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Liver Transplant: What To Expect

At the Washington University and Barnes-Jewish Transplant Center, you receive care from an experienced team of physicians, nurse coordinators and other liver transplant specialists. We have performed more than 1,700 liver transplants since our program began in 1985. Before, during and after transplantation, we’ll provide the information and care you need to manage the physical, emotional and financial issues involved in transplantation.

Learn more about:

Before Liver Transplant: What to Expect

The liver transplant process is complex, and we are here to support and guide you through every step. Your nurse coordinator can discuss your particular situation in more detail and answer any questions or concerns you may have. Learn more about the liver transplant process.

The Transplant Evaluation Process

Your physician or hepatologist (liver specialist) may refer you to the Transplant Center as a potential transplant candidate. Our comprehensive team of hepatologists and transplant specialists will evaluate you thoroughly to determine if a transplant is the best option for you.

  • Evaluation: The evaluation consists of 2-3 days of testing and consultations at the Center for Advanced Medicine at Barnes-Jewish Hospital. In most cases, we perform the evaluation tests on an outpatient basis, so you will not need to be hospitalized.
  • Expedited evaluation: We offer a shortened evaluation for patients with advanced-stage tumors, often with 24-hour response time. A team including a hepatologist, transplant surgeon and oncologist devise the best rapid treatment plan for these patients. If transplantation is a treatment option, we will complete the transplant evaluation testing at a later time.
  • Results: After all tests are complete, our transplant team will thoroughly review and discuss your results and condition, as well as the best options for your health.
  • Waitlist: If the transplant team determines that a transplant is your best option, you will be given the opportunity to go on the United Network for Organ Sharing (UNOS) waitlist for a liver transplant. This is a nationwide list of all people in the country who are awaiting transplant. UNOS assists with the matching, transporting and sharing of organs throughout the U.S.
  • Status: Every person on the UNOS waitlist is assigned a status. This status is an important factor in determining your priority for receiving a transplant. The system places patients in order by taking into account the model for end-stage liver disease (MELD) score (see below), blood type and geographic distance between the transplant candidate and the hospital where the donor’s liver is located.

Understanding MELD Scoring

As part of the transplant evaluation process, you will undergo testing and receive a MELD score. The MELD scoring system, designed by UNOS, is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill). Patients with higher scores have a higher priority for transplants.

Your score (number) depends on how urgently you need a liver transplant within the next three months. The number is calculated by a formula using four routine lab test results:

  • Bilirubin, which measures how effectively the liver excretes bile
  • INR (prothrombin time), which measures the liver's ability to make blood clotting factors
  • Creatinine, which measures kidney function. Impaired kidney function is often associated with severe liver disease
  • Sodium level, because low sodium (hyponatremia) can be dangerous for people who need a liver transplant

Transplant Nurse Coordinator Services

At the beginning of the transplantation evaluation process, you will be assigned a transplant coordinator. This transplant coordinator will be your “lifeline” point of contact during your care. A coordinator is available to you 24/7 if emergency care is needed. The coordinator helps lift the burden of the logistics involved during the transplant process, so you can focus on your health.

The transplant coordinator will help you to understand:

  • The steps to make a decision about whether or not to receive a transplant
  • The testing and other aspects of the transplant evaluation
  • How long the process takes
  • How the UNOS waitlist and organ allocation system work
  • The MELD score

After Liver Transplant: Follow-Up Care

As you recover from surgery, your care team will follow you closely. Soon after transplant, you will be housed on a nursing floor dedicated to liver and kidney transplant patients.

In the first few weeks after transplant, we will see you frequently in our outpatient clinic. You will have physical therapy to regain your strength. If you live outside the St. Louis area, you can arrange temporary lodging near the hospital for the first few weeks of observation.

You will return for follow-up appointments:

  • The first 2 months: You will have lab work twice a week to check for rejection or infection
  • The first 6 months: You will continue to have weekly lab work.
  • The rest of the first year: After your 6-month visit, you will be seen at 9 and 12 months following the transplant. The frequency of lab work will vary depending on your condition. Usually, patients have lab work once or twice a month until the end of the first year.
  • Once per year afterward: We will see you once per year for follow-up after the first year.

We stay in close communication with your primary care physician throughout the transplant process. Over time, we will transition routine care to your primary care physician. However, for continuity of care and to ensure the best outcome for you, we will follow you for the life of your transplant. We coordinate this care while working closely with your primary care physician.

Medications After Transplant

As a transplant recipient, you will need to take immunosuppressive medications daily for the rest of your life. Our transplant team will help you manage and understand your medications. We also will advise you about taking any over-the-counter medications.

It is important to take your medications every day, for the rest of your life. We are here to help you manage any side effects or complications.

  • These anti-rejection medications suppress your immune system so your body doesn't reject the transplanted liver. 
  • Because your immune system is suppressed, you will be more prone to infection, especially during the first 3-6 months after transplant.

While you're taking medications, you need to carefully monitor and report any unusual side effects to your nurse coordinator. Side effects vary by dosage and type of medication. Ask your nurse coordinator or doctor if you have any questions about your particular medication.

Watching for Signs of Liver Rejection

Because a transplanted liver is considered a "foreign object" to your body, your immune system may try to reject the organ. It is common for this to occur within the first few months of transplant.

To help avoid and manage rejection:

  • Our team will discuss the signs and symptoms of rejection with you. 
  • You will have frequent testing and routine clinic appointments to monitor you for rejection. 
  • We will treat rejection as soon as possible to avoid complications.  
  • If you experience rejection, you will take additional medication to suppress your immune system so the rejection resolves and to protect the transplanted liver. 

The risk of rejection decreases over time, but can occur at any time. Follow your medication regimens and physician orders to prevent rejection. If you experience any unusual symptoms, call your transplant nurse coordinator immediately.

Support for Patients and Caregivers

Caregivers play a crucial role in the patient’s surgery and recovery. Our team is here to support both patients and their caregivers to make the transplant experience as smooth and comfortable as possible.

Lodging Before and After Transplant

We offer convenient lodging options for our patients, both before or after transplant.

  • Both on-campus and off-campus accommodations are available.
  • Some off-campus hotels offer special rates for Transplant Center patients.
  • In addition, some lodging expenses related to the transplant may be covered by insurance. Call your insurance company to find out more or talk to one of our experienced financial counselors.

For off-campus lodging assistance and to receive more information on special rates, call Concierge Services at 314.362.5301 or toll-free 800.551.3492, Monday through Friday, 8 a.m. to 5 p.m.

Transplant Support Group and Mentors

Because a transplant is a major procedure with lifelong implications, we sponsor several peer-to-peer networking opportunities, including the Transplant Support Group and our mentor network. Patients often find comfort and support through these groups, where they have an opportunity to meet other transplant patients and share advice and experiences. 

Support groups we offer:

  • The Transplant Support Group offers support and education to transplant recipients, candidates and their families. Members in various stages of the transplant process and guest speakers discuss topics related to any aspect of transplant.
  • The Mentor Program brings together patients beginning the transplant process and patients who have successfully completed transplant. Program participants share information, guidance and emotional support with those involved in the transplant process.

Contact Us

For more information about the liver transplant program at the Washington University and Barnes-Jewish Transplant Center, call 888.998.3135.