Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Liver Transplantation 911

LIVER TRANSPLANTATION

ANDY S. YU, MD and EMMET B. KEEFFE, MD

history & physical

History

■decompensated cirrhosis: hepatic encephalopathy, portal hyperten-

sive bleeding, ascites, SBP, intractable pruritus, recurrent biliary sep-

sis

Physical Signs

■stigmata of chronic liver disease

tests

Pre-OLT Evaluation

Basic Tests: Blood

■CBC; liver and kidney panel; prothrombin time, PTT

■virologic test: anti-HAV antibody; HBsAg, anti-HBc, anti-HBs;

(HBeAg, anti-HBe and HBV DNA if HBsAg+); anti-HCV (HCV RNA

by PCR if anti-HCV+); anti-HDV; CMV antibody; EBV antibody; anti-

HIV antibody

■autoimmune markers: ANA, SMA, AMA

■metabolic markers: iron studies; serum ceruloplasmin, alpha1–

antitrypsin level and phenotype

■other infectious markers: serum RPR

■tumor markers: alpha-fetoprotein; carcinoembryonic antigen

Basic Tests: Urine

■routine urinalysis, culture and sensitivity

■24 hour urine collection for creatinine clearance and protein

Additional Noninvasive Tests

■ultrasound: exclude occlusion of portal vein, hepatic vein, hepatic

artery, or inferior vena cava

■biphasic abdominal CT to rule out liver cancer

■MRI and MR angiogram (if CT contraindicated)

■PPD skin test with controls

■electrocardiogram

■dobutamine echocardiogram-for patients with cardiac risk factors

■carotid duplex-for patients older or with cardiovascular disease

■chest radiograph

■pulmonary function tests