Liver Transplant
A liver transplant is a surgery that removes a liver that no longer functions properly (liver failure) and replaces it with a healthy liver from a deceased donor or a portion of a healthy liver from a living donor.
Why it's done
Liver failure can happen quickly or over a long period of time. Liver failure that occurs rapidly within a few weeks is called acute liver failure. Acute liver failure is a rare condition that is usually the result of complications from certain medications.
Although a liver transplant can cure acute liver failure, it is more commonly used to treat chronic liver failure. Chronic liver failure occurs gradually over months and years. Various conditions can cause chronic liver failure. The most common cause of chronic liver failure is scarring of the liver (cirrhosis). When cirrhosis occurs, scar tissue replaces typical liver tissue and the liver does not function properly. Cirrhosis is the most common reason for liver transplant.
The main causes of cirrhosis leading to liver failure and liver transplant are:
Hepatitis B and C Alcoholic liver disease, which causes liver damage due to excessive alcohol consumption.
Nonalcoholic fatty liver disease is a condition in which fat builds up in the liver, causing inflammation or liver cell damage.
Genetic diseases affecting the liver. These include hemochromatosis, which causes excessive accumulation of iron in the liver, and Wilson's disease, which causes excessive accumulation of copper in the liver.
Diseases that affect the tubes (bile ducts) that carry bile away from the liver. It includes primary biliary cirrhosis, primary sclerosing cholangitis, and biliary atresia. Biliary atresia is the most common reason for liver transplant among children.
A liver transplant can also treat some cancers that originate in the liver.
Risks
Complications of the procedure
Liver transplant surgery carries a risk of significant complications. There are risks associated with the procedure itself and 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 the donated liver
- Infection
- Rejection of the donated liver
- Mental confusion or seizures
Long-term complications may also include the liver disease returning in the transplanted liver.
Anti-rejection medication side effects
After a liver transplant, you'll take medications for the rest of your life to help prevent your body from rejecting the donated liver. These anti-rejection medications can cause a variety of side effects, including:
- Bone thinning
- Diabetes
- Diarrhea
- Headaches
- High blood pressure
- High cholesterol
Because anti-rejection drugs work by suppressing the immune system, they also increase risk of infection. Your doctor may give you medications to help you fight infections.
How you prepare
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.
After you've selected a transplant center, you'll need an evaluation to determine whether you meet the center's eligibility requirements. 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 can 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
Specific tests, procedures and consultations you may undergo include:
- Laboratory tests, such as blood and urine tests to assess the health of your organs, including your liver
- Imaging tests, such as an ultrasound of your liver
- Heart tests to determine the health of your cardiovascular system
- A general health exam, including routine cancer screening tests, to evaluate your overall health and to check for any other illnesses that may impact the success of your transplant
Your evaluation may also include:
- Nutrition counseling with dietitians who assess your diet and make recommendations on how to plan healthy meals before and after your transplant
- Psychological evaluation to assess and treat any underlying issues, such as depression or anxiety, and determine whether you fully understand the risks of a liver transplant
- Meetings with social workers who assess your support network to determine whether you have friends or family to help care for you after transplant
- Addiction counseling to help people who are having difficulty stopping their use of alcohol, drugs or tobacco
- Financial counseling to help you understand the cost of a transplant and post-transplant care and to determine what costs are covered by your insurance
Once these tests and consultations are completed, the transplant center's selection committee meets to discuss your situation. The committee determines whether a liver transplant is the best treatment for you and whether you're healthy enough to undergo a transplant.
If the answer to both questions is yes, then you're placed on the liver transplant waiting list.
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