Liver Transplant Team

Adult Education in Arkansas

por Annie Palmer

Fuchs'Dystrophy

por Samia Tahir

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por Kim Muller

Glomerular Dz

por R G

D2 blds ( will need at least 25ml of bld ) : glucose, HbA1C, TSH/T4/T3, Ca/P/Mg, lipids, iPTH, GXM, ABG, Tb T spot

D1 blds : plain - 2 purple top - 2 blue top - 2 lactate - 1 NH3 - 1 vit D - 1 viro - 2 immuno - 2

D1

D2

D3

D4

- await anaesthesia input

- grand rounds at 8am (ensure pt is in bed) - KIV refer anaesthesia ( check with them ) - KIV scopes if any - email CVM

- bone scan + BMD - OT chit if for scopes - consent for scopes - trace BL changes

- fasting blds - refer dental 8am if not done on D1 - refer PT, dietitian, DNE, MSW - dental clinic morning - followed by spirometry - refer ID, Endo, Psy - 2DE noon

- admit - blds by SN ( easier to do when setting iv plug ) - order 2DE, spiro, BMD, bone scan - KIV refer dental if before 5pm

= important tips

TC = transplant coordinator SN = staff nurse MO = medical officer

Liver Transplant Workup

Urine

urine microalbumin

UFEME

24hr urine protein 24hr urine creat

- start on D1 - instruct SN that scans / clinic visits shouldn't interrupt collection

Scopes

- ensure pt has a recent OGD /colono - if not, arrange for it on a free day inpatient

Bloods

D2 - fasting ( MO to do )

Lipids, glucose, TFT, Ca/P/Mg

ABG

ensure there is no air bubble ( can result in pO2 > 100 & will be rejected )

Blood Bank

Antibody screening

CPOE order ( type Antibody )

ABO / Rh testing

CPOE order ( type ABO )

GXM

the usual paper form

D1 ( SN to do )

- PSA total - Vit D level - NH3 - lactate

Biochem

RP, LFT, Fe panel, ceruloplasmin, AFP, CEA

Immunology

- VDRL, TPPA - Toxo IgG, anti liver Abs, ANA, anti-SMA - CMV IgG, EBV IgG, VZV IgG, - Tb T spot ( call 63214922 to book )

Hematology

FBC, retic, PT/aPTT/INR, fibrinogen

Virology

- HbsAb, anti-Hbs,HbeAg, anti-Hbe Ab, anti-Hbc total, Anti HCV IgG, anti-HAV IgG, - HIV

Others

CXR

ECG

CRE / VRE rectal swabs

CPOE

MIBI

- usually pre-booked and performed before admission - ensure you have a recent report - can call 6704 8172 / 6704 8181 to confirm

2DE

- need to CPOE; TC might have pre-booked - on D2; noon - need to go down to the lab to book slot

spirometry

- need to CPOE; TC might have pre-booked - on D2; usually morning

Referrals

Allied Health

MSW

DNE

if DM

Dietitian

if BMI low or if DM / HLD

PT

Physician

RCCM

If h/o asthma / COPD or if spirometry is abnormal

Renal

if acute renal impairment or existing renal failure

Anaesthesia

once all Ix are done - either on Thurs /Fri ( to confirm with them )

CVM

via email : Tx reg will do

ID

refer on D2; ID will ask for vaccinations and more bloods

Endocrine

refer on D2

Dental

- refer on D1; latest by 8am on D2 - inform dentist that there is no CI for dental intervention and there is no need for abx prophylaxis

For a liver transplant workup, multiple procedural steps and referrals are necessary. Key diagnostics include 2D echocardiography, spirometry, MIBI scans, chest X-rays, and electrocardiograms.