit, patients meet with a transplant coordinator who will start teaching you about the liver transplant process. This is the liver transplant team member that you will see and talk with most often.

The transplant social worker will also meet with you to discuss your social support system and will give you information about planning for the added costs of the transplant process. Expenses typically include post-transplant medications, transportation costs and food and lodging while you are away from home following the transplant. Your social worker will also discuss fundraising methods to help pay for the cost of lifelong post-transplant medications.

Your support network is a very important part of the transplant team, in terms of emotional and logistical support. Typically, a patient's support team will assist with learning about medications, provide reliable transportation to the clinic and hospital before and after transplant, and will alert a patient's doctors if they notice something that you need.

Liver Donor Availability

When a liver becomes available you will be contacted by one of the transplant coordinators. They will instruct you to report to the hospital in a timely manner in preparation for surgery. This call may come at any time day or night. This is why it is important for the transplant team to have reliable contact information for you at all times.

Once you arrive at the hospital you will be admitted and undergo a chest X-ray, electrocardiogram (EKG), blood tests and urine tests to verify that you are ready for the transplant. You will have an opportunity to speak with an anesthesiologist and your surgeon to answer any last minute questions and to discuss what to expect during the procedure. The nurses will show you deep-breathing exercises to practice after surgery, which will help prevent infection. You'll also learn to use an incentive spirometer, a painless, easy-to-use device that will help your lungs expand.

When you are called in for a liver transplant this means that we have identified a potential donor organ for you. As part of the transplant process one of our surgeons will be required to remove the organ from the donor and return the donor liver to Piedmont to be transplanted by your surgeon.

There are times when the surgeon goes to remove the liver and finds that the donor liver is not suitable for transplant. In these situations we will need to cancel the planned transplant. Once you have been able to plan for transportation back home you will be discharged. Your place on the waiting list will be the same and we will call you again when we have identified another potential donor liver for you. These situations are rare, but unfortunate and we ask for your patience if you encounter such an event.

The Road to Recovery

After surgery: you will be in the Intensive Care Unit (ICU) for at least two days, where the nurses and the transplant team will monitor you closely. Here is what to expect:

Your vital signs (blood pressure, pulse, breathing and temperature) and blood sugars will be checked constantly.


Your urine output will be measured hourly.

Frequent labs and X-rays will be done.

You will have intravenous catheters in your hand, arm or neck for drawing blood.

You will be on a ventilator (breathing machine) that will breathe for you. You may remain on it for several days, depending on how sick you were before the transplant, how difficult your surgery was and whether your new liver starts working right away.

When you can breathe easily on your own, and the breathing tube will be removed, after which you will be asked to turn in bed, cough and breathe deeply at least every one to two hours while you're awake.

As your liver starts working normally and you require less monitoring, you will be moved to the Transplant Unit.

What else to expect:

  • You will be weighed daily.
  • You will be given medicine to control pain.
  • You will be given a breathing-exercise device to help improve the air movement in your lungs.
  • As soon as it is safe to do so, the nurses and physical therapists will help you start sitting up and walking.
  • You will have slow bowel action for a few days.
  • You will be taught how to clean and care for your incision.
  • When your bowels start working again, your diet will be advanced from ice chips, to liquids, to a regular diet. Your IVs will be removed when you are ready to go home.

When you go home:

When you return to normal activities depends on how closely you follow the instructions you received in the hospital, how quickly you recover and the kind of activity you want to do. Some things to remember:

  • Heavy lifting should be avoided for at least the first six weeks, to prevent a hernia.
  • To avoid infection, no swimming, hot tubs or saunas until your incision heals completely and the transplant team gives the go-ahead.
  • No driving until the team says so (usually about three months after your transplant)
  • Slowly increase your activity and exercise, but don't do too much too soon. Talk with your transplant team about exercise specifics.
  • It is common to return to school and perform non-strenuous work within a few months after surgery, especially if you were active prior to transplant.
  • You will always need medical care after your transplant, but over time the need for return visits will decrease. The transplant coordinators will work with you to manage your healthcare needs after your transplant and will keep in contact with the transplant team and your family doctors.
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