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Liver Transplantation

A liver transplant is a surgical procedure that removes a liver that no longer functions properly (liver failure) and replaces it with a healthy liver from a living or deceased donor.

Your liver is your largest internal organ and performs several critical functions, including:

  • Removing bacteria and toxins from the blood
  • Preventing infection and regulating immune responses
  • Processing nutrients, medications and hormones
  • Producing bile, which helps the body absorb fats, cholesterol and fat-soluble vitamins
  • Making proteins that help the blood clot

Liver transplant is usually reserved as a treatment option for people who have significant complications due to end-stage chronic liver disease. In rare cases, sudden failure of a previously normal liver may occur.

Liver transplant is a treatment option for people with liver failure whose condition can't be controlled other with treatments and for some people with liver cancer.

Liver failure may happen quickly or over a longer period of time. Liver failure that occurs quickly, in a matter of weeks, is called acute liver failure (fulminant hepatic failure) and is usually the result of medication-induced liver injury.

Although a liver transplant may treat acute liver failure, it is more often used to treat chronic liver failure. Chronic liver failure occurs slowly over months and years.

Chronic liver failure may be caused by a variety of conditions. The most common cause of chronic liver failure is scarring of the liver (cirrhosis), a process in which scar tissue replaces normal liver tissue and impairs liver function. Cirrhosis is the most frequently cited reason for a liver transplant.

Complications of the procedure

Liver transplant surgery carries a risk of significant complications. There are risks associated with the procedure itself as well as with the drugs necessary to prevent rejection of the donor liver after the transplant.

Risks associated with the procedure include:

  • Bile duct complications, including bile duct leaks or shrinking of the bile ducts
  • Bleeding
  • Blood clots
  • Failure of donated liver
  • Infection
  • Rejection of donated liver
  • Mental confusion or seizures

Choosing a transplant center

If your doctor recommends a liver transplant, you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.

When you're considering transplant centers, you may want to:

  • Learn about the number and type of transplants the center performs each year
  • Ask about the transplant center's liver transplant survival rates
  • Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients
  • Understand the costs that will be incurred before, during and after your transplant. Costs will include tests, organ procurement, surgery, hospital stays, and transportation to and from the center for the procedure and follow-up appointments
  • Consider additional services provided by the transplant center, such as coordinating support groups, assisting with travel arrangements, helping with local housing for your recovery period and offering referrals to other resources
  • Assess the center's commitment to keeping up with the latest transplant technology and techniques, which indicates that the program is growing

Liver transplant consultation at Clinics

A thorough evaluation is necessary to determine whether you are eligible for a liver transplant.

After you've selected a transplant center, you'll be evaluated to determine whether you meet the center's eligibility requirements for a liver transplant. Each transplant center has its own eligibility criteria. If you aren't accepted at one transplant center, you may undergo evaluation at another center.

The goals of the evaluation process are to determine whether you:

  • Are healthy enough to have surgery and tolerate lifelong post-transplant medications
  • Have any medical conditions that would interfere with transplant success
  • Are willing and able to take medications as directed and follow the suggestions of the transplant team

Liver transplant consultation at Clinics

A thorough evaluation is necessary to determine whether you are eligible for a liver transplant.

After you've selected a transplant center, you'll be evaluated to determine whether you meet the center's eligibility requirements for a liver transplant. Each transplant center has its own eligibility criteria. If you aren't accepted at one transplant center, you may undergo evaluation at another center.

The goals of the evaluation process are to determine whether you:

  • Are healthy enough to have surgery and tolerate lifelong post-transplant medications
  • Have any medical conditions that would interfere with transplant success
  • Are willing and able to take medications as directed and follow the suggestions of the transplant team

 

Before the procedure

Being placed on the waiting list

Doctors use results of liver function tests and other factors to determine your prognosis and your place on the liver transplant waiting list.

Your prognosis is often called your Model for End-Stage Liver Disease (MELD) or Pediatric End-Stage Liver Disease (PELD) score for children younger than age 12.

MELD scores range from 6 to 40. The scores estimate the risk of death within 90 days without a transplant. The higher your MELD score, the more dire your situation.

Organs are allocated according to MELD scores and stratified by blood type. People with higher MELD scores are generally offered donated livers first. Time spent on the liver transplantation waiting list is used to break ties among people with the same MELD scores and blood type.

Some liver conditions, such as liver cancer, may not result in a person getting a high MELD score. The transplant center can request additional MELD points for people with specific diseases if they meet defined exception criteria.

In addition, adults with acute liver failure are exempted from the MELD-based donor organ prioritization system and may be placed higher on the list according to their disease status.

Waiting for a new liver

The wait for a donor liver can vary greatly. Some people wait days, while other wait months or may never receive a deceased-donor liver.

As you wait for a new liver, your doctor will treat the complications of your liver failure to make you as comfortable as possible.

Complications of end-stage liver failure are serious, and you may be frequently hospitalized. If your liver deteriorates, your MELD score is updated.

Living liver donors

A small percentage of liver transplants are done each year using a portion of a liver from a living donor. Living-donor liver transplants were initially used for children needing a liver transplant due to the scarcity of appropriately sized deceased-donor organs. Now, it has also become an important option for adults who have end-stage liver disease.

While access to deceased-donor liver transplant is determined primarily by the severity of your liver disease, access to living-donor liver transplant is determined primarily by identification of a living donor who is healthy and able to safely undergo a major surgical procedure and is also the right size and blood type.

Most living liver donors are close family members or friends of the liver transplant candidate. If you have a family member or friend who is willing to donate part of his or her liver to you, talk to your transplant team about this option.

Living-donor transplants have good results, just as transplants using livers from deceased donors. But finding a good living liver donor match is difficult due to restrictions on the donor's age, blood type, size and health. The surgery also carries significant risks for the donor.

Your transplant team can discuss the benefits and risks with you and the potential donor.

Domino liver transplant

Another, less common, type of living-donor liver transplant is called a domino liver transplant. In a domino liver transplant, you receive a liver from a living donor who has familial (hereditary) amyloidosis. Familial amyloidosis is a very rare disorder in which abnormal protein deposits accumulate and eventually damage the body's internal organs.

The donor with familial amyloidosis receives a liver transplant to treat his or her condition. Then, the donor can give his or her liver to you in a domino liver transplant, because the liver still functions well. You may eventually develop symptoms of amyloidosis, but it usually takes decades to develop.

Doctors usually select recipients who are 60 years old or older and who aren't expected to develop symptoms before the end of their natural life expectancy. After your transplant, doctors will monitor you for signs of the condition.

Doctors will evaluate you to determine if you may be a candidate for a domino liver transplant or if another procedure would be more appropriate for your condition.

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