A liver transplant is a medical procedure in which your diseased or failing liver is replaced with a donor liver.
According to the Organ Procurement and Transplantation Network, the majority of liver transplants are done on patients who are between the ages of 35 to 64. Since 1988, there have been about 115,000 liver transplants in the United States. However, there is still an average of 16,000 Americans waiting to receive a liver transplant (OPTN, 2012).
According to the American Liver Foundation, the five-year survival rate for liver transplants is about 75 percent. Some patients experience the return of liver disease and need more treatments or another transplanted liver (ALF, 2011).
A liver transplant is typically the last option when other treatments and lifestyle changes have not been able to prevent the liver from failing.
According to the Mayo Clinic, liver failure can happen slowly over the years—called chronic liver failure—or it can occur suddenly in a matter of weeks, known as acute liver failure (Mayo, 2012).
Typically, a liver transplant is needed due to a condition called cirrhosis, which causes the liver to scar and makes it unable to perform its functions in the body. Cirrhosis can be caused by infection with the hepatitis virus or by long-term alcohol abuse.
Other conditions that could result in a liver transplant include:
- alcoholic liver disease
- biliary duct atresia (tubes that carry bile from the liver to the gallbladder are blocked)
- chronic hepatitis B and C
- cystic fibrosis
- early-stage liver cancer
- fatty liver disease
- hemochromatosis (too much iron is present in the body)
- primary biliary cirrhosis (inflammation in the bile ducts blocks the flow of bile and causes scarring in the liver)
- primary sclerosing cholangitis (the bile ducts become inflamed and scarred, and are eventually destroyed)
- Wilson’s disease (an inherited condition that results in too much copper in the body)
A liver transplant is a major surgery and, as such, it comes with many risks. Your doctor will go over these risks: if they outweigh the benefits of the procedure, and what you can do to reduce your chances of complications.
The major concern during a liver transplant is that your body will reject the donor liver. When working correctly, your immune system is supposed to keep you healthy. However, sometimes the immune system attacks the donor liver as if it were an enemy. Your body may reject the new liver or the donated liver might fail to function in your body.
Other risks of liver transplant surgery include:
- bleeding and blood clots
- bone thinning
- cancer or other malignancies due to immunosuppressant medications
- complications with the bile ducts
- high cholesterol
- memory problems
- side effects from medication
Follow your doctor’s instructions before and after your surgery to help lower your risk. Always try to make healthy lifestyle choices—such as not smoking and eating a healthy diet.
Don’t miss any doses of your medications and abstain from alcohol if you have problems with your liver.
Waiting for a donor liver is possibly the hardest part of preparing for the transplant. Once you have undergone the necessary tests, you will be placed on a waiting list for the donor liver. Your waiting time depends on the availability of a matching liver, as well as your:
- blood type
- body size
- stage of liver disease
- overall health
A donated liver can come from a recently deceased donor. However, in some cases, a living donor can donate part of his or her liver. The liver has the ability to regrow itself, making this procedure possible.
Your doctor will perform numerous laboratory tests, imaging tests, and other exams. You may also undergo counseling to help you deal with your emotions and finances after the procedure. If you need a new liver due to excessive alcohol use, you will probably receive counseling for addiction as well.
Your doctor will give you complete instructions on how best to prepare for your surgery. If you are waiting on a donor liver, it is best to have your bags packed well in advance, as the notice could come at any time.
You will be notified when a donor liver is available. Donor livers are transported to the hospital in a saline solution. Organs can survive this way for up to eight hours.
If you receive a portion of a liver from a living donor, the chunk of the donor liver will be removed just before it is implanted in you.
When you and your donor liver arrive at the hospital, you will be prepared for surgery. You will change into a hospital gown, receive an intravenous (IV) line, and undergo general anesthesia. During the procedure, you will be in a painless sleep and will awaken in a recovery room once your new liver is in place.
During the surgery, your surgeon will make a surgical cut in your upper abdomen to access your liver. The necessary blood vessels and bile ducts will be cut and your failing liver removed. The donor liver will then be connected to those vessels and ducts and placed into your abdomen.
When your surgeon is satisfied with how your new liver has been attached, he or she will close the surgical area with stitches. You will be bandaged and moved to an intensive care unit (ICU) to recover.
The entire procedure can take up to 12 hours.
You can expect to remain in the intensive care unit (ICU) for a few days after the procedure. During this time, your vital signs will be closely monitored. Your entire stay at the hospital could last up to two weeks, depending on how well you do in recovery.
Before you leave the hospital, you will be given instructions on how to care for your surgical wound, any restrictions you may have on your lifestyle, and what medications you will have to take. Following this procedure, you will be required to take medication that suppresses your immune system for the rest of your life. These will prevent your body from rejecting, or attacking, your new liver.
These immunosuppressants also leave you open to infection and other problems. Make sure to talk with your doctor about all the side effects you can expect from your medications.
The American Liver Foundation reports that most liver transplant patients are able to fully return to their normal life within six months to a year after their transplant (ALF, 2011).