Diagnosis and Pre-transplant

Some patients might have an irreversible liver disease, but not enough to warrant a transplant, whereas others might be too ill to benefit from a transplant. This assessment can be best made by doctors who specialize in liver diseases i.e. liver transplant surgeons and Hepatologists.

Signs and symptoms of liver disease, and results of some blood tests are commonly used to determine severity of liver disease, which, in turn, determine the treatment required. There are certain scoring systems that indicate the severity of the liver disease. These are the Child-Pugh-Turcotte (CTP) Score, CTP Class (A, B, or C) and Model for End Stage Liver Disease (MELD) Score, and PELD Score. A high score will mean an early transplant, and a low scoring patient may not require a transplant. Patients whose liver disease is affecting other organ systems such as kidney, lungs and brain, may also need an early transplant.

Patients with liver cancer are often diagnosed through routine screening tests such as ultrasound, CT scan or MRI. They might require an early transplant despite not suffering a severe underlying liver disease.

Transplantation will not be offered to patients with current alcohol abuse problems, those with uncontrolled active infections, widespread cancer or severe, untreatable disease of the brain, heart or lungs.

What are the signs and symptoms of liver disease?

Unfortunately patients with cirrhosis feel normal until End Stage Liver Disease sets in, when the following symptoms may develop:

  • Yellowness of the skin and white portions of the eyes or passing dark yellow urine (jaundice)
  • Swollen abdomen – fluid build-up in abdomen (ascites)
  • Excessive sleepiness, inability to sleep, becoming forgetful, drowsy or confused (encephalopathy), due to build-up of ammonia and other toxins
  • Throwing up blood (blood vomiting), passing tarry black stools or fresh red bleeding in stools due to bleeding in intestines
  • Passing light or clay coloured stools
  • Easy or excessive bruising or bleeding, even from simple wounds
  • Constant and severe itching (pruritus) all over the body
  • Tiredness or weakness
  • Loss of appetite
  • Unintentional weight loss
  • Loss of muscle mass
  • Swelling (edema) of hands and feet

If there is mild liver damage a patient may not experience any of these symptoms and could be treated with medication or therapy. If the above symptoms occur, it is called decompensation, and is indicative of poor or inadequate liver function, or failure of medical therapy. Some symptoms are more serious than others. Fever, blood vomiting and mental confusion are the symptoms that need to be treated immediately.

Unfortunately by the time patients undergo tests and are diagnosed with liver problems, they already have advanced chronic liver disease with limited reserve and short life expectancy.

Related Links

Recipient Evaluation and Preparation
Donor Evaluation and Preparation
Approaching the Transplant
Post-transplant Care

References:
www.medanta.org
http://www.bhf.org.uk/
www.unos.org