Patient Education. Transplant Services. For a liver transplant

Transcription

1 Patient Education Preparing for Medical Evaluation, Labs & Tests For a liver transplant The evaluation process is complex and is unique to each patient. The Transplant Team will determine whether the real benefits of a liver transplant outweigh the known risks for you.

2 Preparing for Medical Evaluation, Labs & Tests Page 3-2 Liver Transplant Evaluation Referral to the Transplant Center You have been referred to UWMC s Liver Transplant Center. You and your doctor decided a liver transplant might be the best treatment option for you at this time or at some point in the future. Our team has requested a copy of your medical records. The Medical Evaluation At your first visit, the Transplant Team reviews your medical history and records. They will talk with you and your family about your current health. You will have a complete physical exam, and your questions will be answered. There are many factors in your medical history and present state of health that must be considered before putting your name on a waiting list for a liver transplant. You will not be listed until the medical evaluation ( work-up ) is complete and you have been approved by the Liver Transplant Committee. If it appears that you would benefit from a liver transplant, the work-up is started. We must find out if you are healthy enough to go through with the liver transplant operation. You will undergo

3 Page 3-3 Preparing for Medical Evaluation, Labs & Tests medical tests to look at major body systems, such as the heart and lungs. The dietician will discuss your eating habits and the nutritional needs for a person with liver disease. The work-up may reveal certain conditions that need to be corrected or treated before transplantation. In some cases, the workup may reveal a medical, social or financial problem that would eliminate you as a transplant candidate. All exams and tests at UWMC will be scheduled and coordinated by your scheduling coordinator. We may accept test results that have been done within the last six months. Special tests will be done if any problems are found or if you have other medical problems. The pretransplant evaluation process takes three to four full days of outpatient testing. This may take several weeks or months to complete based upon your schedule and the availability of appointments. It is in your best interest to schedule these appointments as soon as you can. The scheduling coordinator works on your behalf to expedite your work-up. We attempt to accommodate your schedule as much as possible. In some cases, the work-up may reveal a medical, social or financial problem that would eliminate you as a transplant candidate.

4 Preparing for Medical Evaluation, Labs & Tests Page 3-4 If your situation becomes critical, we may hospitalize you to expedite the work-up in an effort to get you listed for liver transplantation sooner. Blood Work for Compatibility A blood test shows whether a donated liver is suitable for liver transplantation. The ABO red blood cell match is a test that shows which red blood cell types are compatible between you and the donor. This is the most important consideration in finding a suitable match. People are identified as blood type A, B, AB, or O. Type O is the most common, followed by type A. Only a small percentage of people have type B or type AB blood. Other Evaluations The social worker will discuss personal, family, and financial situations, including drug and alcohol history (see Social Services section). You will meet with the transplant surgeon to discuss the surgical procedure (see Surgery section). Liver Transplant Class This is a two- to three-hour class for you and your family taught by the transplant nurse coordinator and the transplant pharmacist. The class provides an

5 Page 3-5 Preparing for Medical Evaluation, Labs & Tests overview of the transplant surgery, review of the post-operative follow-up, review of transplant medications and their side effects, and answers to many basic questions. The class is educational in nature and no assessment of individual patient transplant candidacy is made during this time. We ask that you bring your primary support person(s) to class. This support is an important aspect of the transplant process. If they cannot attend class with you, they are welcome to talk with the patient care coordinator about coming on a different day. Financial Evaluation The financial staff will work with you to arrange funding for your liver transplant. Prior to admission for a liver transplant, funding must be established. Patients who do not have enough insurance coverage will be required to make a financial deposit before being accepted and listed for a liver transplant. If you do not have the resources to make this deposit, your social worker can advise you about fundraising activities, etc. Talk with your social worker or financial counselor for more details.

6 Preparing for Medical Evaluation, Labs & Tests Page 3-6 After transplantation, you will be medically disabled for at least six weeks. It is likely that you will be readmitted to the hospital within the first three months after transplant. This would also prevent you from returning to work. Plan to be off full-time work for at least three months after the transplant. The Evaluation Process At a Glance This is a summary of the exams, tests and interviews required of all liver transplant candidates. A more detailed description of individual tests is included under the Tests & Labs subheading in this section (see page 3-8). Interviews with a nurse coordinator, hepatologist, social worker, dietitian and financial counselor Blood tests complete blood chemistry, blood type, arterial blood gas, HIV (for AIDS), hepatitis and other virus blood screening Urine tests to check your kidney function Chest X-ray to find out if you have any lung problems

7 Page 3-7 Preparing for Medical Evaluation, Labs & Tests Bone density studies and spine X- rays to determine health of your bone structure Dental exam to show that no cavities need to be filled or other dental work needs to be done before transplant; this includes a signed dental clearance form from your dentist Abdomen CT scan to look at your liver and blood vessels Heart tests echocardiogram, electrocardiogram (ECG) and persantine thallium; to look at your heart function Skin tests to test for tuberculosis (also called a PPD test) Immunizations vaccinations for influenza, pneumonia, hepatitis A and B, and tetanus Mammogram for female patients Pelvic exam and pap smear for female patients Again, you must attend the transplant class.

8 Preparing for Medical Evaluation, Labs & Tests Page 3-8 Optional Tests May Include: Liver ultrasound Gastrointestinal endoscopy Pulmonary function tests Colon studies colonoscopy or barium enema Consults with bone specialist, cardiologist and pulmonologist Tests & Labs This section provides you with information on the various tests which are commonly scheduled as part of the transplant work-up. Not all patients will need all of these tests. Your patient care coordinator makes these appointments and will send you a letter with your schedule.

9 Page 3-9 Preparing for Medical Evaluation, Labs & Tests CT Scan of the Abdomen Department Radiology Place 2nd Floor, near the Pacific Elevators Phone Hours Mon.-Fri. 8:00 a.m.-9:00 p.m. Takes about 2 hours This is a procedure during which technicians take pictures (X-rays) of your abdomen to view the liver, blood vessels and other organs. Before the test, you will be required to drink several cups of contrast dye. During the test, you will also receive some contrast dye through a needle in a vein in your arm. Drink a lot of fluids after the test to flush the dye out of your system. You should not eat or drink anything (except medications) after you go to bed the night before your CT scan.

10 Preparing for Medical Evaluation, Labs & Tests Page 3-10 Chest X-ray Department Radiology Place 2nd Floor, near the Pacific Elevators Phone Hours Mon.-Fri. 8:00 a.m.- 9:00 p.m. Takes about minutes Since you do not need an appointment for this test, you may have to wait a while if the department is busy. Early mornings are a good time to have this test done. Your coordinator will send a requisition for you. You will disrobe from the waist up. A chest X-ray will be done again when you are admitted for transplant surgery.

11 Page 3-11 Preparing for Medical Evaluation, Labs & Tests Electrocardiogram (ECG or EKG) Department Cardiology Place 4-North, 4th Floor, near the Pacific Elevators Phone Hours Mon.-Fri. 8:00 a.m.-9:00 p.m. Takes about 20 minutes An ECG or EKG is a graphic record of your heart s electrical action. There is no special preparation for this test. An ECG or EKG will be done again when you are readmitted for transplant surgery. Echocardiogram (Echo) Department Cardiology Place 4-North, 4th Floor, near the Pacific Elevators Phone Hours Mon.-Fri. 8:00 a.m.- 9:00 p.m. Takes about 1 hour This is a simple test that is similar to ultrasound. Sound waves are bounced off

12 Preparing for Medical Evaluation, Labs & Tests Page 3-12 your heart to look at the chambers of the heart and to see if the heart walls move normally. The technicians will put some gel over the left side of your chest and roll a transducer over your skin. There are no dietary restrictions for an echocardiogram. Heart Stress Test Persantine Thallium Department Nuclear Medicine Place 2nd Floor, near the Pacific Elevators Phone Hours Mon.-Fri. 8:00 a.m.-5:00 p.m. Takes about 4-5 hours The purpose of this exam is to check the supply of blood to your heart muscle. Through an intravenous (IV) catheter, you will be given a drug called persantine, which will stress your heart. After this, a small amount of radioactive thallium will be given so that pictures of your heart can be taken. After this, the persantine will be inactivated with aminophylline and you

13 Page 3-13 Preparing for Medical Evaluation, Labs & Tests will be asked to return three-and-a-half hours later for a repeat picture of your heart. You should not eat or drink anything (except medications) after you go to bed the night before the stress test. You must avoid caffeine products (coffee, tea, cola) for 24 hours before the test. Blood Tests / Urine Tests Department Laboratory Services Place 3rd Floor, near Surgery Clinic Phone Hours Mon.-Fri. 7:30 a.m.-5:00 p.m. Takes about minutes Your patient care coordinator will inform you of tests that require special dietary restrictions. The blood tests will check your blood chemistries, blood count, and blood type and find out if you ve been exposed to viral illnesses such as HIV. A urine test will be done. The urine will also be cultured to detect any bacteria that may be present. Routine blood and urine tests may be done in the Evening Blood Draw Area on the second floor only by

14 Preparing for Medical Evaluation, Labs & Tests Page 3-14 special arrangement for those people who work during the day. Immunizations and Skin Tests Department Transplant Clinic Place 3rd Floor, near the Pacific Elevators Phone Hours Mon.-Wed. 8:00 a.m.-5:00 p.m. Takes about minutes There are no dietary restrictions for these tests. The immunizations you will need to receive will be for pneumonia, influenza and hepatitis. Please let the nurse coordinator know if you have previously been immunized for any of these conditions. If you are receiving a PPD (tuberculosis) skin test, you will be required to return to the clinic within 48 hours to have the results read. This test must be performed on Monday, Tuesday or Wednesday. Please tell your transplant nurse coordinator if you have had a positive test in the past.

15 Page 3-15 Preparing for Medical Evaluation, Labs & Tests Mammogram Department Radiology Place 2nd Floor, near the Pacific Elevators Phone Hours Mon.-Fri. 8:00 a.m.-5:00 p.m. Takes about 20 minutes This is a simple, safe X-ray to show abnormalities of the breast. Ultrasound of Your Liver Department Radiology Place 2nd Floor, near the Pacific Elevators Phone Hours Mon.-Fri. 8:00 a.m.-4:30 p.m. Takes about 1 hour An ultrasound is a test in which sound waves are bounced off the liver and major blood vessels to find out their size, any abnormalities and the flow of blood in the vessels. This test is not painful. The

16 Preparing for Medical Evaluation, Labs & Tests Page 3-16 ultrasound technicians will put some gel on your abdomen and roll a transducer over your skin. You should not eat or drink anything (except medications) after you go to bed the night before the ultrasound. GI Endoscopy Department GI Endoscopy Clinic Place 3rd Floor, behind Neurology Clinic (near Pacific Elevators) Phone Hours Mon.-Fri. 8:00 a.m.-9:00 p.m. Takes about 2-3 hours An upper endoscopy is an exam where a tube is passed through your mouth and throat and into your stomach. The test is done to look for varices (bulging blood vessels in the esophagus and stomach caused by back-up of the blood from the cirrhotic liver). Varices can occur in patients with late-stage liver disease. IV medication is given to help you relax and keep you comfortable during the procedure. You should not eat or drink

17 Page 3-17 Preparing for Medical Evaluation, Labs & Tests anything (except medications) after you go to bed the night before your endoscopy. Pulmonary Tests Department Pulmonary Diagnostics Place 2nd Floor, near Cascade Elevators Phone Hours Mon.-Fri. 8:00 a.m.-5:00 p.m. Takes about 2 hours You may be required to do a full two hours of breathing tests to make sure your lungs are strong enough to make it through the surgery and the post-operative period. The technicians will have you breathe into a variety of tubes and machines to check your lung capacity. The technicians will also draw a small sample of blood from your wrist to see how well you oxygenate your blood.

18 Preparing for Medical Evaluation, Labs & Tests Page 3-18 Who makes the decision about transplantation? Candidacy After all the tests and consults are completed, your case is presented to the Liver Transplant Committee. Members of the liver Transplant Team are present, and your case is discussed. There are two decisions to be made at this time. First, it will be decided if you meet criteria for a liver transplant. Criteria for candidacy include but are not limited to: The presence of end-stage liver disease, which cannot be cured by other medical treatments At least six months abstinence from alcohol and illicit substances and at least two months from nicotine products Stable support system such as family and friends Full understanding of the transplant process Ability and demonstrated compliance to the medical care required No active infections

19 Page 3-19 Preparing for Medical Evaluation, Labs & Tests No active cancer, with the exception of some liver tumors No other medical conditions that will interfere with your recovery from a transplant (such as heart or lung disease) Secondly, the team will decide your candidate category of: Accepted: The person meets criteria for transplant and is listed when the entire workup is completed. A person continues in this status unless something is found in additional tests that is a contraindication for transplant. Deferred: The person does not currently meet criteria for transplant, but the team is willing to work with the individual so they might meet criteria. For example: a medical problem that needs specific treatment, counseling for psychiatric diagnosis or treatment for past alcohol or drug abuse. If the requirements are completed, the case will be presented again. A person who is deferred may be given a time limit with the expectation that requirements will be completed.

20 Preparing for Medical Evaluation, Labs & Tests Page 3-20 Denied: The person does not meet criteria either due to medical or psychosocial reasons. For example: individuals who make the choice not to follow through with recommendations from the committee are declined based on poor compliance with the medical care required. The selection of a specific patient will be based on the merits for candidacy. The team will work with each patient to establish his or her candidacy. The team relies on you to come to all appointments and to complete all of the recommendations from the committee. The coordinators and support staff will work with you to schedule follow-up visits.

21 Page 3-21 Preparing for Medical Evaluation, Labs & Tests Make the Most of Your Waiting Time If Listed: Set up childcare or guardianship, if needed. Make plans for your pets, if needed. Arrange all forms of transportation to and from UWMC (this includes airline, taxi and other sources through friends and family). If you will be traveling to UWMC by airplane, you must check into all available flights to Seattle- Tacoma International Airport based on a 24-hour schedule. Discuss this with a travel agent to make plans ahead of time if possible. If you are a Medicaid recipient, and you live outside of a two-hour radius from UWMC, you must contact your local Medicaid Transportation Broker for assistance with an open-ended ticket. If you have private insurance, you may contact your insurance case manager to ask about travel benefits. Plan financially for meals and lodging.

22 Preparing for Medical Evaluation, Labs & Tests Page 3-22 Make sure that your pager is on 24 hours a day and you have an extra supply of functioning batteries. Obtain an answering machine or voice mail service. If you are anticipating a transplant, you should keep a living will and durable power of attorney ready. This takes time to prepare, so do it even before you are listed. Contact your social worker for sample forms, if needed. Ask your doctor about any doubts or concerns you may have. No question is stupid, nor is any concern irrelevant. You may also attend a surgeon s talk at UWMC. It is helpful to prepare your list of questions ahead of time. The Internet is a vast but not necessarily correct or up-to-date source for information about your transplant. Your doctor is the best person to answer questions. Read all that you can, but please rely on your doctor for medical decision-making.

23 Page 3-23 Preparing for Medical Evaluation, Labs & Tests Notes

24 Preparing for Medical Evaluation, Labs & Tests Page 3-24 Questions? Notes Your questions are important. Call your transplant coordinator during business hours Box N.E. Pacific St., Seattle, WA University of Washington Medical Center 06/2003 UH1914