Patient Tests

Doppler Ultrasound of the Liver
This is a non-invasive procedure that provides the transplant surgeon with information necessary for the surgical procedure, such as the portal vein size, direction of flow, liver vessel patency, and liver size. Patients should not eat or drink for 8 to 12 hours before the test. The procedure takes about 30 to 60 minutes.

Computerized Tomography (CT) Scan of the Abdomen with Contrast
The CT Scan provides a series of cross-sectional images in sequence that creates a three-dimensional picture. This scan will identify abnormal structures or masses in the body. This test also can give information regarding the size of the liver, which will be useful in determining a suitable donor. A contrast media (dye) may be used to enhance the images either through drinking the contrast media or intravenous injection. Patients allergic to iodine should advise the hospital immediately. Patients also will be requested to sign a consent form if dye is used. Patients should have no food or drink for 4 to 8 hours before the test. This test takes about 90 minutes.

MRI (Magnetic Resonance Imaging)
This technique provides images through a combination of computers, radio waves and a powerful magnet. Serial images are obtained to give information about the size and structure of the liver and specifically if there are any masses in the liver. This test may be requested if patients are unable to tolerate the dye required for the CT Scan. This test takes about an hour.

Esophagogastroduodenoscopy/Upper Endoscopy
A flexible tube is passed through the mouth into the stomach as the physician visually inspects the esophagus, stomach, and first portion of the small bowel (the duodenum). The physician is inspecting for varices (distended blood vessels), inflammation, and/or ulcers. Patients will be asked to sign a consent form for this procedure. Again, patients must not eat or drink for 8 to 12 hours before this test. The procedure will take 30 to 45 minutes. After the procedure is completed, patients should not eat or drink for 2 to 4 hours. A nurse will monitor the patient's vital signs during and after the procedure. Because of the sedation, patients should bring someone with them to drive them home.

Flexible Sigmoidoscopy
All patients over 40 will be required to have this test conducted for cancer screening. A long tube is passed into the rectum to visually inspect the lining (mucosa) of the rectum and sigmoid colon. If polyps are identified, a biopsy will be performed. Patients must sign a consent form for this procedure. A light dinner the night before and a light breakfast may be allowed. Heavy meals, fruits, vegetables and milk products should be avoided for 24 hours prior to this test.

Colonoscopy
If the sigmoidoscopy identifies polyps, the physician will require a full colonoscopy to visualize more of the colon. The preparation is similar to that above. In this test, however, the scope is passed further into the colon.

Liver Biopsy
Obtaining liver tissue allows physicians to inspect the tissue and determine the cause of liver failure. The liver biopsy may be obtained in three ways: 1) percutaneous-a needle inserted through the skin, 2) laparoscopy-the biopsy obtained through a small tube introduced into the abdomen to visualize the liver, or 3) directly during an abdominal surgical procedure. For the percutaneous biopsy or laparoscopy biopsy, patients will be asked to sign a consent. Preparation is minimal for the needle biopsy through the skin. Patients are not required to fast before this test. This procedure takes as little as 10 to 15 minutes. However, patients are required to stay in bed for at least four hours after the biopsy.

Cardiology Evaluation
Based on the patient's age and history of illness, he/she will be asked to have several examinations performed to provide physicians with information to establish the relevant risks in transplantation. All patients will have at least an EKG, Echocardiogram and chest x-ray.

Electrocardiogram (EKG)
This is a graphic picture of the heart's electrical activity, obtained by placing 12 leads or electrodes on the chest, arms, and legs. The rhythm of the heart is traced onto paper for the physicians to inspect. Abnormal rhythms or heart rate is detected in this manner. There is no preparation for this test. It will take about 10 minutes for the tracing to be run.

Two-dimensional Echocardiogram
An echocardiogram can determine the size, shape and position of the heart, as well as the movement of the heart valves and chambers. The physician providing this evaluation must measure the pulmonary artery pressure. This is a non-invasive test that requires no preparation. This procedure takes approximately 30 minutes.

Thallium Stress Test
A stress test is used to detect coronary artery disease. Exercise will enhance any potential abnormalities and better help the physician evaluate the heart's potential ability to tolerate the anesthesia and stress placed on the heart during the transplant procedure. Consent is required. The patient should not eat or drink, especially alcohol or caffeine, or smoke for 2 to 3 hours before this test. A light breakfast may be acceptable based on the time scheduled. The exercise portion of the test takes about one hour, but the patient will be asked to return a few hours later for a follow-up scan.

Dobutamine Stress Echocardiogram
This is the preferable method to study the heart. It combines the Echocardiogram and the Stress Echocardiogram into one exam to provide information on both the electrical activity and functional ability of the heart. Pulmonary artery pressure is accurately measured. Consent is required. The patient should not drink alcoholic, caffeinated, or decaffeinated beverages (coffee, tea, colas, or chocolate) after midnight the night before the test. The patient also should not eat for two hours prior to the test. The exam takes about two hours.

Right Heart Catheterization
This test allows physicians to directly measure the pressure in the right side of the heart. Pulmonary hypertension is extremely dangerous for anyone undergoing liver transplantation. If there are indications of this condition by echocardiogram, direct and accurate pressures must be measured. A consent form must be signed. There is no special after care required. This test should take about an hour.

Cardiac Catheterization
Cardiac catheterization provides visualization of the vessels to determine patency of the coronary arteries, heart size, structure of the valves and pulmonary pressures. The patient may be required to come to the hospital the morning of the test, but may be asked to stay overnight. The patient may not eat or drink after midnight the night before the test. A consent form must be signed. The procedure takes between two and three hours.

Cardiac Consultation
The patient may be asked to see a cardiology specialist to give the transplant team an opinion as to the risk of liver transplantation. The cardiologist will utilize the above data to reach a conclusion.

Pulmonary Evaluation
Based on individual health status, the patient may be asked to undergo pulmonary function tests and arterial blood gases. If the patient smokes, it is very important that he/she does not smoke from this time forward. Smoke paralyzes cilia, which are very fine hair-like structures that help clear secretions from the lungs. This is very important in avoiding pneumonia, especially when undergoing a long surgical procedure, such as a transplant.

Pulmonary Function Test
This test measures the ability of your lungs to expand and the capacity for gas exchange. The patient will be asked to sit in a special booth and breath through a mouthpiece. A clip will be placed on the nose to prevent air exchange other than through the mouth. Food and drink should be restricted before a pulmonary function test. A light breakfast usually is acceptable. This test takes approximately 45 minutes.

Arterial Blood Gases
Arterial blood gas analysis will provide information as to how well the patient's blood is oxygenated. This is a simple blood test but the blood is drawn from an artery instead of a vein. It may hurt a bit more than when an IV is inserted.

Renal (Kidney) Evaluation
Evaluation of kidney function is important to determine if there is any chronic kidney failure. Diabetes and hypertension can predispose kidney failure. The medications the patient will be on after the transplant can decrease the effectiveness of the kidneys. We must identify those issues before the transplant. A small number of candidates have required both a liver and a kidney transplant.

Other tests may include:

• Creatinine Clearance
• Glofil
• Nephrologist Evaluation
• Psychological-Sociological Evaluation
• Dental Evaluation
• Gynecological Evaluation
• PAP Smear
• Mammogram

BLOOD WORK
In addition, completed blood work may be evaluated for the following information:

Tissue Typing
Blood will be taken to establish blood type, which is a key component in identifying an appropriate organ donor.

PRA
This blood test measures how well the patient will match with any potential donor.

Virology
Blood will be tested for many different viruses, including hepatitis, CMV (cytomegalo-virus), and HIV.

Chemistries
Liver function tests and kidney function tests will give important information in determining when transplant will be necessary.

Hematology and Coagulation Studies
Blood count, platelet count and clotting studies also are important in determining the status of liver condition and general condition.