A liver transplant is a significant medical procedure that involves extensive testing, detailed timing, and long-term monitoring. The liver specialist, generally a hepatologist, is at the heart of this process, with responsibilities extending far beyond diagnosis. They are involved at every stage of the patient’s journey, from initial assessment to long-term post-operative care, to ensure the transplant has the best possible outcome.
Pre-Transplant Assessment and Risk Evaluation
A liver specialist must first confirm that the patient’s liver condition is severe enough to require transplantation before a liver transplant can be considered. This confirmation involves comprehensive clinical evaluation, blood tests, imaging scans, and liver function assessments. The specialist will determine if the patient meets the eligibility criteria based on factors such as the severity of liver disease (often evaluated using the MELD score), presence of comorbidities, history of infections, and psychosocial stability. The liver specialist must also assess whether the patient is likely to tolerate major surgery and comply with long-term post-operative regimens. The patient will be referred for a formal transplant work-up and placed on a waiting list if they qualify.
Preparing the Patient for Surgery
Once listed for transplant, the liver specialist plays a key role in optimising the patient’s health while awaiting a suitable donor. This step often includes managing complications of liver failure such as ascites, variceal bleeding, hepatic encephalopathy, and coagulopathy. Medication regimens may be adjusted to ensure stability and nutrition plans may be implemented to improve the patient’s strength before surgery. During this waiting period, the liver specialist conducts regular reviews, monitoring for deterioration or acute decompensation that could alter the urgency of transplantation. They also educate the patient and family about what to expect during surgery and post-operative care to improve preparedness and adherence.
Coordinating with the Transplant Team
The specialist does not work in isolation. They collaborate closely with liver transplant surgeons, anaesthetists, radiologists, transplant coordinators, and social workers to ensure all aspects of care are addressed. The specialist’s input is particularly critical in pre-operative discussions where they provide clinical context, recent lab results, and patient history. During emergency transplants, they may make rapid decisions about donor-recipient suitability, timing, and surgical readiness. Their goal is to maximise the success rate while minimising the risk to the patient.
Immediate Post-Transplant Management
Following surgery, the liver specialist resumes their central role in managing the patient’s recovery. They monitor liver function tests to assess how well the new liver works and adjust medications accordingly, especially immunosuppressive therapy—which prevents organ rejection. The liver specialist also screens for post-operative complications such as infections, bile duct leaks, or thrombosis. Constant monitoring is essential in the first few weeks after surgery when risks are highest. The specialist helps the patient adapt to their new medication schedule and coordinates rehabilitation efforts, including nutritional support and physiotherapy.
Long-Term Follow-Up and Chronic Care
Even years after a successful liver transplant, the liver specialist remains involved in the patient’s care. Regular check-ups are necessary to monitor graft function, detect signs of chronic rejection, and adjust immunosuppression dosages. The specialist also screens for other long-term complications, such as cardiovascular issues, renal dysfunction, or secondary malignancies, which may arise as a result of prolonged immunosuppressive therapy. Education on lifestyle choices, such as avoiding alcohol and ensuring vaccinations are current, also falls under their scope of care. Maintaining liver health post-transplant is a lifelong commitment—and the liver specialist ensures patients have the guidance and monitoring they need.
Conclusion
The liver specialist is a vital figure throughout the liver transplant journey. Their responsibilities extend beyond diagnosis to include pre-transplant evaluation, care coordination, post-operative monitoring, and lifelong follow-up. Patients getting a liver transplant benefit greatly from having a dedicated and experienced specialist.
Visit National University Hospital (NUH) to gain liver evaluation and professional guidance today.
