Liver Transplantation can become the best treatment for some forms of severe chronic liver disease. In part because there are more people in need of liver transplantation than there are available livers, a strict and nationally observed system for organ allocation governs priority. This means a patient’s position on the “transplant list” is determined by the severity of their disease alone.
Since New Mexico has no liver transplant program, the UNM liver clinics coordinates care of these patients in collaboration with transplant centers in Arizona, Colorado, and Texas among others. A full time nurse-coordinator is crucial to both the process of evaluating for transplantation potential as well as post-operative management, working closely with members of the Gastroenterology and Hepatology division.
Evaluation starts when blood tests show the disease is severe enough for transplant to be considered. A number of other tests may then be done to assure that the transplant could be safely performed. For instance transplant surgeons may need demonstration of reliable heart and lung function, but also of the good support necessary to reliably follow-through with required medications and post-operative monitoring. Ultimately it is the transplant program, and not UNM physicians, who decide if a patient with severe liver disease is “healthy enough” to put on the transplant list. “Healthy” is a relative thing of course since chronic liver disease leaves even the “healthiest” more fragile and susceptible to complications. Nevertheless, patients “move up the list” as their disease worsens or patients above them are taken off – either because of successful transplantation or, unfortunately, because they succumb to complications of their disease before a compatible liver becomes available.
After transplantation medications are required to keep the body from “rejecting” the donated liver. Monitoring these medications, liver health, and in some cases, recurrent disease in the transplant, are also carried out through the UNM liver clinics in collaboration with transplant programs through regular blood tests, imaging, and periodic clinic visits. For these and other patients close collaboration with our colleagues in Surgical Services, Radiology and of course Primary Care is the rule. The liver disease clinics are also the sites in which patients with a variety of chronic liver diseases not requiring transplant are seen. Such conditions as auto-immune hepatitis, Primary Biliary Cirrhosis and Hepatitis B among others are seen regularly. Hepatitis C patients have their own separate clinic.