Before having a liver transplant you will need to have a number of tests to help the doctors decide whether this operation is the best treatment for you. You may already be familiar with some of these tests from your diagnosis phase. You may also have to repeat a number of tests during your assessment for a transplant.
This period of assessment, which lasts around five days, can be a difficult time but it is important that the doctors see that you are fit enough to have the operation. It is also important for the doctors to be sure that you are fully aware of the commitment that you need to make to your own healthcare after the operation.
Sometimes the tests will show that you may have other medical conditions which will need to be treated before a transplant can take place.
You may find it helpful to view the following workbook developed by Leeds Transplant team: Alcohol and the liver workbook
How will I feel during the testing period?
During the assessment period you will probably be feeling very unwell. Being poked and prodded is probably the last thing you want. The doctors are aware of this and understand that you will have some bad days when you are not feeling your best. It is important to talk honestly about your feelings and concerns with the medical staff.
After all the tests have been done, the transplant team will discuss whether a transplant is the most suitable course of treatment for you. If the transplant team do not think that a transplant is the best option at this stage, you will be given another course of treatment.
During your assessment many different healthcare professionals may ask very similar questions. While this may seem repetitive and boring, you must remember that it is very important that you answer all the questions as truthfully and fully as possible. These interviews will help the transplant team decide whether you are a suitable candidate for a transplant.
The basic tests you will have are:
Blood tests are used to understand your general health and find out if there are any factors which can cause problems in people with transplants. People with cirrhosis have a much higher chance of getting liver cancer (hepatocellular carcinoma, or HCC), therefore your test will also check for cancers.
A chest X-ray uses radiation to form a picture of your heart and lungs so that your doctors can tell whether these organs are working well.
Lung function tests are used to check how much air is moving in and out of your lungs.
Blood oxygen test
In order to measure the amount of oxygen in your blood, doctors will take a small amount of blood from a vein in your wrist.
An electrocardiogram, commonly called an ECG, is used to find out how your heart is working. Leads are attached by pads to your chest, arms and legs and linked to a machine which measures the electrical activity in the heart.
Echocardiogram and stress echo
An echocardiogram is another heart test and is used to assess the size of your heart and its ability to pump blood properly. The procedure is similar to ultrasound where a probe, like a microphone, is moved by hand over your heart area to send sound waves through your skin. It will record any reflected sound waves and send them to a computer which is able to process the waves as pictures. In addition to this procedure you will be required to perform a physical exercise, such as running or walking on a treadmill, so that doctors can compare your heart action following activity.
During a coronary angiography a dye will be injected into your arteries and an X-ray will be taken. This helps doctors understand how healthy your arteries are and whether there are any problems that could make the transplant too risky to carry out. This test is only required in selected cases where there are risk factors such as coronary disease, age (over 60), smoking and hypertension (high blood pressure).
Kidney function tests
Problems with the kidneys are a common side effect of liver failure. Tests for kidney function include blood and urine tests.
Ultrasound is the same technology used to confirm all is well in pregnancy. Gel will be applied to your skin, which may feel slightly cold. A probe will be moved across your skin to send sound waves into the liver area. The reflected sound waves, or echoes, are picked up through the probe and used to build a screen image of the liver's condition. This painless test is often used to check the condition of the bile ducts.
CT scan (computerised tomography)
A CT scan uses special X-ray equipment to give doctors a detailed picture of your internal organs and body tissue, particularly the chest and abdomen. To help with this you will be given a dye which you might either swallow or have injected into your veins. You will then lie on a bed which will be passed through a scanner.
MRI (magnetic resonance imaging)
An MRI scan uses magnetic fields to create a computerised image of the body that is even more detailed than a CT scan. As with a CT scan, you will be asked to lie on a bed which will be passed through a scanner.
A liver biopsy is a process where a tiny piece of the liver is taken for study. A fine hollow needle is passed through the skin into the liver and a small sample is withdrawn. The test is usually done under local anaesthetic and may mean an overnight stay in hospital, although some people may be allowed home later the same day. As the test can be uncomfortable with a small risk of internal bleeding or bile leakage, a stay in bed of at least six to eight hours is required.
During an endoscopy a very thin tube with a tiny camera is lowered down your throat and into your stomach. This is usually done under local anaesthetic. Endoscopy is used to find out whether the tiny veins (varices) in your stomach and gut are damaged or bleeding.