O Lt Eval Houston Grand Rounds

Liver Transplantation and Hepatitis C A Clinical Update Joseph S. Galati, M.D Medical Director St. Luke’s Texas Liver Institute

Liver Transplant Evaluation Goals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Liver Transplant Evaluation RISK BENEFIT

Components of the Evaluation Liver Transplant Surgery Medical evaluation Psycho-social Evaluation Financial Evaluation Nutritional Evaluation Radiology Pharmacy

Liver Transplant Evaluation Transplant Nurse Coordinator Medical Evaluation Financial evaluation Psychosocial evaluation

Evaluation for Liver Transplantation ,[object Object],[object Object],[object Object]

Medical Evaluation for Liver Transplantation Severity of Liver Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medical Evaluation Assessment of Extrahepatic Diseases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation for Liver Transplantation Surgical Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object]

Psycho-Social Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation for Liver Transplantation Assessment of Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object]

Patients with History of Substance Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object]

Psychosocial Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],I will not drink I will not smoke pot I will take my pills X___________

Survival After Liver Transplantation By Pre-Transplant Length of Abstinence

Evaluation for Liver Transplantation Financial Assessment ,[object Object],[object Object],[object Object]

Primary Biliary Cirrhosis When to refer to OLT ? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Primary Sclerosing Cholangitis: When to refer to transplant ? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Viral Hepatitis and Liver Transplant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Liver Transplant Evaluation Acceptable candidate P lace on waiting list Unacceptable candidate Able to modify negative factors Unable to modify negative factors Reject for liver transplant

On the “List” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Deaths on the Waiting List 1990/1995/2000 This accounts for a 25% death rate on the liver list

Cadaveric Donors, Cadaveric Transplants, and Number on Waiting List Source: Donors from OPTN data as of 9/5/00; transplants from Scientific Registry data as of 9/5/00; snapshot of OPTN waiting list on the last day of each year. Donors Transplants Waiting List at Year’s End

Waiting List Characteristics Liver Registrants in 1999 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Liver Graft Survival Rates by Waiting List Status at Transplant Note: Waiting list status for 1-year survival reported for codes 1, 2A, 2B, and 3; 5-year survival reported for codes 1, 2, 3, and 4. Source: Scientific Registry data as of 9/5/00. 1 Year (1998 Cohort) 5 Years (1992-97 Cohort)

So…when is the proper time to refer for transplant?

O Lt Eval Houston Grand Rounds

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