Liver Transplant in America

Liver Transplantation

Liver Transplant: The liver is the body’s largest internal organ, weighing about 3 pounds in adults. It is located below the diaphragm on the right side of the abdomen.

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

  • Makes most proteins needed by the body
  • Metabolizes, or breaks down, nutrients from food to make energy, when needed
  • Prevents shortages of nutrients by storing certain vitamins, minerals, and sugar
  • Makes bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K
  • Makes 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

Liver Transplant Needed?

A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can happen suddenly (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection. Liver failure can also be the end result of a long-term problem. The following conditions may result in chronic liver failure:

  • Chronic hepatitis with cirrhosis.
  • Primary biliary cholangitis (previously called primary biliary cirrhosis, it isa 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 (a rare disease of the liver that affects newborns)
  • 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 buildup of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)

How Are Candidates for Liver Transplant Selected?

Specialists from a variety of fields are needed to determine if a liver transplant is appropriate. Many health care facilities assemble a team of such specialists to evaluate (review your medical history, do tests) and choose candidates for a liver transplant. The 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

Screening for Liver Transplant Donors

Hospitals will evaluate all potential liver transplant donors for evidence of liver disease, alcohol or drug abuse, cancer, or infection. Donors will also be tested for hepatitis, HIV, and other infections. If this screening does not reveal problems with the liver, donors and recipients are matched according to blood type and body size. Age, race, and s*x are not considered.

The transplant team will discuss transplantation options with you at a pre-transplant evaluation, or you can contact 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. Make sure 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 blood tests, an electrocardiogram, and a chest X-ray will generally be taken before the operation.

You also may meet with the anesthesiologist and a surgeon. If the donor liver is found to be acceptable, you will proceed with the transplant. If not, you will be sent home to continue waiting.

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. But the immune system can’t distinguish between your transplanted liver and unwanted invaders, such as viruses and bacteria. So, your immune system may attempt to attack and destroy your new liver.

This is called a rejection episode. About 64% of all liver-transplant patients have some degree of organ rejection, most within the first 90 days of transplant. 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 being rejected, you are at higher risk for infections. This problem lessens as time passes. Not all patients have problems with infections, and most infections can be treated successfully as they happen.

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What Are Anti-rejection Medications?

After the liver transplant, you will receive medications called immunosuppressants. These drugs slow or suppress your immune system to prevent it from rejecting the new liver.

Most transplant centers use either two of three agents. This typically involves a combination of a calcineurin inhibitor (CNI) such as cyclosporine(Neoral) or tacrolimus (Prograf), a glucocorticoid such as prednisone(Medrol, Prelone, Sterapred DS), and a third agent such as azathioprine(Imuran), mycophenolate mofetil (CellCept), or sirolimus (Rapamune). Once patients achieve adequate liver function and are free from rejection for six months, ongoing immunosuppression can often be with monotherapy, typically a CNI. You must take these drugs exactly as prescribed for the rest of your life.

Follow-Up Is Necessary After a Liver Transplant

Your first return appointment after a liver transplant will generally be scheduled about 1 to 2 weeks after discharge. During this visit, you will see the transplant surgeon and transplant coordinator. If needed, a social worker or a member of the psychiatric team may also be available.

Patients usually return to their transplant hospital approximately 5 months after the transplant. If a T-tube was inserted during the operation, it will be removed by the transplant surgeon at this time.

Typically patients are scheduled to return to the hospital at their 1-year transplant anniversary date and annually thereafter.

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, your primary care doctor will remain an important part of your medical care.