INTERVIEWER: Welcome to the University
of Washington's Liver Transplant educational series.
We are pleased to offer this educational seminar
to our transplant patients and caregivers
so that you will be more informed regarding
liver disease, the transplant evaluation process, what
to expect before and after transplant surgery,
as well as medications you will need
after transplant to maintain your new liver function.
In this transplant educational segment,
we will focus on our liver transplant program and liver
disease.
As a patient, you should feel confident
that you have chosen an excellent transplant program
for your transplant needs.
The University of Washington Medical Center
has been performing liver transplants since 1990.
Our top rated surgeons have performed more than 2,500 liver
transplants to date.
And our patients spend less time on the liver transplant
waitlist than the national average.
You will find our survival rates are among the highest
in the United States.
Data proves how well our transplant program performs.
The Scientific Registry of Transplant Recipients,
better known as SRTR, obtained statistics
from transplant organizations to see how patients
do after liver transplant.
This information is available to let people know how
a transplant program is doing.
This is known as transplant outcomes.
The better the outcome, the better the transplant center.
SRTR will report transplant outcomes on their website,
and our medical center will provide updated reporting
to all patients on our transplant list.
We encourage you to review this data as it will offer you
confidence in your decision to use
the University of Washington Medical
Center for your transplant needs.
The University of Washington is a large network
of multiple medical facilities and neighborhood clinics.
Most patients are referred to our program
by their local primary gastroenterologist.
Patients are then scheduled for transplant assessment
at the University of Washington's Montlake campus.
Some patients may be referred to us
from one of our sister hospitals,
such as Harborview Medical Center's Liver Program,
UW Eastside Hepatology Clinic, Northwest Hospital's Hepatology
Clinic, or from our UW satellite clinic in Spokane, Washington.
Regardless of where your referral started,
your transplant evaluation will take place
at the University of Washington's Montlake campus.
For patients who live far away from Seattle,
our team will make every effort to consolidate appointments
so that your evaluation is completed in a timely manner.
So what is liver transplant surgery?
Liver transplant surgery is a surgical procedure
where your diseased liver is removed and replaced
with a healthy liver from a donor.
The University of Washington performs cadaveric liver
transplantation and living donor liver transplantation.
The images you see here show these types
of transplant surgery.
During cadaveric transplant surgery,
the diseased liver is removed, and a healthy donor liver
from a deceased donor is transplanted in its place.
Similarly, during liver donor liver transplant,
the diseased liver is removed, and a portion
of a liver taken from a living donor
is transplanted in its place.
As you move through this educational series,
you will learn more about these types of transplant surgery
that we perform at our facility.
As you move forward in your transplant evaluation,
you will begin to meet your transplant clinical care team.
Each team member plays a distinct role
in your transplant evaluation.
As you can see in this slide, there
are multiple disciplines who help in the assessment,
as well as treating the transplant patient.
Your transplant hepatologist is a physician
who is board certified in liver disease.
During your transplant clinic visit,
this physician will determine if you would
benefit from liver transplant.
Our transplant surgery team will meet with you
to discuss what to expect during transplant surgery,
including risks, complications, as well as the recovery
process.
You will have an opportunity to ask questions at this clinic
visit, and we encourage you to bring a caregiver with you.
You will be assigned a dedicated transplant nurse
coordinator who will be your advocate during the transplant
process.
This nurse will also provide education
and help to oversee your transplant evaluation.
A social worker will meet with you
to evaluate any existing psychosocial issues, including
care support, chemical dependency,
as well as your ability to cope with the stress of having
a transplant.
We also have a transplant psychiatrist
available to meet with patients, should this consulting service
be requested by our team.
Our transplant dietician will assess your current diet
and provide nutritional education,
as well as offer recommendations for additional nutritional
support, such as tube feeding if needed.
Our program also has a dedicated financial counselor,
who is available to talk with you about costs associated
with transplant, as well as insurance coverage.
Finally, our transplant pharmacists
work closely with our transplant surgeons
and hepatologists to make sure all medications prescribed are
safe for you.
Your transplant clinical care team
works together to offer you the best possible care as you are
evaluated for liver transplant.
Here, we will present information
regarding liver disease and causes of liver failure.
We will also discuss the signs and symptoms
that many patients experience, as well as what
to do in case of an emergency.
Please remember that the information we cover here
is just a general overview of liver disease.
Please reach out to your transplant nurse coordinator
at the conclusion of this educational series
to answer any questions you may have.
The liver is the largest organ in our body.
It is situated in the right upper quadrant
of the abdominal cavity right underneath your diaphragm.
The liver is triangular and has two lobes, a right lobe
and a smaller left lobe.
There are blood vessels which bring blood in and out
of the liver, as well as bile ducts
which transport bile from the liver to aid in digestion.
The liver has over 500 functions,
way too many to review in detail,
but we will go over some of the main functions.
The liver is a large filter, which
cleans our blood of toxins and other compounds.
It is responsible for the production
of bile, which helps the small intestine break down fats
to make them easier to digest.
The liver is responsible for the metabolism of bilirubin, which
is the pigment formed in your liver
when it breaks down red blood cells.
The liver is also responsible for storing many vitamins
and helps to break down carbohydrates
into sugars so that your body has energy to function.
Some other liver functions include the production
of albumin, which helps to prevent leaking blood vessels.
And your liver even plays a role in helping your blood to clot.
As you can see, your liver is a necessary organ
to help in daily functions that your body needs to survive.
This unique organ is the only organ in our body
that can fully regenerate itself if it's healthy.
This means it can grow, which is why living donor liver
transplant can be an option.
As we have seen in the previous slide,
your liver is essential to life.
So what happens when your liver becomes sick?
Liver disease occurs when your body
is exposed to an injury which causes your liver cells to die.
When these cells die off, scar tissue is replaced.
With less liver cells, your liver
can no longer function at full capacity.
What injuries cause liver disease?
In this slide, we will review the most common causes
of liver failure.
Chronic liver disease.
Most patients have chronic liver failure and advanced cirrhosis.
This type of liver disease has happened
over a long period of time and leads
to scarring of the liver and loss of liver function.
The most common causes of chronic liver failure
include hepatitis B and hepatitis C,
alcohol abuse, fatty liver disease, autoimmune disorders,
primary biliary cirrhosis, and primary sclerosing cholangitis,
as well as other causes.
Liver cancer.
Some patients have a tumor in their liver.
Liver cancer, also known as hepatocellular carcinoma,
is an indication for liver transplant,
as transplant is considered the cure.
We also evaluate patients for cholangiocarcinoma,
a cancer of the bile ducts within the liver.
Both cancers must meet certain qualifying criteria
for transplant to be considered.
Acute liver failure.
Acute liver failure happens suddenly it
happens in patients who don't have pre-existing liver
disease.
Sometimes patients may be prescribed a medication
and have an adverse reaction, or people
overdose on drugs such as Tylenol,
or they consume a toxic substance,
which may lead to their liver failing overnight.
Patients in acute liver failure will be hospitalized
and in our intensive care unit.
Patients in acute liver failure will require a transplant
within a short period of time, as this form of liver disease
can quickly lead to death.
When a person's liver becomes sick, cells in the liver
begin to die off and get replaced with scar tissue.
Since the liver has less healthy cells functioning,
the body begins to show signs of advanced liver failure.
This slide is an example of the signs and symptoms
most liver patients experience.
We will spend some time talking about the common ones.
Some patients may develop jaundice.
Jaundice is the yellowish color to your skin or sclera, which
is the white part of your eye.
This is due to a high level of bilirubin
that is in your blood.
If you or your caretaker notice a change
in the color of your skin or eyes,
you should follow up with your local physician.
Many of our patients have fluid in their abdomen.
This condition is called ascites and is
when fluid builds up in spaces within the abdomen.
This can lead to swelling of the abdomen, which
can lead to a decrease in appetite and weight loss.
Some patients may even develop fluid
in their lung cavity, known as hepatic hydrothorax.
To help with these conditions, patients
will be prescribed diuretics, also known as water pills.
Typical medications prescribed are Aldactone, Spironolactone,
Furosemide, and Lasix.
Some patients may undergo a procedure
called a paracentesis, or thoracentesis.
This is when a sterile needle is inserted
in a fluid pocket in your abdomen or lung cavity
to remove the fluid.
We advise patients not to have a permanent drain placed
to help relieve this fluid, as this can
lead to infection and death.
Hepatic encephalopathy.
Patients may also develop brain fog known
as hepatic encephalopathy.
As we have learned, our liver is a big filter,
and its job is to remove toxins from our body.
Ammonia is a toxin that your liver cannot remove efficiently
due to fewer liver cells working.
With a higher level of ammonia in the blood,
patients can develop foggy thoughts, change of mood,
increased fatigue, and even a change in personality.
Medications prescribed for this condition
include Lactulose or a pill known as Rifaximin or Xifaxin.
Caregivers need to monitor that all medications are
taken as prescribed.
A few missed dosages can lead to a rapid decline
in a patient's mental status.
Esophageal varices.
During your transplant evaluation,
you'll be asked to undergo an upper endoscopy known
as an EGD.
This screens for esophageal varices.
Esophageal varices are vessels in your throat
that can become enlarged due to increased
pressure from a poorly functioning liver.
This can lead to blood vessels that suddenly bleed.
Patients may start coughing up bright red blood or coffee
ground colored vomit.
This can be frightening, and patients will
need to seek emergency care.
Some patients who develop this condition
will be placed on a medication to help lower
their blood pressure.
Common medications prescribed are Nadolol or Propranolol.
There are many other symptoms of liver disease
that some patients may experience,
such as itchy skin, darkened color
of urine, pale-colored stool or bloody tar-colored stool,
chronic fatigue, loss of appetite, nausea or vomiting,
and a tendency to bruise more easily.
We encourage you to reach out to your transplant nurse
coordinator if you would like to review the symptoms you
are experiencing.
What should you or your caregivers
do if an emergency occurs?
Patients with chronic health conditions
live with a lower quality of health than many others.
Being able to recognize when you need
to access emergency services is extremely important.
For caregivers, this can be challenging
if the patient is refusing to go to a local emergency
room or urgent care.
This slide offers you information
on when to seek emergent care.
Patients need to go to the emergency room
if they have difficulty in breathing
or are actively bleeding, such as coughing up
red blood or bloody stools.
We encourage using 911 for all emergencies,
as this will shorten the treatment time when you
arrive at the local hospital.
Patients with hepatic encephalopathy
can become disoriented, combative, sleep excessively,
or show signs of general confusion.
Hepatic encephalopathy can quickly
deteriorate to a condition where the patient can
become unconscious, which can even lead to death.
Caregivers need to make sure that the medications prescribed
for this condition are taken as directed.
Missing one or two doses can lead to a rapid decline
in a patient's mental status.
Once you get to the local hospital,
be sure to let the admitting physician know
the name of the primary care doctor, as well as
the local gastroenterologist.
It's also a good idea to let the doctor know
that the patient is under evaluation for a liver
transplant.
Upon discharge, make sure follow-up appointments are
scheduled with your local primary doctor
or local gastroenterologist.
We also ask that you touch base with your transplant nurse
coordinator, as our transplant center would
like to know about any changes to your medical condition.
As you move forward with liver transplant,
many of your local doctors will begin
to defer to the transplant center for advice.
Some of your local physicians may even
assume we have become your primary care team.
Please remember that the liver transplant
doctors are following you for liver transplant services only.
This means that routine issues that you may be experiencing,
such as ascites, hepatic encephalopathy abdominal pain,
fatigue, and other concerns should be addressed
by your local providers.
The liver transplant team is available for anything
regarding your transplant evaluation, medical testing,
as well as questions related to transplant listing.
Thank you for watching this segment on our transplant
program in liver disease.
Should you need additional information,
please reach out to your transplant nurse coordinator.
You can now move on to part 2 of this educational seminar.