Liver Transplants

10/15/12Liver Transplants: Donors, Waiting Lists, Screening, Surgery, and More

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Digestive Disorders Health Center

Liver Transplantation

The liver is the body's largest internal organ, weighing about 3 pounds in adults. It is located below thediaphragm on the right side of the abdomen.

The liver performs many complex functions in the body, including:

Produces most proteins needed by the body.

Metabolizes, or breaks down, nutrients from food to produce energy, when

needed.

Prevents shortages of nutrients by storing certain vitamins, minerals and

sugar.

Produces bile, a compound needed to digest fat and to absorb vitamins A,

D, E, and K.

Produces most of the substances that regulate blood clotting.

Helps the body fight infection by removing bacteria from the blood.

Removes potentially toxic byproducts of certain medications.

When Is a Liver Transplant Needed?

A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can

occur suddenly (acute liver failure) as a result of infection or complications from certain medications, forexample. Liver failure can also be the end result of a long-term problem. The following conditions may resultin chronic liver failure:

Chronic hepatitis with cirrhosis.

Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys

the bile ducts).

Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the

backup of bile in the liver).

Biliary atresia (malformation of the bile ducts).

Alcoholism.

Wilson's disease (a rare inherited disease with abnormal levels of copper throughout the body, including

the liver).

Hemochromatosis (a common inherited disease where the body has too much iron).

Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting

Article Link: http://www.webmd.com/digestive-disorders/digestive-diseases-liver-transplantation



in cirrhosis).

Liver cancer.

How Are Candidates for Liver Transplant Determined?

Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate.The evaluation includes a review of medical history and a variety of tests. Many health care facilities offer aninterdisciplinary approach to evaluate and select candidates for a liver transplant. This interdisciplinary healthcare team may include the following professionals:

Liver specialist (hepatologist).

Transplant surgeons.

Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients

(this person will be your primary contact with the transplant team).

Social worker to discuss your support network of family and friends, employment history, and financial

needs.

Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany a liver

transplant.

Anesthesiologist to discuss potential anesthesia risks.

Chemical dependency specialist to aid those with history of alcohol or drug abuse.

Financial counselor to act as a liaison between a patient and his or her insurance companies.

Which Tests Are Required Before Getting a Liver Transplant?

You will need to bring all previous doctor records, X-rays, liver biopsy slides, and a record of medications toyour pre-evaluation for a liver transplant. To complement and update previous tests, some or all of thefollowing diagnostic studies are generally performed during an evaluation.

Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its

size and shape.

Doppler ultrasound to determine if the blood vessels to and from the liver are open.

Echocardiogram to help evaluate the heart.

Pulmonary function studies to determine the lungs' ability to exchange oxygen and carbon dioxide.

Blood tests to determine blood type, clotting ability, and biochemical status of blood and to gauge liver

function. AIDS testing and hepatitis screening are also included.

If specific problems are identified, additional tests may be ordered.

How Does the Liver Transplant Waiting List Work?

If you become an active liver transplant candidate, your name will be placed on a waiting list. Patients arelisted according to blood type, body size, and medical condition (how ill they are). Each patient is given apriority score based on three simple blood tests (creatinine, bilirubin, and INR). The score is known as theMELD (model of end stage liver disease) score in adults and PELD (pediatric end stage liver disease) in

Liver Transplants: Donors, Waiting Lists, Screening, Surgery, and More


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children.

Patients with the highest scores are transplanted first. As they become more ill, their scores will increase andtherefore their priority for transplant increases, allowing for the sickest patients to be transplanted first. Asmall group of patients who are critically ill from acute liver disease have the highest priority on the waitinglist.

It is impossible to predict how long a patient will wait for a liver to becomeavailable. Your transplant coordinator is always available to discuss where

you are on the waiting list.

Where Does a Liver for a Transplant Come From?

There are two types of liver transplant options: living donor transplant anddeceased donor transplant.

Living donor

Living donor liver transplants are an option for some patients with end-stage liver disease. This involvesremoving a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor andrecipient liver segments will grow to normal size in a few weeks.

The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychologicalevaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determiningwho is an appropriate donor.

Recipients for the living donor transplant must be active on the transplant waiting list. Their health must alsobe stable enough to undergo transplantation with excellent chances of success.

Deceased Donor

In deceased donor liver transplants, the donor may be a victim of an accident or head injury. The donor'sheart is still beating, but the brain has stopped functioning. Such a person is considered legally dead,because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usuallyin an intensive-care unit.

The identity of a deceased donor and circumstances surrounding the person's death are kept confidential.

Screening for Liver Transplant Donors

Hospitals will evaluate all potential liver transplant donors for evidence of liver disease, alcohol or drugabuse, cancer, or infection. Donors will also be tested for hepatitis, AIDS, and other infections. If this

screening does not reveal problems with the liver, donors and recipients are matched according to bloodtype and body size. Age, race, and sex are not considered.

The transplant team will discuss transplantation options with you at a pre-transplant evaluation, or you cancontact the transplant team for more information.

What Happens When They Find a Liver Transplant Match?

When a liver has been identified, a transplant coordinator will contact you by telephone or by pager. Makesure that you do not eat or drink anything once you have been called to the hospital. The transplant



coordinator will notify you of any additional instructions. When you arrive at the hospital, additional bloodtests, an electrocardiogram, and a chest X-ray will generally be taken before the operation. You also maymeet with the anesthesiologist and a surgical resident. If the donor liver is found to be acceptable you willproceed with the transplant. If not, you will be sent home to continue waiting.

What Happens During the Liver Transplant Operation?

Liver transplants usually take from six to 12 hours. During the operation, surgeons will remove the liver andwill replace it with the donor liver. Because a transplant operation is a major procedure, surgeons will need toplace several tubes in the body. These tubes are necessary to help your body carry out certain functionsduring the operation and for a few days afterward.

Tube Placement

A tube will be placed through your mouth into the windpipe (trachea) to help you breathe during the liver

transplant operation and for the first day or two following the operation. The tube is attached to a ventilator

that will expand your lungs mechanically.

A nasogastric (N/G) tube will be inserted through the nose into your stomach. The N/G tube will drain

secretions from your stomach and it will remain in place for a few days until your bowel function returns to

normal.

A tube called a catheter will be placed in your bladder to drain urine. This will be removed a few days after

the operation.

Three tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will

remain in place for about one week.

In most cases, the surgeon will place a special tube, called a T-tube, in the bile duct. The T-tube will drain

bile into a small pouch outside of your body so it can be measured several times daily. Only certain

transplant patients receive a T-tube, which remains in place for five months. The tube causes no

discomfort and does not interfere with daily activities.

What Complications Are Associated With Liver Transplant?

Two of the most common complications following liver transplant are rejection and infection.

Rejection

Your immune system works to destroy foreign substances that invade the body. The immune system,however, cannot distinguish between your transplanted liver and unwanted invaders, such as viruses andbacteria. Therefore, your immune system may attempt to attack and destroy your new liver. This is called arejection episode. About 70% of all liver-transplant patients have some degree of organ rejection prior todischarge. Anti-rejection medications are given to ward off the immune attack.

Infection

Because anti-rejection drugs that suppress your immune system are needed to prevent the liver from beingrejected, you are at increased risk for infections. This problem diminishes as time passes. Not all patientshave problems with infections, and most infections can be treated successfully as they occur.

What Are Anti-rejection Medications?



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After the liver transplant, you will receive medications called immunosuppressants. These drugs slow orsuppress your immune system to prevent it from rejecting the new liver. They may include azathioprine(Imuran), Cellcept (mycophenolate mofetil), prednisone (Deltasone, Kedral, Medrol, Orasone, Prelone,Sterapred DS), cyclosporine (Neoral), Prograf (a brand of tacrolimus, also known as FK506), andRapamune (sirolimus). You must take these drugs exactly as prescribed for the rest of your life.

When Will I Be Able to Go Home After a Liver Transplant?

The average hospital stay after a liver transplant is two weeks to three weeks. Some patients may bedischarged in less time, while others may be in the hospital much longer, depending on any complicationsthat may arise. You need to be prepared for both possibilities.

To provide a smooth transition from hospital to home, the nursing staff and your transplant coordinator willbegin to prepare you for discharge shortly after you are transferred from the intensive-care unit to the regularnursing floor. You will be given a discharge manual, which reviews much of what you will need to know beforeyou go home.

You will learn how to take new medications and how to monitor your own blood pressure and pulse. As youperform these functions regularly, you will become an important participant in your own healthcare. Beforeyour discharge, you will also learn the signs of rejection and infection and will know when it is important to callyour doctor.

Readmission after discharge is common, especially within the first year after a transplant. The admission isusually for treatment of a rejection episode or infection.

What Follow-Up Is Necessary After a Liver Transplant?

Your first return appointment after a liver transplant will generally be scheduled about one week to two weeksafter discharge. During this visit, you will see the transplant surgeon and transplant coordinator. If needed, asocial worker or a member of the psychiatric team may also be available.

All patients return to their transplant hospital approximately five months after the transplant. If a T-tube wasinserted during the operation, it will be removed by the transplant surgeon at this time.

All patients are scheduled to return to the hospital at their one-year transplant anniversary date and annuallythereafter.

Your primary care doctor should be notified when you receive your transplant and when you are discharged.Though most problems related to the transplant will need to be taken care of at the transplant hospital, yourprimary care doctor will remain an important part of your medical care.



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WebMD Medical ReferenceSOURCE: The American Liver Foundation

Reviewed by Venkat Mohan, MD on March 01, 2010

2010 WebMD, LLC. All rights reserved.

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Liver Transplants