The liver, the largest organ in your body, has many functions including processing proteins, fats and carbohydrates, and breaking down toxic substances such as drugs and alcohol. The liver makes the chemical components that help your blood clot. If the liver fails, you lose the ability to clot blood and process nutrients needed for life.
The liver also excretes a yellow digestive juice called bile, which may accumulate if your liver is not functioning properly. Your eyes may become “jaundiced” or yellow or your skin may itch from the accumulated bile. Some medications help treat the symptoms of liver failure, but there are no drugs that “cure” liver failure.
If your liver begins to fail, you may be eligible for a liver transplant. Liver transplants provide patients a chance for a longer, more active life in the final stages of liver disease or end-stage liver disease.
Because the liver has so many functions, a number of different diseases and conditions can result in liver failure. They include:
- Congenital Liver Damage or Cirrhosis
- Physical and Chemical Changes
- Budd-Chiari Syndrome, a blockage of the veins draining from the liver
- Some liver cancers such as hepatoma and hepatoblastoma
- Fast appearing or fulminant liver failure
A liver transplant may not be recommended if you have an infection outside the liver, a medical condition that poses a problem or if you are an active substance abuser. People who have certain cancers — such as metastatic carcinoma and cancer of the bile ducts called cholangiocarcinoma — or have certain heart or lung conditions are not considered candidates for liver transplant.
In North America there are more than 17,500 patients on the waiting list, with more added each day. Almost 5,000 patients receive transplanted livers every year, but more than 1,700 patients die each year while on the waiting list.
When being evaluated for a liver transplant, a series of tests will be conducted, including:
- Blood tests to help determine how well your liver is functioning, and to assess your kidney function.
- Ultrasound scan to view the blood flow to and from your liver, and locate any abnormal masses in the liver. A probe will be moved over your liver so that its image can be reflected and reviewed on a screen.
- Chest X-ray to help detect infection in your lungs and assess the status of your bones.
- Electrocardiogram to help identify any changes in your heart rhythm.
- Pulmonary function test to measure your lung capacity. You will be asked to breathe into a machine and blood will be drawn to determine how well oxygen is being absorbed from your lungs.
Patients with a history of drug or alcohol dependency are required to remain drug and alcohol free for six months prior to transplant and agree to random screening.
Liver transplantation can be done with a cadaveric donor from someone who has died or by a living donor. To receive a cadaveric donor, you are put on a waiting list until a donor becomes available. This can occur at any time, day or night. The wait is generally two to three years.
A healthy liver has two lobes, one is about 60 percent of the total liver and the other is 40 percent. Either lobe can be transplanted and grow into a full healthy liver for the recipient. A liver donated from a person who has died can be split and used for two recipients. A living person can donate a portion of liver and still maintain liver health.
In living donor liver transplantation, a piece of liver is removed from a living donor and transplanted into a recipient. The procedure, performed after the diseased liver has been removed, is possible because the liver regenerates or grows. The liver’s unique ability to regenerate itself — combined with technological advances — allows more people to be donors.
Regeneration happens over a short period, possibly days to weeks and certainly within eight weeks. When surgeons remove a piece of the donor’s liver, the part that remains grows back quickly to its original size.
Living donors not only reduce the waiting time, but they improve the chance for transplant success. Patients who receive transplants from living donors can better prepare for their surgery, knowing well in advance when the transplant will take place. Also, the liver itself is “fresher” because donor and recipient are in nearby operating rooms and the donated liver portion is transported within minutes.
Donors should be:
- 18 to 55 years of age
- In good health with no major medical or psychiatric illnesses
- A non-smoker for at least six weeks prior to surgery
- Able to understand and comply with instructions for surgery preparation and recovery
Donors cannot be pregnant and cannot be overweight, although overweight candidates who lose weight may be considered.
A living donor doesn’t have to be a blood relative of the liver recipient but you must have a compatible blood type. You must be in good health and be motivated to donate for altruistic reasons. If live donation is a feasible option for a patient, a donor evaluation will be performed after the recipient’s testing is completed.
Once the donor’s blood type is confirmed, they will receive a detailed confidential questionnaire about their family medical history, lifestyle and other information. Tests include:
- Chest X-ray
- Electrocardiogram (EKG or ECG)
- Abdominal ultrasound
After the liver transplant surgery is complete, the patient will go directly to the intensive care unit (ICU), usually for one or two days. When you are ready to leave the ICU, you will be transferred to a care unit in the hospital. Everyone recuperates from liver transplantation differently. Depending on your condition, you will be hospitalized for two to eight weeks following the transplant.
After you are discharged from the hospital, you will be seen in the liver transplant clinic at least once a week for the first month. As you improve, you will be seen less often; eventually, you will be seen once a year.
Laboratory blood tests are obtained twice a week following transplantation. Gradually, the frequency of blood tests will be reduced.
Patients undergoing organ transplantation may face complications. Some possible transplant complications and medication side effects include:
- Recurrent disease
Immunosuppressive medications help to prevent and treat rejection. These drugs decrease your body’s resistance to foreign bodies, such as your new liver. You will need to take these medications for the rest of your life or you will reject your liver. Immediately after surgery, the dosages will be high since the probability of rejection is greatest at this time. Dosages will be lowered quickly to smaller amounts if there are no signs of rejection.
The medications you will take for rejection impair your body’s ability to fight off infections. You will be given medication to help prevent infections but you also will need to use caution and avoid contact with people with infections, especially during the first three to six months after transplant.