4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

Guidebook for the Solid Organ Transplant Programme Chapter 4
4.1.2 INDICATIONS AND REFERRAL GUIDELINES CONT.
After transplantation, patients will be seen by the transplant team through the Transplant
Outpatient Clinic but are also expected to be followed by the referring physician and the family
practitioner. The role of the transplant team is limited to monitoring graft function, prescribing
immunosuppression and assisting with management of transplant-related complications. The
family physician should be prepared to provide non-transplant care.
Contraindications: The following are generally considered to be contraindications to liver
transplantation:
Active or chronic infection outside the biliary tree
Extensive malignancy
Systemic disease which significantly limits life expectancy or quality
Refusal to accept blood transfusions or blood products
Ongoing or recurrent alcohol or substance abuse
Inability to follow a complex medical regimen
Patients may be referred directly to the Clinical Liver Coordinator at BC Transplant (604-877-
2240 or 1-800-663-6189).
(See Appendix A: Liver Transplant Referral form)
4.1.3 ASSESSMENT
Patients are usually seen on an outpatient basis at BC Transplant unless they are too ill and need
to be hospitalized. Critically ill patients may be transferred to Vancouver General Hospital for
assessment. Following assessment, they are transferred back to their referring physician
whenever possible for ongoing management. Patients should be referred when they are still
relatively stable to minimize the likelihood of death or complications that preclude
transplantation before the evaluation is completed or a suitable donor organ can be obtained.
At the time of the initial assessment, patients will be seen by the Clinical Coordinator, a
Transplant Hepatologist and Surgeon. All referred patients will be discussed at a weekly
meeting of the liver transplant team. At that time, a recommendation will be made about the
most appropriate management of the patient’s liver disease. Patients deemed to require
transplantation will then have further investigations, including a CT scan of the abdomen. They
will be seen by an Anaesthetist and by the team’s Psychologist, Social Worker and Dietician. In
some cases, consultation with other specialists may also be sought. During the assessment
phase, the transplant team provides patients and families with information about transplantation,
including the risks and benefits of the procedure, medication regimens and the transplant
process.
Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 4
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