Clinical Referral Form
Patients can be referred by filling out a secure patient referral form online, or by calling the clinic directly at 210-575-8752.
The Liver Disease and Transplant Program at Texas Transplant Institute, on the campus of Methodist Specialty and Transplant Hospital, is nationally recognized for its successful outcomes. The expertise of the liver disease and transplant team make the program one of the top programs in the country for transplantation, hepatology and liver disease care. The program is led by a group of physicians who have more than 60 years of combined expertise in all aspects of liver disease management and transplant procedures.
The natural course of liver diseases vary, therefore, expert long-term care is required for years throughout the natural history of the disease. Our integrated liver transplant program offers specialized care for complicated cases in hepatitis B and C, associated liver cancers and liver failure by a board-certified hepatologist with special board certification in transplant hepatology.Our surgeons are trained in advanced Hepatobiliary surgery techniques focusing on the operative removal of tumors.
The Liver Disease and Transplant Program offers solutions to make your transplant happen. The program has performed over 500 transplants since 2001. On a percentage basis, we have transplanted more medically urgent patients that any other transplant program in Texas. End your wait. EXPERIENCE COUNTS.
A liver transplant is performed in cases of end-stage liver disease (ESLD) or liver failure. Diseases and conditions resulting in end-stage liver disease for which transplantation may be indicated include primary biliary cirrhosis, sclerosing cholangitis, liver cancer, and alcohol/drug abuse. Hepatitis B and C viruses can also develop into liver failure, possibly requiring a transplant. However, a transplant does not cure hepatitis. Early diagnosis and disease management can help patients decrease their risk of hospitalization.
The goal of the Liver Transplant Program is to exhaust all medical therapies before resorting to a liver transplant, which is reserved as a final life-saving option. The Liver Failure Clinic at the Texas Transplant Institute offers comprehensive treatment programs for liver failure management. Our hepatologist has extensive experience with the latest clinical treatments including radio frequency ablation, chemoebolization, as well as access to new clinical research and treatment protocols. In addition, the Liver Failure Clinic offers ongoing educational sessions for patients and their families; licensed nurses, dietitians, social workers, and chemical dependency counselors provide information and answer questions regarding physical, psychological, and social issues.
A patient receives a liver transplant from a deceased donor. The potential recipient is placed on the UNOS national donor waiting list. Because the donated liver must match the recipient's blood type and size, the waiting period can be a few weeks to several years. While waiting, the recipient must follow the physician's orders and be evaluated periodically.
Although not yet performed at Texas Transplant Institute, another type of transplant is the living donor partial liver transplant. Because the liver is the only organ to regenerate itself, new technologies have made it possible to remove a portion of a healthy liver for transplantation. This type of procedure is most often done for pediatric patients.
A donated liver can become available any time of the day or night. While on the waiting list, the patient follows physician orders and routine medical evaluations. Once a liver becomes available, the patient is contacted and given specific instructions. The patient will undergo a complete physical exam and any additional pre-operative tests prior to transplantation.
The first step in the transplantation process begins with a referral to the Texas Transplant Institute by the prospective patient's physician. A transplant financial coordinator verifies transplant insurance benefits and begins creating a financial plan regarding all transplant services. The clinic then contacts the patient and the referring physician's office to discuss expectations and schedule a half-day pre-transplant evaluation. The patient's referring physician is considered part of the transplant team and will be involved in all facets of the transplantation process.
During the initial clinic visit, the patient meets the transplant team which includes the transplant hepatologist or transplant surgeon, nurse, dietitian, and social worker for a psychosocial evaluation. After the first visit, the transplant team will review the medical, psychosocial, and diagnostic test results from the evaluation.
Shortly after the first clinic visit, the patient, referring physician, and insurance company are given the recommendations made by the transplant team regarding any additional tests which must be performed to complete the evaluation. Once all testing is complete, the transplant hepatologist, surgeon and other team members meet at a Patient Care Conference to discuss the patient’s transplant evaluation and determine if the patient is suitable for placement on the organ waiting list or requires further evaluation. The patient, referring physician, and insurance company will be notified, regardless of the outcome of the Patient Care Conference. If the patient is to be added to the UNOS waitlist, they will be given specific instructions by the transplant clinic as to the frequency of follow-up while they are waiting for an organ to become available.
The average wait for a liver is 6 to 12 months and organs are allocated according to the Meld/Peld Scoring System. Some patients, depending on their clinical condition, will require hospitalization while waiting for their transplant. Patients who reside outside of San Antonio may require temporary lodging near the transplant center during their wait. Texas Transplant Institute will assist out-of-town patients in finding housing accommodations for the immediate post-transplant period.
Private insurance, as well as Medicare and Medicaid, provides coverage for liver transplants. However, the costs may not be fully reimbursed. Our financial coordinators can assist the patient with information and planning.
Our medical, social, and financial specialists are always available to answer questions and provide assistance regarding transplantation.
The transplant operation usually lasts approximately 8 to 12 hours. An incision is made in the upper abdomen, and the diseased liver is removed. The donor liver is reconnected to the major blood vessels and bile ducts, and the incision is then closed. A tube (foley catheter) is placed in the bladder for post-operative urine drainage. Surgical drains are also inserted around the incision to facilitate fluid drainage. Surgical drains are also inserted around the incision to facilitate fluid drainage.
After surgery, the patient is taken to the Intensive Care Unit (ICU) and then transferred to the hospital transplant unit when appropriate. Feeling weak and fatigued is a common post-operative experience. However, the patient can get out of bed, sit in a chair, and walk with assistance. Physical and occupational therapists work with the patient to gradually increase physical strength and activity endurance. Coughing and deep breathing exercises are also performed to clear the lungs. Most liver transplant patients spend approximately 10 days in the hospital following their operation. However, each individual recovery course varies and some patients may require a prolonged hospital stay.
While hospitalized, the multi-disciplinary transplant team of nurse coordinators, dietitians, social workers, and other dedicated individuals provide post-transplant education and support services. The patient is informed about diet and exercise. Classes are held to teach medication usage. Discharge arrangements are also planned and may include home care, resumption of daily activities, and scheduling of follow-up clinic visits.
After discharge, activity will be limited for six to eight weeks. Mild exercise, such as walking is highly encouraged, but driving and heavy lifting are prohibited. The patient must keep a daily record of temperature, blood pressure, weight, and doses and times medication is taken. Patients usually return to work within three months.
Infection and rejection are the main risks associated with transplants. Each transplant patient is prescribed immunosuppressive, or "anti-rejection" medications. These medications prevent the body's immune system from rejecting the new transplanted organ. To maximize their effectiveness, immunosuppressive medications must be taken daily throughout the patient's life. For a period of time after the transplant, patients will require routine blood tests to determine if the medication needs adjustments to help prevent rejection of the new liver. Therefore, post-transplant patients are required to have regular follow-up visits during the first two years.
Because post-transplant medications are designed to suppress the immune system to reduce the risk of rejection, they also increase the risk of infection. Immediately following discharge, it is imperative that patients avoid large crowds and contact with unhealthy individuals.
Immunosuppressive medications are vital for transplant success. However, a lifetime prescription can be financially challenging. Private insurance, Medicare, and Medicaid often cover a percentage of the costs. Our financial counselors can assist the patient with information and planning.
Our medical, social, and financial specialists are always available to answer any questions and provide assistance following transplantation.
Liver Disease and Transplant Team
- Preston F. Foster, MD, FACS
Surgical Director, Liver Disease and Transplant Program
Liver, Kidney and Pancreas Transplant Surgeon
- Madhavi Rudraraju, MD
Medical Director, Liver Disease and Transplant Program
- Luke Y. Shen, MD
Liver, Kidney and Pancreas Transplant Surgeon
- Lokesh Bathla, MD
Hepatobiliary & Pancreatic (HPB) Surgeon
Abdominal Organ Transplant Surgeon
- Omer Junaidi, MD
- Fernando Membreno, MD, MS
- Francis H. Wright, Jr, MD
Liver, Kidney and Pancreas Transplant Surgeon
- Katrina Peterson, RN, MSN, FNP
- Yuni Corwin, DNP, MSN
- Yesenia Williams, MSN, RN, FNP-BC
- Robin Gatewood, RN, MSN, Oncology Nurse Navigator
Liver Disease and Transplant Clinic Locations
San Antonio Liver Disease and Transplant Clinic
Texas Transplant Institute at Methodist Specialty and Transplant Hospital
a department of Methodist Hospital
San Antonio, TX 78229
Toll free: 1-844-869-4401
Austin Transplant Outreach Clinic
St. David’s Medical Center
900 East 30th St, Suite 201
Austin, TX 78705
Corpus Christi Transplant Outreach Clinic
3240 Ft. Worth St, Suite 109
Corpus Christi, TX 78411
Laredo Transplant Outreach Clinic
6801 McPherson Rd, Suite 219
Laredo, TX 78041
McAllen Transplant Outreach Clinic
222 East Ridge Rd, Suite 210
McAllen, TX 78041