Download Pre-liver Transplant Education Packet

Table of Contents
Introduction
Normal Liver Function
Symptoms of Liver Disease
Cirrhosis
Complications of Cirrhosis
Liver Transplant Program
Evaluation
Selection Process
Wait List
Waiting Period
Liver Transplant Options
Organ Offer
Day of Transplant
Surgery
Medical Risks
Post Surgical Care and Recovery
Hospital Stay
Discharge/Rehabilitation
Transplant Resources
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Introduction
You have been told that you need or may need a liver transplant. Before you
become eligible to receive a transplant you must learn about the procedure,
understand the commitment involved, and realize that not everyone in need
of a liver transplant will ultimately
obtain one . The num ber of liv er
transplant procedures performed in th e United States is l imited by the
number of donor organs available. Th ere are many more people who need
liver transplants than there ar e organs available (~17,000 patients on the
waiting list with only ~4500 d onors/yr). Living donor transplants may help
make up some of the shortfall in liver donors but is only possible in a very
small number of adult patients needing liver transplants. Selection of patients
for transplantation is a complicated process that attempts to place organs in
suitable recipients on the basis of n eed, medical urgency and likelihood for
survival. Before you start your evaluation, we would like you to becom
e
more familiar with the evaluation proc ess. This h andout will provide you
with additional infor mation about the transplant evaluation process, the
transplant procedure, and what to expect after the actual transplant.
Liver transplantation is not a cure. A transplant provides a chance to
prolong your life and to improve your quality of life. Unfortunately, you may
be exchanging new symptoms and pr oblems for your old symptoms and
problems. You m ust realize that you wi ll be taking medications for the rest
of your life. This is probably the most important decision that you will
make in your lifetime. Try to learn as much as you can, review the
information we give you, and ask questions when you do not understand.
Making sure that th e patient is a suitab le transplant candidate is crucial to
the success of the tr ansplant and a posi tive outcome. We know that the
evaluation process can be extensive and extremely stressful for ill patients,
and their families and friends who support them, so our goal is to make the
process as smooth as possible.
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Normal Liver Function
The liver is the largest organ in the body, weighing about 3 pounds. The li ver is
an active organ responsible for many vital life functions. The primary functions
of the liver are:
Bile production which aids in the digestion and absorption of fats
Distribution of the nutrients found in food
Excretion of bilirubin, cholesterol, hormones, and drugs
Metabolism of fats, proteins, and carbohydrates
Enzyme activation
Storage of proteins, vitamins, and minerals
Synthesis of plasma proteins, such as albumin, and clotting factors, and
It helps “clean” the blood by removing medications and toxins.
Due to these important activities, the liver is exposed to a number of insults and
is one of the body's organs most subject to injury.
Symptoms of Liver Disease
The symptoms of liver disease include:
jaundice (yellowing of eyes and skin)
severe itching
dark urine
mental confusion or coma
vomiting of blood
easy bruising and tendency to bleed
gray or clay-colored stools
abnormal buildup of fluid in the abdomen
Cirrhosis
When the liver is damaged it attempts to repair itself (regeneration). During the
repair process, scar tissue ( fibrosis) may develop. Over time, the scar tissue
increases to the point where it surrounds
entire areas of liver. When l arge
portions of the liver are surro unded by scar tissue, cirrhosis is said to be
present. Thus, cirrhosis is the end result of the liver attempti ng to repair itself.
While some patients with cirrhosis have near normal liver function, most will
ultimately experience a variety of probl ems. Many of thes e problems (for
example, esophageal varices, s plenomegaly, ascites, encephalopathy), develop
as a result of the way cirrhosis changes blood flow through the liver.
Complications of Cirrhosis
1. Esophageal Varices
Definition: Esophageal varices are the enlarged veins (varicose veins )
located in the l ower end of the esopha gus (swallowing tube). These veins
develop because cirrhosis blocks blood fro m flowing freely through the liv er.
Once the blood is blocked from flowing through the liver, it must find another
way to return to the heart. Th e veins surrounding the esophagus and stomach
provide a pathway f or blood to return t o the hear t. Over ti me, these veins
become larger and develop into varicose veins or varices. The enlarged v eins
surrounding the esophagus are esophageal varices, and the veins surrounding
the stomach are gastric varices. If the pressure within these v eins becomes
high enough the veins can rupture, leading to life threatening bleeding.
Symptoms: Bleeding from varices is generally brisk and associated with
symptoms. The most frequent s ymptoms include: weakness, light-headedness,
nausea, vomiting of blood or c offee colored material, and pas sage of bowel
movements that ar e bloody or black
(like tar). Bleeding from varices
represents a life-thr eatening medical emergency. If you develop signs of
bleeding, you should call 911 or someone should take you to the nearest
hospital immediately.
Prevention: Variceal bleeding may be prevented by the administration of
medications which reduce pre ssure within the por tal vein and within the
varices. Beta-blockers (propranolol or nadolol) are the drugs most often used.
When these are given it slows the heart rate. A us ual target heart rate for
cirrhotic patients on beta-blockers is 55-60 beats per minute.
Treatment: Endoscopic Therapy: Bleeding from esophageal varices can
usually be stopped with endoscopic th erapy. The endosc ope is a fl exible
lighted instrument that is inserted th rough the mouth in order to examine the
esophagus, stomach, and small intestine. In pa tients with ble eding varices,
the bleeding can usually be stopped with sclerotherapy (injection) or rubber
band ligation.
2. Ascites
Definition: Ascites is the fluid that accum ulates in the abdominal cavity as
a consequence of cirrhosis.
Symptoms: Pain in the abdomen, abdomi nal distention, loss of appetite,
back pain, shortness of breath, fluid retention, and leg swelling.
Treatment: Salt restriction and diuretics are the primary treatment. When
salt restriction alone is ineffective, patients are treated with di uretics (water
pills) such as spironolactone (Aldac tone) and/or furosemide (Lasix ) or
torsemide (Demadex). When di uretics are ineffective, patients may need to
have the fluid removed by placing a needle into the abdominal cavity
(paracentesis).
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3. Spontaneous Bacterial Peritonitis (SBP)
Definition: SBP is an infection within the ascites fluid.
Symptoms: Increased ascites, abdominal pain, fever, confusion (worsening
encephalopathy).
Treatment: Intravenous antibiotics.
Prevention: Oral antibiotics
may prev ent episodes of sponta neous
peritonitis. Preventive antibioti cs are recommende d for patients with severe
ascites and for those who have experienced a previous bout of peritonitis.
4. Splenomegaly
Definition: Splenomegaly is an enlargement of the spleen and occurs in
patients with cirrhosis. It is caused by blood backing up i nto the spleen as a
result of the elevated pressure within the liver.
Symptoms: Enlargement of the spleen generally occurs without any pain or
discomfort. Some pa tients will be able to feel the spleen in the left side of
the abdomen. Platelets and white bloo d cells can become trapped within the
enlarged spleen leading to abnormally low platelet and white blood cell
counts. L ow platelet counts c an lead to bleeding problems; low white bloo d
cell counts may cause problems with infections.
Treatment: No trea tment is required for splenomegaly due to cirrhosi s.
The problem is in th e liver, not the sp leen. Surgic al removal of the spl een
rarely helps and is not necessary.
5. Hepatic Encephalopathy
Definition: Hepatic Encephalopathy is a brain dysfunction ca used by the
accumulation of toxic chemicals in the blood stream. The normal liver acts as
a filter removing harmful substances from the blood. With cirrhosis the liver is
not able to remove a vari ety of toxic chemicals. These chem icals remain i n
the blood and eventually enter the brai n, causing a variety of disturba nces
with brain function. The toxin most easily identified is ammonia.
Symptoms: Fatigue, sleepiness, conf
usion, depression, irritability,
personality changes, forgetful ness, slurred speech, tremors (shakes), and
problems with balance may occur. As the condition worsens, patients bec ome
drowsier and eventually lapse into
a coma. Some patients
with
encephalopathy develop a peculiar odor on their breath (fetor hepaticus ) from
the toxins.
Treatment: The toxins are produced in
the i ntestine by bacterial
metabolism of protein. The following therapies help reduce the levels of
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ammonia and other toxins.
a) Laxatives. The longe r material remains in the colon the more toxins
that are produced; thus, constipation must be avoided. We recommend
that people with enc ephalopathy have at least 1-2 bowel mov ements
each day. Lactulose (Chronul ac, Duphalac) is the preferred agent
because it clears more ammonia from the intestines than other laxatives
and also works to keep the bow els moving. Lactulos e causes abdominal
bloating and leads to increased intestinal gas. It is easier to take when
mixed with juice.
b) Avoidance of Medications. Certain medications may increase the brain’s
sensitivity to ammonia and other to xins. These medications include
sedative drugs (e.g., Valium, A tivan, Xanax), pain medicatio ns (e.g.,
Darvocet, codeine, Vicodin, Percocet, Demerol), anti-nausea agents
(e.g., Phenergan, Compazine), and anti histamines (e.g., Be nadryl).
These medications s hould not be taken unless you check with your
physician.
6. Hepatocellular Carcinoma (Liver cancer)
Cancer of the liver (hepatocellular carcinoma, HCC, or hepatoma) can occur as a
complication of cirrhosis from any cause. Some types of cirrhosis are more likely
to be associated with hepatocellular carcinoma (HCC) than others. Patients with
cirrhosis caused by hemochromatosis, al pha-1-antitrypsin deficiency, and those
patients with cirrhosis caused by long-sta nding infection with he patitis B a nd C
viruses are at the greatest risk. In patien ts with cirrhosis due to hepatitis C, for
instance, the risk of developi ng HCC ranges between 1.5-6% per year. Thus, 1 0
years after being diagnosed with cirrhosis a patient with chronic hepatitis C has
somewhere between a 15-60% of developi ng HCC. Men are more likely to
develop HCC than women, drin kers more likely than non-drinkers, and s mokers
more likely than non-smokers.
Liver Transplant
The information in this section, disc ussions with your physicians and other
members of the transplant team , and written material from the program ar e all
intended to give you the information necessary t
o assist you in making an
informed decision regarding the risks of liver transplantation.
Please ask questions about anything that you do not understand. You are fr ee to
change your mind and withdraw your consent at any time prior to the transplant.
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Evaluation
Most evaluations are conduc ted on an ou tpatient basis over two or three days.
You will be evaluated to determi ne the medical appropriateness of a transplant.
The work-up is designed to: 1) determ ine whether you need a trans plant, 2)
detect problems which might complicate the transpl ant, 3) determine whether
you have other c onditions which make transpl antation impossible. The
evaluation consists of the following tests and procedures:
1. Blood tests will help determine the extent and/or cause of your liver disease.
Other tests performed will be blood type f or organ matching and screening for
the immunity or presence of specific viruses, including HIV.
2. A chest x-ray helps your physician rule out pneumonia a nd identify any
problems with your lungs. A
chest x- ray (CXR) is a painless, three-minute
procedure, which tak es an internal pict ure of your chest including the l ungs,
ribs, heart, and the contours of the great vessels of your chest. A chest x-ray can
aid in diagnosing infection, collapsed lung, hyperinflation, or tumors.
3. A urine test is used to screen for the presen ce of drugs and alcohol in your
system.
4. An echocardiogram and EKG will show how well your heart is beating and
the function of your heart valves. This will assist yo ur physicians in deciding i f
your heart function is strong enough for transplant surgery. An echocardiogram is
an ultrasound of the heart. It examin es the chambers, valves, aorta, and the
wall motion of your heart. It is also performed to evaluate the impact of lung
disease on the mechanics of your heart, providing information concerning the
pressure in the pulm onary arteries (PA pressure). Thi s information is important
in planning the exact approach during the transplant operation.
5. An ultrasound of your liver and abdom en helps assess the circulation to your
liver. You may require frequent ultrasounds during your waiting period.
6. A CT Scan or an MRI determines the extent of l iver disease, the pres ence of
any tumors, and verifies the circulation to your liver.
The following tests are sometimes needed to complete your evaluation:
7. A Liver Biopsy is a procedu re which may be requeste d by your transplan t
physician. During a liver biopsy a needle will be used to remove a tiny portion of
your liver through a needle. This is an
outpatient procedure. A micr oscope
examination will provide information to your physicians regarding the nature and
severity of your disease.
8. Pulmonary Function Tests may be required, especially if you are a smoker or
have a his tory of lung disease. This is a breathing test to analyze your lung
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capacity. Pulmonary Function Tests meas ure lung volume and the rate of air
flow through your l ungs. Pulmonary function tests require that you perform a
variety of breathing exercises by blowing into tube. The r
esults of these
exercises measure the progress of your
lung dis ease. Please inform the
respiratory technician before these test s if you are taking bronchodila tors or
other inhaled medication.
9. Arterial Blood Gases (ABG) measure the amount of oxygen that your blood is
able to carry to your body tissues. This is performed by placing a needle into an
artery in your wrist. A small amount of blood is requi red. This procedure takes
about 5 minutes. Any discomfort at the site where the needle was inserted will
go away within a few minutes.
10. You will meet with members of
the transplant team in the
Clinic as part of the education and evaluation process.
Transplant
11. The Transplant Social Worker will meet with you to evaluate your ability
to cope wi th the stress of tran splantation and assess your ab ility to foll ow a
rigorous treatment plan.
12. You will meet with a
Transplant Psychologist/Psychiatrist to screen
patients for possible issues that may interfere with the transplant success.
13. Every patient meets with a Registered Dietitian who performs a nutritional
assessment and provides education to patients.
14. All patients meet with the Financial Counselor who will discuss the costs
associated with your transplant and the cost of the medications. They will work
with you to understa nd your insurance coverage. It is required that you arrange
for payment of the costs that may not be covered by insurance. You may not be
able to u ndergo a transplant if you
have not made acc eptable financial
arrangements for payment when a suitable liver becomes available.
15. The Nurse Coordinator will provide education regarding the trans plant
evaluation process, listing for transplant, and patient responsibilities before and
after transplant. This meeting is intended to provide you with an opportunity to
ask questions and to become fully informed about the liver transplant process.
16. A Transplant Hepatologist is a physician who specializes in liver disease.
The transplant hepatologist will conduct a full history and physical
exam.
He/she will also assist in the medical management of your liver disease and work
with the transplant team to determine if you are medically suitable for a
transplant.
17. Your Transplant Surgeon will conduct a physical exam. He will also meet
with you and discus s the appropriaten ess of a transplant based on the
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information obtained during your evaluati on. The surgeon will also discus s the
significance of undertaking a liver transplant, along with the risks of the surgery
and the possible complications after your transplant.
Transplant Selection Process
After the work-up ha s been completed a nd you have met with the key m embers
of the transplant team, your case will be presented to the Tra nsplant Selection
Committee. Base d on your tes t results a nd evaluations, the Committee will
decide if you are an appropriate candi date for transplantation. The c ommittee
may make any of the following recommendations:
1. you don’t need a transplant.
2. you are not a transplant candidate because of co-existing problems.
3. the committee needs more information.
4. the committee would like you t o be followed for a period of time (generall y
6-12 months) before being placed on the waiting list.
5. you are an acceptable candidate and c
an be placed on the transplant
waiting list immediately.
You will not be placed on the waiting list until you hear from us telling you
that you have been accepted. You will receive a written letter confirming your
status on the waiting list.
Once you are listed, you will be followed cl osely. The success of liver transplant
is dependent upon the maintenance of a heal thy lifestyle.
You must
remember:
1. No alcohol. Alcohol i s very toxic to the liv er. You will not be e valuated or
listed for transplant until you have been abstinent for at least 6 months.
You may be asked to submit to r andom testing for alcohol. We may require
that you a ttend AA or a simila r alcohol treatment program. If we detect
that you are drinking, you will be taken off the list and not transplanted.
2. Smoking. Smoking is strongly discouraged. It is important to kn ow that the
longer the time betw een smoking cessation and transplantati on the better .
Continued smoking leads to more complications after surgery, such as cancer
or blotting of your blood vessels, and reduces your chances of surviving.
3. No illegal drugs. You will be drug tested and if illegal or un-prescribe
d
drugs are detected, i ncluding marijuana, you will be taken off the list and
not transplanted.
4. Compliance is critical, because it is import ant to m aintaining you’re you r
health and the health of your transplant ed liver. You will be instructed on
how to tak e your medications , and tol d when you w ill need to return for
appointments. It is expected that you will follow the inst ructions we give
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you. If you repeatedly do not follow our management instructions, you
will not be transplanted.
5. Social Support is necessary. Immediately after the transplant you will need
to rely on your family and friends for help.
If you do not have adequate
support from your family or friends, you may not be transplanted.
Waiting List
The liver transplant waiting list is a co mputer list maintained by UNOS (United
Network for Organ Sharing). The determination of who gets a liver is based on a
formula that takes i nto consideration lab values s uch as: cr eatinine, total
bilirubin, and INR (a measure of blood clotting). UNOS will then assign a model
for end-stage liver disease (MELD) score based upon these values. The higher the
MELD score the sicker the patient, and th e higher on the transplant waiting list.
Livers are only match ed for blood type (A, B, O, AB) a nd size (the liver must fit
into the body). Unli ke other organs, spe cial tissue typing is n ot necessary to
determine which liver donor makes the best match.
The MELD score assigned to eac h patient is re-assessed and re-certified by the
transplant coordinator in accordance with the following UNOS schedule:
Adult Patient Reassessment and Re-certification Schedule
Status 1
Status re-certification
Every 7 days.
MELD Score 25 or greater
Status re-certification
Every 7 days.
Score <= 24 but > 18
Score <= 18 but >=11
Score <= 10 but > 0
Status re-certification
Every 1 month.
Status re-certification
Every 3 months.
Status re-certification
Every 12 months.
Laboratory values must
be no older than 48
hours.
Laboratory values must
be no older than 48
hours.
Laboratory values must
be no older than 7 days.
Laboratory values must
be no older than 14 days.
Laboratory values must
be no older than 30 days.
Once you are listed, we must be able to get in touch with you at all times. It
is important to provide us with several contact num bers. If we can not fi nd you
then we c an not tra nsplant you. If we need to contact you, we will call your
home first. While on the waiting list you need to let us know if you have a
problem or get admitted to the hospital. Patients on the wai ting list are seen
in our clinic at least once every 6 mo nths. When you are ca lled in for your
transplant we would like you here as soon as possible (if you live out of town, we
usually have plenty of time for you to ge t here). Plan your trip ahead of time.
Don’t wait for the phone call from the transplant center to find someone to
drive you.
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Waiting Period
After you have been listed you will begi n the waiting period. This time varies
depending upon orga n availability and the severity of your illness. During this
time you will be see n in the tr ansplant clinic and you will nee d to have re gular
lab work to maintain your position on the UNOS waiting list.
It is very important that you contact ou r office with any changes such as your
phone number, address, and insurance coverage. If you are hospitalized or your
disease worsens, you must contact your coordinator. Any medical changes may
alter your position on the waiting list.
You will need to be available, by phone or pager, at all times so that when an
organ becomes available you ca n be reach ed by your coordinator. You wi ll be
required to come to University Hospital, St. Paul immediatel y. The transplant
will usually occur within 6 to 12 hours of initial contact.
A patient may wish to register at more than one tr ansplant center. However,
each center may have certain requirements for placement on the waiting list.
Patients should inform the centers they contact of their multiple listing plans.
If a patient would like to change transplant centers, the patient may transfer his
or her primary waiting tim e to the new c enter upon listing at that c enter. The
patient would then c ontact their original center requesting re moval from that
list.
Liver Transplant Options
There are more people waiting for live r transplants than ther e are avai lable
livers. All patients accepted by a tran splant program are registered on the
national organ transplant waiting list managed by UNOS (United Network for
Organ Sharing). UNOS is a non-profit ch aritable organization which operates the
Organ Procurement and Transplantation Network (OPTN) under federal contract.
UNOS maintains a centralized computer network and the UNOS o rgan placement
specialists operate the network 24 hours a day, seven days a week. Patients are
prioritized on the waiting list based on several factors. Adult liver transplant
patients are prioritized using the MELD system. (MELD = Model for End Stage
Liver Disease). A higher score means th at you are sicker and you will be put
higher on the list to get a liver. Additi onal information about the waiting list and
UNOS can be obtained by logging on to www.unos.org.
The current organ options available in Texas are outlined below.
1. Option 1 is an organ by standard allocation: If it is deter mined that you
are a candidate for transplant y ou will be listed on the UNOS waiting lis t. You
will be given a MELD score based upon the results of your blood work. In order to
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maintain your UNOS listing, periodic blood tests will be required an d your
medicines may be changed as needed to keep you in the best possible shape for
a transplant. It is very important that you keep all your appointments and keep
your lab testing current.
When an organ becomes available, medical information is entered into the UNOS
computer system and a list of potential recipients is generated. The transplant
centers whose patients appear on the ra nked list are contacted. Your surgeon
will consider the organ based upon established medical criteria, organ condition,
recipient condition, patient av ailability, and or gan transportation. By policy,
the transplant team has only one hour to make its decision. If an organ is
declined it is offered to the next patient on the list until it is placed.
2. Option 2 is an extended criteria donor liver. There is a serious shortage of
deceased donor livers. One way to incr ease the number of livers is to us e
extended criteria donors. The m ost common reasons that donor livers fall into
the category of extended criteria are listed below:
The donor has a history of hepatitis C. When a donor has active hepatitis C,
we will consider transplanti ng the organ into a r ecipient who also has
hepatitis C. In all cases we will assess the donor liver prior to
transplantation, sometimes with a liver biopsy, to e nsure that there is n o
evidence of damage to the donor liver from hepatitis.
The donor is an inactive carrier of hepatitis B. Any transplant patient who
receives an inactive carrier of hepatitis B organ w
ill require additional
treatment after the transplant. An init ial three-dose treatment of hepati tis
B immunoglobulin is administered and an oral anti-viral agent, Lamivudine,
is used on an ongoing basis.
The donor liver contains some fat (steatosis). The presence of fat in the
liver is very common in the general popul ation and usually goe s unnoticed
with no ill effects. Th is may prolong the ti me it takes for the donor liver to
function optimally after transpl antation. For this reason these livers may
not be suitable for some patients.
The donor is from an older age group. (greater than 65 years) The natural
life span of the human liver is not completely understood. We do know that
livers from older donors m
ay experience a delayed function aft
er
transplant. Every liver offered from an older donor is carefully evaluated by
the surgeon prior to implantation.
Donation after cardiac death. Cardiac death means that the donor heart
has stopped beating prior to donati on. (The stan dard donor has been
declared brain dead but the heart still functions). A liver from this type of
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donor has an increased chance of dela yed graft function and complications
of the bile duct passages.
There are other reasons which would place a donated liver in the extended
criteria category. Your surgeon will discuss the s
pecific details of an
extended criteria donor organ with you at the time the liver is offered.
All extended criteria donor organs are reviewed by the surgeon pri
or to
implantation. The decision to accept a particular liver is based upo n your
specific needs at the time the liver is
offered. The transplant surgeon may
advise you to consider accepting a liver from one of the above groups depending
upon your situation.
If you agree to be considered for an
extended criteria donor liver you will
remain on the UNOS waiting list. You
will continue to be a candidate for a
standard allocation donor liver; however, extended criteria d onor organs will
often become available sooner . The deci sion to accept an extended criteria
organ must be balanced with the risk of dying or becoming sicker on the waiting
list. You will always have the option to de cline or to accept an extended criteria
donor liver at the time it is offered. If you decline, it will in no way affect your
status on the UNOS wait list.
Organ Offer
When a deceased or gan donor i s identified, an organ procurement coordinator
from Southwest Tra nsplant Alliance accesses the U NOS computer. The UNOS
computer matches e very patient on the l iver transplant waiting list agai nst the
donor's characteristics. The computer then generates a ranked list of patients
for each organ tha t is procured from th at donor in ranked order according to
organ allocation policies. Factors affe cting ranking include blood type, size,
length of time on the waiting list, distance between the pote ntial recipient and
the donor, and de gree of medic al urgency as set forth by the MELD allocati on
system. The organ is then offered to the transplant team of the first person on
the list.
Day of Transplant
When you are selected as the recipient for an organ you will be called and you
must come in to the hospital right away. If the organ is considered an extended
criteria organ, your surgeon wi ll review this with you and assist you in making
your decision. You always have the opti on to decli ne an organ and it will not
affect your UNOS status.
As soon as you arrive at the hos pital you will be admitted to the hospital. After
hours you will enter the hospital through the Emergency Department. The
coordinator contacting you will provide you with ex act instructions. You will
have a bri ef exam, blood and urine tests, x-rays and an EKG. Y ou will rec eive
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your first doses of anti-rejection medication. In s ome cases the donor organ is
not suitable for transplantation and the transplant will be called off. The actual
operation takes between 4-8 hours. Afterwards you will be taken to the SICU.
Surgery
If everything goes as expected, you will spend 1-2 days in the ICU and 5-10 days
in the hospital. During your hos pital stay you will nee d to be monitored closely
for signs of infection and rejection. If there are abnormaliti
es in your blood
tests we will do a liver biopsy to look for rejection. Most patients undergo
several liver biopsies after their transpla nt. Mild e pisodes of rejection occur
frequently and are usually easily treated with corticosteroids (i.e., cortisone or
prednisone) or by adjusti ng your othe r anti-rejection medications . The
medications you take to prevent rejection reduce your ability to fight infections.
If you live more than 1 hour away from the hospital , we will ask that you stay
nearby for 3-4 week s after you are disc harged. S ince you will not be strong
enough to stay alone, a family member or
friend will need to stay with you.
Arrangements with family and friends must be planned ahead of time.
During the transplant surgery you will be put under general anesthesia, whic h
means you will be given drugs to put you to sleep, block pain, and paralyze parts
of your body. You will also be placed on a machine to help you breathe. The
Anesthesiologists will talk with you in more detail about the risk s of anesthesia.
The transplant surgeon will m ake an incision in y our abdomen as large as
necessary to remove your liver and impl ant the donated liv er. Through this
incision your liver and gall bladder will be removed and a donated liver (without
a gallbladder) will be placed into your abdomen.
During the surgery you may require veno bypass. If required, your surgeon will
place incisions in your underarm or neck and groin for the placement of tubes.
These tubes will connect to a machine that will allow your blood to bypass your
liver during surgery. The transplant surg eons will decide if this machine w ill be
used based upon your condition.
Drains will be put into your body to allo w fluids to be removed and to help you
heal. A tube may be placed into the bile duct to keep it open while it heals.
Special mechanical boots will be used to keep blood flowing through your legs to
try to prevent dan gerous blood clots. You will be in the operating room for
approximately four (4) to six (6) hours.
Immediately Post-Transplant
Once in the ICU, you will begin to wake u p slowly as the anesthetic begi ns to
work its way out of your system. Initially , a respirator helps you breathe. It is
connected to a tube that is pl aced in your windpipe. After you are fully awake
and are able to breathe on your own, this tube will be removed. During the time
15
that the respirator is helping you breathe, your hands will be lightly restrained in
order to prevent you from accidentally removing this tube.
You will not be able to talk during this time, sinc e this tube is blocking your
vocal cords. The nurses in the ICU wil
l assist you in communicating. Also
necessary during this initial recovery pe riod is a nasogastri c tube (NG tube).
This is a small plasti c tube tha t is inserted throu gh your nose and the n passed
into your stomach. During surgery it keeps your stomach empty of any res idual
food you may have had prior to the operation, as well as intermittently removing
the stomach juices that are normally produced. The s urgery causes your
stomach and intestines to be “asleep” temporarily; therefore, it may take one or
more days before you r stomach and intes tines are ready to rec eive food again.
You will receive liqui d nutrition through a second t ube called a feeding tube .
You will be allowed small amounts of ice chips in order to keep your mouth from
feeling too dry. Once you have passed ga s or had a bowel mo vement, the NG
tube will be removed. The feeding tube will be removed when you are able to
eat enough.
In order to empty your bladder , you will have a catheter that will drain urine
from your bladder into a bag
on the ou tside of your body. This is usually
removed as soon as you are able to use the restroom. While in use, it hel ps us
monitor how well your kidneys are functioning.
Most transplant surgeons make an incision that is sometimes referred to as a
“Mercedes” incision because it looks like an inverted “Y” or the Mercedes-Benz
emblem. Occasionally, it may be necessary to plac e a drain i n your inci sion,
which will be connected to a “grenade-like” bulb. This will drain off any excess
blood or fluid that may accumulate.
Several intravenous lines (IVs) w ill be needed to give you fluids and medic ations
until you are able to drink and eat again.
This IV line or “triple lumen” will
often be placed in your neck or below your collarbone. This line may also be
used to draw blood for the daily laboratory valves.
Overall, those who have undergone liver transplantation say that there was not
as much pain involved as they anticipated. We believe this is due, in part, to
the type of incision that is ma de, plus the use of steroid medications . The
steroids are given both during and after the surgery and as a res ult significantly
decrease the internal swelling. By doing so, pain is lessened.
Medical Risks of Transplant
There are inherent ri sks in all s urgeries, especially surgeries conducted under
general anesthesia. Most complications are minor and get better on their own. In
some cases, the complications ar e serious enough to r equire another surgery or
medical procedure. One year after tran splantation approximately 88% of liver
transplant patients are living and approximately 81% are living after 3 years.
16
1. Pain. Immediately following the s urgery, you will experi ence pain. Most
transplant recipients have a si gnificant reduction in pain thr ee weeks after
surgery. Some people continue to have pain for a longer time.
2. Delayed Function. There may be a
delay in the function of your
transplanted liver. Such a delay may incr ease the l ength of y our hospital stay
and increase the risk of other complications.
3. Primary Nonfunction. There is a rare possibili ty that the transp lanted liver
will not function. When this occurs a second tr ansplant is needed. You will be
placed on the UNOS waitlist in the highes t priority category allowed. If a second
liver does not become available, death may occur.
4. Clotting/Stricturing. Hepatic artery thrombosis (clotting)/stenosis
(narrowing) occurs in a small percentage of liver transplants . A hepatic a rtery
thrombosis is a clo t that develops in the major bl ood vessel going to your liver.
Hepatic artery thrombosis can cause two complications including liver abscess
and/or biliary strictures. A hepatic artery stenosis is the narrowing of the artery
that supplies blood to the liver. When this occurs, an angiogram is performed to
assess the extent of the problem. Some times another surgery will be necessary
to revise the area where the donor artery and the recipi
ent artery are
connected. In the w orse scenario the li ver may suffer irreversible damage from
lack of blood flow requiring a second transplant.
5. Bile Leaks. Some transplant patients experience bile leaks. Bile is a secretion
of the liver that aids in digesti on. Most bile leaks get better without the need
for surgery. Occasionally, tubes need to be placed through the s kin to aid in the
healing process. In some cases surgery is necessary to correct the bile leak.
6. Biliary Strictures (narrowing). Some tr ansplant patients ha ve a long term
complication of biliary strictures. A biliary stricture is a narrowing of the ducts
transporting bile. Some of the strictures can be repaired by non-surgical means
such as the insertion of tubes, but some will require surgical repair.
7. Diarrhea. As a result of not having a gallbladder, some patients have periods
of diarrhea and cramping. In the vast majo rity of cases this goes away after two
or three months.
8. Blood clots. These clots us ually develop in the legs and can break free and
move through the h eart to th e lungs. In the lungs, they ca n cause s erious
interference with breathing whi ch can lead to death. Blood cl ots are treated
with blood-thinning drugs that may need to be take n for an extende d period of
time.
17
9. Bleeding. Bleeding during or after surgery may re quire blood transfusions or
blood products. T he use of blood or bloo d products has th e following general
risks: itching, rash, f ever, headache, or shock; respiratory distress (shortness of
breath); kidney damage; system ic infection; exposur e to blood borne viruses
including hepatitis (an inflam matory disease affecting the li ver), and Human
Immunodeficiency Virus (HIV, the virus that causes AIDS); and death. The risk of
getting the HIV virus and/or he patitis C is approxima tely 1 in 2 million per unit
transfused. The risk of getting hepatiti s B is approximately 1 in 100,000 per unit
transfused. In rare cases, blood transfus ions (usually multiple tr ansfusions) can
adversely affect a person’s ability to
receive future organ or bone marrow
transplants.
10. Infection. The risk of infection including urinary tract infection is higher for
transplant recipients than other surgical patients because the treatments
needed to prevent organ rejection make the body less capable of fighting
infection. Also, liver disease itself decreases the body’s ability to fight infection.
The abdominal incision for the l iver transplant and any incision needed for the
liver bypass machine (neck, underarm, and groin) are potential sites for
infection. Infections in the sites where tubes are placed in your body (tubes to
help you breathe, tubes in your veins to provide fluids, nutrition, and to monitor
important body func tions) can cause pn eumonia, blood infections, and local
infections.
11. Nerve Damage. Damage to nerves may occur. This can happen from direct
contact within the abdomen or from pressure or positioning of the arms, legs, or
back during the surgery. Nerve damage can cause numbness, weakness,
paralysis, and/or pain. In most cases th ese symptoms are temporary, but in rare
cases they can last for extended periods or even become permanent.
12. Psychiatric. Depression can be due to many fa ctors such as an underlying
disease (particularly hepatitis C), brain chemical imbalances requiring
antidepressant drugs of one type or anot her, or hor monal imbalance. A s erious
procedure such as a transplant c an create many personal and f amily stresses. It
is not unc ommon for transplant patients to exper ience anxiety and perhaps
depression following their surgery, hospital confinement, and return home.
13. Disease recurrence after transplantation. Unfortunately, in most cases
liver transplantation does not cure the primary cause of liver disease. As a result
of the many surgical and medical adv
ances within the practice of liver
transplantation, most liver transplant re cipients can anticipate long-term
survival and therefore recurrence of the original disease may become a threat to
the long-term success of transplantati on. The severity of recurrence varies
among patients largely due to unknow n reasons. In severe cases a second
transplant is indicated; unfortunately, some patients may not be an appr opriate
candidate for a second transplant.
18
The most common c ause of recurrent dis ease include viral hepatitis B and C.
Medications to treat hepatitis B before liver transplantation and measures to
prevent its recurrence after liver transplantati
on with oral and injectable
medications may be necessary. As for hepa titis C, recurrence in the bl ood is
universal and there are no effective measures to prevent that. Up to 40% of
patients will have accelerated liver damage from the hepatitis C and may even
develop cirrhosis by 3 -5 years after tran splant. Treatment for h epatitis C after
liver transplantation is possible.
Liver tumors may rec ur after transplantatio n and the risk is higher in pati ents
with larger tumors or those with involvement of the blood vess els. This has led
to strict criteria for selecting liver cancer patients for liver transplantation.
Autoimmune liver diseases such as prim ary biliary cirrhosis, primary sclerosing
cholangitis and autoimmune hepatiti s may recur. In most cases, the
immunosuppressive medications used to prevent rejection are sufficient to
prevent significant autoimmune damage to the new liver.
For patients with alcoholic liver disease, recidivism (relapse) may occur after
liver transplantation. This has been sh own to lead to nonc ompliance with the
transplant medications and a higher ra te of medical problems, particularly
infections.
14. Other. Other possible complications include: injury to structures in the
abdomen, pressure sores on the skin due to positioning, burns caused by the use
of electrical equipment duri ng surgery, damage to arteries and veins,
pneumonia, heart attack, str oke, permanent scarring at the site of the
abdominal incision.
Recovery
The average length of stay in the ICU is variable and largel y dependent on your
body’s tolerance of the surgical procedur e as well as your preoperative medical
condition. Once your conditi on warrants it, you will be transferred to the
transplant nursing floor. You should ex pect to spend 7-10 days in the hospital
post-transplantation. You will be given a private room and your family will have
the freedom to come and go as they choose.
Soon after your transfer to the transplant floor, you will be ins tructed to begin
getting out of bed. A physical th erapist will come to w ork with you in rebuil ding
your strength. The i ndividuals working wi th you are familiar with the needs of
transplant patients and will work di ligently to help you walk and begin
functioning on your own.
You will be encouraged to do c oughing and deep breathing exerc ises in order to
keep your lungs clear and expanded and prevent pneumonia. You will be a sked
to use an incentive spirometer every hour while awake. Your li ver is in the right
19
upper portion of your abdomen and is dire ctly below your right lung. This lung
was pushed aside during the s urgery, and may initially collect fluid (pl eural
effusion) or may not expand as well as it should. Frequent coughing and deep
breathing will help r eturn your lungs to normal: cl ear, expanded, and f ree of
mucus.
Your diet will also be advance d during this time. You will begin with clear
liquids and progress to solid food. We ll-balanced, high pro tein meals are
necessary because your body will need adequate calories and protein to heal and
rebuild itself. Few dietary restrictions are necessary. To help with your
individual needs, the transplant dietitia n will discuss and instr uct you on foods
that will be be neficial in thi s rebuilding process. B efore discharge, the
transplant dietitian will counsel you indi vidually on the long-term nutritional
guidelines that you will need to follow.
Throughout your stay in the hos pital, the transplant team will record your daily
lab and test results on a flow chart. Th is chart remains in your records in our
transplant office so that we can follow your progress over time and provides an
overall picture of your recovery. We feel that disc ussing your results and the
intended plan of care while in your room provides an additi
onal learning
opportunity for you. Please do not hesi tate to ask questions during this time. A
separate section in this manual explains the meaning of each of the different lab
tests.
Medications for Life
You will be required to take medications for the rest of your life to prevent your
body from rejecting the transpl anted liver. The types and doses of medications
will be determined and adjusted by your physicians based on yo ur condition and
health. Following transplanta tion you will receive further instructions
and
teaching regarding the medications speci fically ordered for you. Listed below
are examples of som e, not all , of thes e medications and pote ntial side effects
and risks. It is important to note that all anti-rejection medications can increase
your risk for infections and malignancies.
Tacrolimus (Prograf): headache, tremors, insomnia , reduced kidney fun ction,
numbness and ti ngling of the extremitie s, elevated blood s ugar (diabetes),
decreased magnesium levels, increased po tassium levels, and other serious side
effects.
Cyclosporine (Neoral, Sandimmune): tremors, high blood pressure, reduced
kidney function, changes in gums, increased hair growth, and other serious side
effects.
Mycophenolate mofetil (CellCept): gastrointestinal disturbances, reduced white
blood cell count, reduced platelet count, and other serious side effects.
20
Steroids: elevated blood sugar, weight gain, high blood pressure, osteoporosis,
stomach ulcers, mental status changes, cataracts, muscle weakness, impairment
of wound healing, and other serious side effects.
Sirolimus (Rapamune): elevated cholesterol and tri glycerides, impairment of
wound healing, lung problems, and other serious side effects.
The goal of various medications during and after transplantation is to hel p your
body tolerate the donated organ. Other medications may be required f or the
rest of your life to treat or prevent various infections. Your potential need for
these medications m ay be determined by the blood work obtained duri ng the
evaluation process.
Risks involving medical costs and insurance
After you have a liver transplant, health insurance companies may consider you
to have a pre-existing condition and refuse pay for medical care, treatments, or
procedures. After the surger y, your health insurance and life insurance
premiums could be raised and remain higher. In the future, insur ance companies
could refuse to insure you.
Benefits
The benefit of liver transplantation to you is the hope of living l onger than your
liver disease would h ave likely permitted. This pote ntial benefit cannot r esult
from surgery alone; i t is dependent upon your following the ri gorous treatment
plan prescribed by your physicians.
Alternatives
You have the choice NOT to undergo transplantation. If you choose not to have a
transplant, treatment for your liver dis ease will continue. If you do not undergo
the transplant surger y, your condition is likely to worsen and limit your life
expectancy.
Protected Health Information
If you bec ome a transplant ca ndidate, federal regulations require that some
personal health information about you be sent to the UNOS registry to allow you
to be listed for an organ.
Teaching Facility
Your physicians are associated with the University of Texas Southw
estern
Medical Center which is a teaching facility . This means that res idents, fellows,
students, and others may assist with parts of procedures or other medical acts as
deemed appropriate by, and under the supervision of, your physicians.
21
For the purpose of advancing medical ed ucation and research, you cons ent to
the admittance of observers and discussi on of your procedure with ot hers who
may not be directly r esponsible for your care. You also consent to the review of
and use of your medical information and records. The use of your medical
information and records will not result
in your identity being publis hed or
revealed.
In summary, transplantation, including the ri sks and complications outlined in
this document, can result in serious injuries, damage, and death. Your physicians
cannot predict how y our body will respond to a liver transplant. It is not known
how the c ondition that caused your underlying liver disease will affect your
transplanted liver.
22
TRANSPLANT RESOURCES
Here is a list of resources that may be help ful to transplant patients, their families or
support persons, and living don ors. Please note that the Inter net is a vast but not
necessarily correct and accurate source. Your doctor is the best person to answer
questions. Read every source; by all m eans – but please re ly on your doctor for
medical decision-making.
Information and Support Resources
UTSW Kidney, Liver and Pancreas Transplant Support Group
Meets Second Tuesday of every month in DePaul Auditorium
Contact program social worker at (214) 645-1919 for more information.
Organ Transplant Support, Inc.
P.O. Box 471
Naperville, IL 60566-0471
E-mail: [email protected]
630-527-8640
630-527-8682 (Fax)
Scientific Registry of Transplant Recipients
www.ustransplant.org
Transplant Health
An interactive resource for health living that provides comprehensive health
information for before and after transplant.
www.transplanthealth.com
Transplant Experience
The Transplant Experience program was created to meet your specific needs
throughout the transplant process. It’s information. It’s tools and tips. It’s real
advice, from experts in transplantation and other transplant recipients.
www.transplantexperience.com
United Network for Organ Sharing (UNOS)
www.unos.org
www.transplantliving.org
ww.optn.org
Addiction Recovery Resources
Narcotics Anonymous 24 Hour help Line:
(972) 699-9306 or
Spanish 1-888-600-6229
Turtle Creek Manor, Inc.
2707 Routh Street
Dallas, TX 75201
Outpatient and non-hospital residential mental health and substance abuse services
Forms of Payment Accepted: Self Pay & Private Health Insurance
www.tcmanor.org
Catholic Charities Diocese of Dallas
St Joseph Adolescent and Family Services
5415 Maple Avenue, Suite 320
Dallas, TX 75235 (214) 631-8336
Outpatient Substance abuse treatment services
Forms of Payment Accepted: Self payment, Medicaid, private health insurance
www.catholiccharitiesdal.org
Green Oaks at Medical City Dallas
7808 Clodus Fields Drive
Dallas, TX 75251 (972) 991-9504
Outpatient, Partial hospitalization / Day treatment, Hospital inpatient Substance
abuse treatment, Detoxification
Forms of Payment Accepted: Self payment, Medicaid, Medicare, Private health
insurance, Military insurance
Hotline: (972) 991-9504 x8818
Website: http://www.greenoaksnetwork.com
Nexus Recovery Center Inc and Nexus Residential Facility
8733 La Prada Drive
Dallas, TX 75228 214) 321-0156
Outpatient, Non-hospital residential (24 hour) Substance abuse treatment services
Forms of Payment Accepted: Self payment, private health insurance
Intake: (214) 321-0156 x2106
Website: http://www.nexusrecovery.org
Recovery Healthcare Corp
2520 Electronic Lane, Suite 810
Dallas, TX 75220 (214) 350-1711
Outpatient, partial hospitalization & day treatment
Forms of Payment Accepted: Self payment, Medicaid, private health insurance
Website: http://www.recoveryhealthcare.com
Smoking Cessation Information and Web Sites
American Lung Association
1-800-586-4872
www.lungusa.org
24
Additional Smoking Cessation Websites
www.cancer.org
www.americanheart.org
www.cdc.gov/tobacco/
Hepatitis C Education and Support
Since information about hepatitis C chan ges too fas t to be up-to-date i n a resource
book, only Web sites are listed. If you do no t have Internet ac cess, go to your local
public library or Internet café or the Patie nt Information Center at the HEP office to
see these sites.
Hep C Connection
Provides a newsletter, support groups and information about hepatitis C.
800-522-HEPC (helpline)
www.hepc-connection.org
Hepatitis Foundation International
A community that helps people with Hepatitis concerns manage and fulfill their lives
1-800-891-0707
www.hepfi.org
American Liver Foundation
75 Maiden Lane, Suite 603
New York, NY 10038
800-465-4837 American Liver Foundation’s Help Line
www.liverfoundation.org
Hepatitis C Outreach Project
Support groups and information.
503-285-8712
www.hcop.org
Financial and Fundraising
National Transplant Assistance Fund (NTAF)
3475 West Chester Pike, Suite 230
Newton Square, PA 19073
800-642-8399
E-mail: [email protected]
www.transplantfund.org
25
New Start News Publication
A publication of the National Transplant Assistance Fund. New Start News is available
free of charge to anyone interested in NTAF
National Foundation for Transplants (NFT)
5350 Poplar Avenue, Suite 430
Memphis, Tennessee 38119
800-489-3863
www.transplants.org
Medicare
800-MEDICARE
www.medicare.gov
National Insurance Consumer Helpline
Call to obtain the phone number of your state insurance department.
800-942-4242
Social Security: Disability Information
1-800-772-1213
www.ssa.gov/disability
Texas Medicaid Program
877-252-8263
www.hhsc.state.tx.us/medicaid/
Prescription Drug Assistance Programs
Many pharmaceutical manufacturers have financial aid progra ms for pa tients who
qualify. Ask your so cial worker for th e manufacturers’ contact numbe rs for the
medications prescribed for you, or contact the agency described below.
Partnership for Prescription Assistance
The Partnership for Prescription Assistance brings together America’s pharmaceutical
companies, doctors, other health care providers, patient advocacy organizations and
community groups to help qualifying patients who lack prescription coverage get the
medicines they need through the public or private program that’s right for them.
1-888-477-2669
www.pparx.org
Needy Meds
Resource to assist in locating prescription assistance programs
www.needymeds.com
Medicare Prescription Drug Coverage “Part D”
(1-800-633-4227) www.medicare.gov/part-d/
26
Transportation Resources
Medicaid Transportation
1-877-633-8747
Providing travel and lodging assistance to and from medical appointmen ts to patients
covered by Medicaid and meet specific eligibility criteria. Social Wor
k referral
required.
Angel Flight
3237 Donald Douglas Loop South
Santa Monica, CA 90405
800-446-1231 or 888-426-2643
www.angelflight.com
A national nonprofit organization of private pilots who provide free air transportation
for patients who are traveling to and from medical treatment. Serves patients with
limited financial resources.
Corporate Angel Network (CAN)
Westchester County Airport Building 1 Loop Road
White Plains, NY 10604
914-328-1313
A nonprofit organization that arranges free air transportation for patients using
corporate aircraft.
National Patient Air Transport
Help Line (NPATH)
800-296-1217
www.patienttravel.org
Provides referrals to more than 40 air transportation options for patients throughout
the nation, including commercial airline programs and nonprofit organizations, such
as Air
Lifeline, Angel Flight, and Corporate Angel Network.
27
OVERNIGHT LODGING CONVENIENT TO UTSW
These nearby hotels and motels offer transplant patients of UTSW medical discount rates.
Please notify hotel staff at check-in that you are a patient of UTSW or have a family member at
UTSW to get the Patient-Family Medical Rate. The information listed was current when
printed, but cannot be guaranteed. Please verify information with individual hotels.
HOTELS
SHUTTLE
Additional
Information as
provided by hotel
$79
No
Boutique Style Hotel
Built 1925/Historic
Landmark
Multilingual staff
* Rate based on availability
$50.99
Yes
To Love Field &
within 3 miles of
downtown
Continental Breakfast
included
$59
No
Continental Breakfast
included
Guest Laundry facilities
(Letter from hospital
required)
Complimentary Breakfast
RATES
(+ tax)
1
Hotel Indigo
1933 Main Street
Dallas, Texas 75201
214/741-7700
2
Baymont Inn & Suites
2370 W NW Hwy.
Dallas, Texas 75220
214/350-5577
3
Best Western
2023 Market Center Blvd.
Dallas, Texas
214/741-9000
4
Bradford Homesuites
2914 Harry Hines Blvd
Dallas, TX
(214) 965-9990
$70-80
Yes
Every 30 minutes
until 8:30pm
To and from
UTSW
5
Candlewood Suites
7930 N. Stemmons Fwy
Dallas, Texas 75247
214/631-3333
1 Bedroom
$59
2 Bedroom
$69
Yes
Kitchenette
Mini-Grocery on site
Free use of washer/dryer
$49.95
No
.
$95
Yes
To and from
UTSW M-F
In-room internet access;
Full Restaurant
moderately priced
$57
(single or
double)
Yes
To and From
Love Field &
UTSW
* reserved upon
check-in
In-room internet access;
Guest Laundry facilities;
Restaurant
6
7
8
Comfort Inn
14040 Stemmons Fwy
I35 @ Valwood Pkwy
Dallas, Texas 75234
972/406-3030
Courtyard Market Center
2150 Market Center Blvd.
Dallas, Texas 75207
214/653-1166
Crowne Plaza
7050 Stemmons Fwy
Dallas, Texas 75247
214/630-8500
9
Doubletree Dallas Market
Center
2015 Market Center Blvd
Dallas, Texas 75207
214/741-7481
10
Embassy Suites
2727 Stemmons Fwy
Dallas, Texas 75207
214/630-5332
11
Hampton Inn
1015 Elm Street
Dallas, TX 75202
(214) 742-5678
$75
Within 3 miles
To and From
Love Field &
UTSW
12
Hawthorne Suites by Hyatt
7900 Brookriver Dr
Dallas, TX
(214) 688-1010
$45 1 bdr
$65 2 bdr
Yes
To and From
UTSW & Love
Field
Complimentary Breakfast
Washer/Dryer
Free Local Calls
13
Holiday Inn Select-North
2645 LBJ Fwy
Dallas, Texas 75234
972/243-3363
$43
Yes
To and From
DFW Airport
and Love Field
on Sunday’s
Internet access;
24 hr. business center
14
Quality Inn Market Center
1955 N. Market
Dallas, Texas 75207
214/747-9551
$49
No
Complimentary Breakfast
15
Ramada Inn
1575 Regal Row
Dallas, Texas 75207
214/638-6100
3.56 miles
$42
Yes
Continental Breakfast
included
16
Radisson Hotel Dallas Love
Field
1241 W. Mockingbird Ln
Dallas, Texas 75247
214/630-7000
2.47 miles
$59
Yes
6:00 a.-11:00p
In-room internet access;
full service restaurant
complimentary breakfast
$79
(mention
“We Care”
promo)
Yes
7a-11p
In-room internet access;
In-room Sony Play station;
Restaurant; Full Service
$94
Yes
(Within 3 miles)
And to Love
Field &
UTSW
Complimentary Cooked to
Order Breakfast;
Wireless Internet Access;
Complimentary manager’s
reception (Beverages and
snacks; 7 days a week)
Internet
Pool
ON SITE ACCOMODATIONS:
Guest House at UTSW Single Room $40 Double Room $50
$10 discount per night for senior citizens
(214) 645-1200
Space is limited
Maureen Heller * Please contact transplant social worker April Morgan at (214)
645-1919 for special pricing for low income families
Please note: There are some community based options for lodging when
financial means are a barrier. Please contact transplant social worker April
Morgan at (214) 645-1919 to learn more about these options.
29