Table 2.

Overview of testing and evaluation prior to liver transplantation

Item	Detail
Expert consultation	Meeting with transplant hepatologist and transplant surgeon to review appropriateness of transplant evaluation and address questions/concerns.
Basic laboratory testing	Blood typing, comprehensive metabolic panel, complete blood counts, coagulation parameters, urinalysis, drug screen, calcium, and vitamin D.
Infectious disease testing	Viral hepatitis serologies, tuberculosis testing, and RPR for syphilis. Consideration of coccidioides and strongyloides testing if indicated.
Cardiac evaluation	Electrocardiography and echocardiography. Non-invasive cardiac stress testing, with cardiac catheterization if abnormal.
Pulmonary evaluation	Pulse oximetry. If < 96% on room air, perform arterial blood gas sampling. Bubble echocardiography, pulmonary function tests and chest CT if concern for arterial hypoxemia. Routine echocardiography with right heart catheterization if concern for pulmonary arterial hypertension.
Age-appropriate malignancy screening	Colonoscopy, mammography, Papanicolaou screening, and low-dose chest CT as indicated. Hepatocellular carcinoma screening with abdominal imaging ± alpha fetoprotein testing.
Hepatic imaging	Triple-phase CT, gadolinium-enhanced MRI, or abdominal ultrasound with doppler imaging.
Bone density testing	Calcium, vitamin D, and dual-energy X-ray absorptiometry.
Psychiatric evaluation	Address substance abuse and active psychiatric conditions, as indicated.
Social work evaluation	Identify psychosocial barriers to transplantation and initiate remediation.
Nutritional evaluation	Assess nutritional status and implement plan to address BMI extremes.
Financial and insurance screening	Ensure adequate coverage for pre-transplant evaluation, transplantation, and post-transplant care.

Adapted from the 2013 AASLD guidelines [3••]