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Liver Transplant Evaluation and Assessment Guide

Signs of liver disease

We aim to help you manage your symptoms due to liver disease. We are here to support you, your family and significant others. Please ask members of the transplant team if you have any concerns. It is better to ask questions even if they seem minor, rather than worry about them, as the answer to your question may be very simple.

When the liver does not work properly, you may develop one or more symptoms or signs of liver failure.

Jaundice

Jaundice is when bilirubin accumulates in the blood. The skin and or the whites of your eyes appear yellow or greenish yellow due to high levels of the bile pigment. You may also become very itchy when you are jaundiced.

The itch associated with jaundice may be helped by:

  • Bathing using non fragrant soaps, try sorbolene or dove
  • Application of urea based skin creams to keep the skin moist
  • Wearing cotton clothes and avoiding synthetic materials
  • In some patients the doctor may start you on medications

Bleeding

Bleeding from the gums and easy bruising are frequently seen in patients with liver disease. Bleeding and or easy bruising is often due to minimal trauma in the presence of low platelet count.

Tips to minimise bleeding problems

  • Use an electric razor to shave
  • Use a soft toothbrush and avoid brushing too hard
  • Blow your nose gently

Portal hypertension

Portal hypertension is high blood pressure in the hepatic portal system—made up of the portal vein and its branches that drain from most of the intestine to the liver. If the vessels in the liver are blocked due to liver damage or scarring then blood cannot flow properly through the liver. This increased pressure in the portal vein may lead to the development of large, swollen veins also known as varices within the oesophagus, stomach, rectum, or umbilical area or belly button. Varices can rupture and bleed, resulting in potentially life-threatening complications.

Internal bleeding affects many people, so it is important to know the signs of bleeding:

  • Sudden fullness of the stomach
  • Becoming more tired
  • Blood stained or “coffee ground” vomiting
  • Black bowel movement or red blood in your bowel movement

Salt and fluid retention

Salt and fluid retention are common signs of liver failure and are due to the damaged liver no longer able to get rid of salt from the body, as well as low protein levels and disturbed kidney function. Retaining of salt can cause swollen ankles and ascites or fluid in the abdomen.

Treatment includes:

  • Low salt and high protein diet
  • Medications called diuretics or fluid tablets
  • Paracentesis or drainage of fluid from the abdomen

Hepatic encephalopathy

Hepatic encephalopathy is a condition which affects the brain. It can develop when the liver is damaged and unable to remove toxins, including ammonia from your blood.

Encephalopathy can present in several ways including:

  • Memory loss
  • Personality changes
  • Concentration and sleeping pattern changes
  • Confusion

Infections, some medications and constipation can cause episodes of encephalopathy. Sedatives or sleeping tablets can make the symptoms worse.

This condition can be very distressing to you and your family. Up to 70 per cent of patients with liver failure may have encephalopathy. In some cases, you may have to stop working and may have to stop driving. Your doctor will advise you if you have to stop driving, for your own safety and that of others on the road.

Ammonia

Bacteria in the intestine act on urea and protein to produce ammonia. Ammonia is cleared from the blood by a healthy liver. To help clear the ammonia from the body, patients are given Lactulose, a sweet liquid laxative which works by flushing out the ammonia in the intestine and decreasing the levels of bacteria in the bowel. The dose of lactulose is adjusted so that you are passing 2 to 3 soft bowel motions a day.

Muscle wasting

Muscle wasting is common in patients with liver disease, and can result in weakness, loss of function and can make it more difficult to get through a transplant operation. It is important that we monitor your weight, muscle strength and fitness. You can help preserve your muscle mass by eating well – having small and regular meals, following a high protein diet and including a snack before bed. The dietitian will advise you of any supplements or dietary restrictions you need.

If you have been admitted to hospital for your assessment, and there are particular foods you like, a relative or friend is welcome to bring them in.

Exercise

You are encouraged to keep active and fit before your transplant. This is important because being unfit and losing muscle mass is linked to more health problems both before and after your liver transplant and can impact on your ability to get through and recover from surgery.

Aerobic exercises for example walking, cycling or swimming are good for your fitness levels and muscle function, and resistance and strength exercises, for example weights, help maintain your muscle mass and strength. When you come to clinic, your doctor and dietitian will speak to you about exercise. If you do not feel safe to exercise, or have concerns, you can speak to your general practitioner about being referred to an Exercise Physiologist in the community.

Nutritional problems

Inability to absorb and process vitamins and minerals can occur in liver disease. The levels of essential vitamins and minerals in your blood will be checked, and you will be advised if you need to take supplements.

Alcohol and smoking

Continuing to smoke or drink alcohol will prevent you from being considered for a liver transplant. If you are having problems avoiding alcohol or quitting smoking please ask for help as we have several programs available.

In this guide:

  1. Information and contact details for the liver transplant hepatology team
  2. The liver - its function and anatomy
  3. Signs of liver disease
  4. Pre-transplant assessment and evaluation
  5. The assessment team
  6. Allied Health Services
  7. Palliative care
  8. Pharmacy—medications before your transplant
  9. Case discussion and assessment presentation
  10. Will I make the list?
  11. The liver transplant waiting list
  12. Model for End stage Liver Disease (MELD)
  13. Support Through Education Program (STEP)
  14. The Donor
  15. What happens when you are notified that a donor liver is available?
  16. The liver transplant operation
  17. Intensive Care Unit (ICU) patient information
  18. The recovery period
  19. Pharmacy—medications after your transplant
  20. Rejection
  21. Donor family correspondence and information
  22. Glossary

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Last updated:
25 November 2022
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