Liver transplant is a treatment option for people who have end-stage liver failure that can't be controlled using other treatments and for some people with liver cancer. Liver failure can occur rapidly, in a matter of weeks (acute liver failure), or it can occur slowly over months and years (chronic liver failure).
Liver failure has many causes, including:
- Liver cirrhosis
- Alcoholic liver disease
- Nonalcoholic fatty liver disease
- Early-stage liver cancer
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Wilson's disease
- Biliary duct atresia
- Cystic fibrosis
Liver transplant surgery carries a risk of significant complications, including:
- Bile duct complications, including bile duct leaks or shrinking of the bile ducts
- Blood clots
- Failure of donated liver
- Memory and thinking problems
- Rejection of donated liver
Side effects of anti-rejection medications
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 medications can cause a variety of side effects, including:
- Bone thinning
- High blood pressure
- High cholesterol
Being placed on the waiting list
If you have chronic liver failure, your doctor may refer you to a transplant center to undergo evaluation for liver transplant. The transplant center team conducts a wide variety of tests and procedures to determine whether to place your name on the waiting list for a new liver.
Tests, procedures and consultations you may undergo include:
- Laboratory tests, including 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
- Nutrition counseling with dietitians who assess your nutritional status and make recommendations regarding nutritional intake before and after transplant
- Psychological evaluation to 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 with alcohol, drug or tobacco addictions to quit
- Financial counseling to help you understand the cost of a transplant and post-transplant care and to determine what costs are covered by insurance
Once these tests and consultations are completed, the transplant center's selection committee meets to discuss your case. It 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 transplant waiting list.
Determining your position on the waiting list
Doctors use results of liver function tests and other factors to determine your prognosis and your place on the transplant waiting list. Your prognosis is sometimes called your Model for End-Stage Liver Disease (MELD) score. The higher your MELD score, the more dire your situation. Organs are allocated based on MELD scores. People with higher MELD scores generally are offered donated livers first. MELD scores range from 6 to 40.
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 criteria.
Waiting for a new liver
Your wait for a donor liver could be days, or it could be months. Or a donor liver that's a good match for you might not become available.
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 completed each year using a portion of a liver from a living donor. 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 like transplants using livers from deceased donors. But fewer living transplants are performed because of restrictions on the donor's age, size and health that make finding a good match difficult. The surgery carries significant risks for the donor. Your transplant team can discuss the risks with you and the potential donor.
During a liver transplant
If you're notified that a liver from a deceased donor is available, you'll be asked to come to the hospital immediately. Your health care team will admit you to the hospital, and you'll undergo an exam to make sure you're healthy enough for the surgery.
Liver transplant surgery is done using general anesthesia, so you'll be unaware during the procedure.
The transplant surgeon makes a long incision across your abdomen to access your liver. The location and size of your incision varies according to your surgeon's approach and your own anatomy.
The surgeon disconnects your liver's blood supply and the bile ducts and then removes the diseased liver. The donor liver is then placed in your body, and blood vessels and bile ducts are reattached. Surgery can take up to 12 hours, depending on your situation.
Once your new liver is in place, the surgeon uses stitches and staples to close the surgical incision. You're then taken to the intensive care unit to begin recovery.
Liver transplant using a living donor
If you're receiving a liver transplant from a living donor, such as a friend or family member, surgeons will transplant a portion of the donor's liver in your body. Surgeons first operate on the donor, removing the portion of the liver for transplant. Then surgeons remove your diseased liver and place the donated liver portion in your body. They then connect your blood vessels and bile ducts to the new liver.
The transplanted liver portion in your body and the portion left behind in the donor's body regenerate rapidly.
After a liver transplant
After your liver transplant, you can expect to:
- Possibly stay in the intensive care unit for a few days. Doctors and nurses will monitor your condition to watch for signs of complications. They'll also test your liver function frequently for signs that your new liver is working.
- Spend 5-10 days in the hospital. Once you're stable, you're taken to a transplant recovery area to continue recuperating.
- Have frequent checkups as you continue recovering at home. Your transplant team designs a checkup schedule for you. You may undergo blood tests a few times each week at first and then less often over time.
- Take medications for the rest of your life. You'll take a number of medications after your liver transplant, many for the rest of your life. Drugs called immunosuppressants help keep your immune system from attacking your new liver. Other drugs help reduce the risk of other complications after your transplant.
Expect six months to a year of recovery before you'll feel fully healed after your liver transplant surgery. You may be able to resume normal activities or go back to work a few months after surgery. How long it takes you to recover may depend on how ill you were before your liver transplant.
Survival rates after liver transplant
Your chances of a successful liver transplant and long-term survival depend on your particular situation. In general, about 72 percent of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 72 will live for five years and 28 will die within five years.
People who receive a liver from a living donor have higher survival rates because having a living donor usually means a shorter wait for a liver. For liver transplants using living donors, the five-year survival rate is about 78 percent. That means that for every 100 people who receive a liver transplant using a living donor, 78 will live for five years and 22 will die within five years.