28 Liver Recipient Explant Pathology_Form.xlsx

Data System for Organ Procurement and Transplantation Network

Liver Recipient Explant Pathology_Form.xlsx

Liver Recipient Explant Pathology Form

OMB: 0915-0157

Document [xlsx]
Download: xlsx | pdf























Fields to be completed by members















































Form Section Field Label Notes























1- Provider Information Transplant Center Code//Recipient Center Display Only - Cascades from TCR























1- Provider Information Transplant Center Type//Recipient Center Display Only - Cascades from TCR























1- Provider Information Transplant Center Display Only - Cascades from Database























2- Recipient Information Recipient First Name//Name: Display Only - Cascades from TCR























2- Recipient Information Recipient Last Name//Name: Display Only - Cascades from TCR























2- Recipient Information Recipient Middle Initial//Name: Display Only - Cascades from TCR























2- Recipient Information Tx Date Display Only - Cascades from Database























2- Recipient Information Recipient SSN//SSN: Display Only - Cascades from TCR























2- Recipient Information DOB Display Only - Cascades from Database























2- Recipient Information Gender Display Only - Cascades from TCR























3- Clinical Information Was evidence of HCC (viable or non-viable tumor) found in the explant?























3- Clinical Information Number of Tumors























3- Clinical Information Tumor #1//Size























3- Clinical Information Tumor #1//Location























3- Clinical Information Tumor #1//Tumor Necrosis























3- Clinical Information Tumor #2//Size























3- Clinical Information Tumor #2//Location























3- Clinical Information Tumor #2//Tumor Necrosis























3- Clinical Information Tumor #3//Size























3- Clinical Information Tumor #3//Location























3- Clinical Information Tumor #3//Tumor Necrosis























3- Clinical Information Tumor #4//Size























3- Clinical Information Tumor #4//Location























3- Clinical Information Tumor #4//Tumor Necrosis























3- Clinical Information Tumor #5//Size























3- Clinical Information Tumor #5//Location























3- Clinical Information Tumor #5//Tumor Necrosis























3- Clinical Information Worst Tumor Differentiation























3- Clinical Information Vascular Invasion























3- Clinical Information Lymph Node Involvement























3- Clinical Information Other Extrahepatic Spread























3- Clinical Information Satellite Lesions























3- Clinical Information Pre-transplant treatment for HCC?



















































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