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Liver transplant
Definition
Liver transplant is surgery to replace a diseased liver with a healthy liver.
Alternative Names
Hepatic transplant; Transplant - liver
Description
The donated liver may be from:
- A donor who has recently died and has not had liver injury. This type of donor is called a cadaver donor.
- Sometimes a healthy person will donate part of his or her liver to a patient. For example, a parent may donate to a child. This kind of donor is called a living donor. The liver can regrow itself. Both people usually end up with fully working livers after a successful transplant.
The donor liver is transported in a cooled salt-water (saline) solution that preserves the organ for up to 8 hours. The necessary tests can then be done to match the donor with the recipient.
The new liver is removed from the donor through a surgical cut in the upper abdomen. It is placed into the patient who needs the liver (called the recipient), and attached to the blood vessels and bile ducts. The operation may take up to 12 hours. The recipient will often need a large amount of blood through a transfusion.
Why the Procedure Is Performed
A healthy liver performs more than 400 jobs each day, including:
- Making bile, which is important in digestion
- Making proteins that help with blood clotting
- Removing or changing bacteria, medications, and toxins in the blood
- Storing sugars, fats, iron, copper, and vitamins
The most common reason for a liver transplant in children is biliary atresia.
The most common reason for a liver transplant in adults is cirrhosis. Cirrhosis is scarring of the liver that prevents the liver from working well. It can worsen to liver failure. The most common causes of cirrhosis are:
- Long-term infection with hepatitis B or hepatitis C
- Long-term alcohol abuse (See: Alcoholic liver disease)
Other illnesses that may cause cirrhosis and liver failure include:
- Autoimmune hepatitis
- Hepatic vein blood clot (thrombosis)
- Liver damage from poisoning or medications
- Problems with the drainage system of the liver (the biliary tract), such as primary biliary cirrhosis or primary sclerosing cholangitis
- Metabolic disorders of copper or iron (Wilson's disease and hemochromatosis)
Liver transplant surgery is often not recommended for patients who have:
- Certain infections, such as tuberculosis or osteomyelitis
- Difficulty taking medications several times each day for the rest of their lives
- Heart, lung, or liver disease (or other life-threatening diseases)
- History of cancer
- Infections such as hepatitis that are considered to be active
- Smoking, alcohol or drug abuse, or other risky lifestyle habits
Risks
Risks for any anesthesia are:
- Problems breathing
- Reactions to medications
Risks for any surgery are:
- Bleeding
- Heart attack or stroke
- Infection
Liver transplant surgery and management after surgery carry major risks. There is an increased risk of infection because you must take medications that suppress the immune system to prevent transplant rejection. Signs of infection include:
- Diarrhea
- Drainage
- Fever
- Jaundice
- Redness
- Swelling
- Tenderness
Before the Procedure
Your doctor will refer you to a transplant center. The transplant team will want to make sure that you are a good candidate for a liver transplant. You will make a few visits over several weeks or months. You will need to have blood drawn and x-rays taken.
If you are the one getting the new liver, the following tests will be done before the procedure:
- Tissue and blood typing to make sure your body will not reject the donated liver
- Blood tests or skin tests to check for infection
- Heart tests such as an EKG, echocardiogram, or cardiac catheterization
- Tests to look for early cancer
- Tests to look at your liver, gallbladder, pancreas, small intestine, and the blood vessels around the liver
- Colonoscopy, depending on your age
You will want to look at one or more transplant centers to determine which is best for you:
- Ask the center how many transplants they perform every year, and their survival rates. Compare these numbers to those of other transplant centers.
- Ask what support groups they have available, and what travel and housing arrangements they offer.
If the transplant team thinks you are a good candidate for a liver transplant, you will be put on a national waiting list.
- Your place on the waiting list is based on a number of factors. Key factors include the type of liver problems you have, how severe your disease is, and the likelihood that a transplant will be successful.
- The amount of time you spend on a waiting list is usually not a factor in how soon you get a liver, with the possible exception of children.
While you are waiting for a liver, follow these steps:
- Follow any diet your transplant team recommends.
- Do not drink alcohol.
- Do not smoke.
- Keep your weight in the appropriate range. Follow the exercise program your doctor recommends.
- Take all medicines prescribed for you. Report changes in your medications and any new or worsening medical problems to the transplant team.
- Follow-up with your regular doctor and transplant team at any appointments that have been made.
- Make sure the transplant team has your correct phone numbers, so they can contact you immediately if a liver becomes available. Make sure that, no matter where you are going, you can be contacted quickly and easily.
- Have everything ready ahead of time to go to the hospital.
After the Procedure
If you received a donated liver, you will likely need to stay in the hospital for a week or longer. After that, you will need to be closely followed up by a doctor for the rest of your life. You will have regular blood tests after the transplant.
The recovery period is about 6 - 12 months. Your transplant team may ask you to stay close to the hospital for the first 3 months. You will need to have regular check-ups, with blood tests and x-rays for many years.
Outlook (Prognosis)
People who receive a liver transplant may reject the new organ. This means that their immune system sees the new liver as a foreign substance and tries to destroy it.
To avoid rejection, almost all transplant recipients must take medicines that suppress their immune response for the rest of their lives. This is called immunosuppressive therapy. Although the treatment helps prevent organ rejection, it also puts people at a higher risk for infection and cancer.
If you take immunosuppressive medicine, you need to be regularly screened for cancer. The medicines may also cause high blood pressure and high cholesterol, and increase the risks for diabetes.
A successful transplant requires close follow-up with your doctor. You must always take your medicine as directed.
References
Keefe EB. Hepatic failure and liver transplantation. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 157.
Martin P, Rosen HR. Liver transplantation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 95.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
