Liver disease often progresses quietly with few symptoms until it becomes advanced. Early evaluation can make the difference between careful monitoring and prevention or the need for transplant down the road.
To help patients access expert care sooner, UPMC Passavant now offers a liver transplant evaluation clinic in Wexford, connecting patients to the full expertise of UPMC’s Center for Liver Care and the Starzl Transplant Institute.
We spoke with Alexander Miller,M.D., physician, Hepatology, Gastroenterology, UPMC Passavant, about how the clinic works, why early referral matters, and what this new service means for patients and families in the North Hills.
Q: Can you share your path to UPMC, explain your current role, and describe the procedures and services you provide?
A: As I was finishing my transplant hepatology fellowship at UPMC Presbyterian, I learned that UPMC Passavant was growing its footprint in the North Hills and was looking to expand hepatology services. Given the increasing prevalence of fatty liver disease, alcohol associated liver disease, and cirrhosis, there is a significant need for specialized liver care. I saw this as an opportunity to help fill that gap and build a hepatology-focused practice in the North Hills.
My clinic is almost entirely focused on patients with liver disease, ranging from abnormal liver enzymes and fatty liver disease to more complex conditions. I also perform liver transplant evaluations, which involve determining whether patients meet medical criteria for transplant and can safely undergo such a major procedure.
I am part of the broader UPMC Center for Liver Care and the Starzl Transplant Institute. Our multidisciplinary team includes transplant surgeons, nutritionists, pharmacists, social workers, behavioral health specialists, physical therapists and others. We evaluate patients individually and then come together weekly to determine whether someone can be listed for transplant.
While my clinic focuses primarily on general hepatology, I reserve appointments on the first Tuesday of each month specifically for transplant evaluations. During these visits, I see patients in person and guide them through the transplant process, while coordinators and other specialists complete their portions of the evaluation virtually. The full evaluation typically takes two to three hours.
Q: Where is this service located? Are there other locations across UPMC where this type of transplant evaluation is offered?
A: This is a newer satellite clinic model. The initial transplant evaluation takes place at our clinic in Wexford.
The additional workup, including labs, imaging, and certain procedures, is scheduled at UPMC Passavant–McCandless. While transplant referrals still come through the Center for Liver Care, patients now have the option to complete their evaluation in the North Hills, which is often far more convenient than traveling downtown to Presbyterian or Montefiore.
UPMC offers similar clinics in Erie, York, Williamsport, and Harrisburg. These clinics typically hold transplant evaluation days once a month and follow a similar hybrid in person and virtual approach.
Q: If a patient ultimately receives a liver transplant, what does follow-up care look like?
A: Immediately after transplant, patients are primarily managed by the transplant surgeons, with hepatologists closely involved. After discharge, patients have very frequent follow-up visits, often for six to eight weeks.
Over time, those visits become less frequent. Patients transition back to medical hepatology for lifelong follow-up. This includes monitoring liver function, managing immunosuppression, watching for medication side effects, and ensuring age- appropriate cancer screenings continue.
Q: Why is it so important for patients to be seen early for liver care or transplant evaluation?
A: One of the best scenarios is when we see someone early enough that they do not need a transplant yet. That allows us to monitor them closely, provide anticipatory guidance, and help prevent complications.
In transplant medicine, timing is critical. Patients must be sick enough to need a transplant, but not so sick that they are unable to survive the procedure. If liver disease progresses too far, patients can develop acute or chronic liver failure that affects other organ systems, making transplant no longer an option.
Q: What signs or symptoms might prompt someone to seek evaluation for liver disease?
A: Liver disease can be very variable, and many patients have no symptoms at all. Some people may notice jaundice or yellowing of the skin or eyes. Others may develop swelling in the legs, fluid in the abdomen known as ascites, or confusion and mental fog called hepatic encephalopathy.
Many patients with cirrhosis are completely unaware they have liver disease until it is discovered through blood work or imaging, making routine care with a primary care provider important. Primary care clinicians often detect abnormalities early and can refer patients for further evaluation before symptoms develop.
Q: What is the most important takeaway you want patients and families to understand about liver health?
A: Every patient is unique, and liver disease is not a one-size-fits-all condition. We rely on many pieces of information to form a complete picture. Regular follow-up with primary care providers is essential because early changes can be subtle.
There is also a lot of stigma surrounding cirrhosis. Many people assume it is only related to alcohol or hepatitis, but there are many causes of liver disease. Education is a big part of what we do, and understanding liver health helps patients feel empowered rather than surprised or discouraged by a diagnosis.
Q: What is your favorite part of your job?
A: One of my favorite parts is hearing each patient’s story. Every person has a different background and experience, and I enjoy putting together all the pieces together to understand what is truly going on.
In transplant care especially, it is incredibly rewarding to see someone who has been very sick regain their quality of life after a successful transplant. Watching patients regain energy, strength and independence is what keeps me motivated and passionate about this work.
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