Labs

When liver transplant patients are admitted they are usually placed on a daily lab schedule. You can assume that the patient should be on this regimen unless otherwise instructed.

Daily Labs	CBC with differential Comprehensive metabolic panel Magnesium Phosphorus Calcium GGT Dbili Immunosuppressive level Tacrolimus Cyclosporine
Weekly Labs	EBV PCR sent to Pittsburgh CMV urine shell assay Rapamune

Labs should all be drawn just prior to the dosing of the immunosuppressive. Usually at 7:30 AM. If the other daily labs need to be drawn at a different time because of a biopsy or other procedure then the Tacrolimus or Cyclosporine level must still be drawn at 7:30 AM.

When the patients are on Neoral (Cyclosporine) we may chose to monitor peak levels rather than trough levels. This would mean timing the levels to be drawn 2 hours after the dose is given. In this case it is usually better to have the daily labs drawn at 10 PM rather than 10 AM so that all labs can be drawn together and we have liver enzymes to evaluate on morning rounds.