A liver transplant can help save your life when your liver no longer works. Also called a hepatic transplantation, the treatment involves surgical removal of your entire liver. It’s then replaced with a healthy donor liver. This may come from a living or deceased donor.
Having a healthy liver is essential to longevity because your liver is responsible for filtering blood and removing toxins from your body. Liver transplant is a last-resort measure for chronic (long-term) liver diseases and severe acute (sudden-onset) liver diseases.
According to the American Liver Foundation, around 6,000 liver transplant surgeries are performed in the United States every year.
A doctor may recommend a liver transplant for a person with end-stage liver disease. A person with this condition will die without a transplant.
A liver transplant may also be suggested if other traditional treatments for liver disease aren’t enough to keep a person alive. Liver transplants may be offered for chronic liver disease or if liver failure happens very quickly.
Cirrhosis is the most common reason why adults need liver transplants. Cirrhosis replaces healthy liver tissue with scarred tissue. Causes of cirrhosis include:
- alcohol abuse
- chronic hepatitis B or chronic hepatitis C
- nonalcoholic fatty liver disease
- autoimmune hepatitis
- biliary atresia, a liver disease in newborns
- metabolic disorders
Your medical team will also consider other factors when determining if you need a liver transplant. These include:
- how severe your condition is
- other medical conditions you have
- a history of tuberculosis and chronic infections like HIV
- your overall physical condition
- your mental well-being
- level of support from your family or friends
Before granting a liver transplant, a doctor will weigh whether it will both extend a person’s life and be successful. A person may not be a likely transplant candidate if they have other chronic conditions that could affect a transplant’s success.
Examples include a person who has cancer that has spread to other body parts or has severe heart problems. As another example, if a person has cirrhosis from alcoholism, their ability to quit drinking is evaluated as part of the transplant planning.
If you become eligible for a liver transplant, you’ll be placed on a national waiting list. As of early 2015, an estimated 17,000 people were awaiting a liver transplant in the United States.
List placement and waiting for a match
Where you’re placed on the list is in part decided by a Model of End-Stage Liver Disease (MELD) score. This score is based on blood tests, such as:
- measuring your level of creatinine, which shows how well your kidneys are working
- checking your international normalized ratio, which is a measure of how well your liver is making blood-clotting proteins
Those with the highest scores are sicker patients, and they are placed higher on the list. Regular blood tests are necessary to update your MELD score and position on the list.
There is also a Pediatric End-Stage Liver Disease score for those younger than age 12.
Transplant surgery’s success depends on a good match with a qualifying donor, so your wait time may also vary based on your body size and blood type.
Various factors determine whether a person receives a liver transplant. For instance, if two people with high MELD scores qualify for a liver transplant, the person who has been on the list the longest may receive a transplant sooner. In addition, a person high on the transplant list who has a rare blood type may be less likely to match with a donor.
A person experiencing acute liver failure may be placed near the top of the list because their risk of death could be more imminent compared to someone with a chronic condition.
When a match is found
Waiting for a liver transplant is a long process, but the surgery coordination happens quickly once you have a match. The liver can come from a deceased donor who had a healthy liver. Sometimes a donated liver may be used for two recipients. The right side of the donated organ is more often used in adult recipients, while the smaller left side is more often used for children.
It’s possible that a living donor can donate a portion of their liver as well. However, the living donor must be a good match in terms of blood type and other factors.
Getting the transplant is just a part of the process of getting a new liver. According to the National Institute of Diabetes and Digestive and Kidney Diseases, a three-week hospital stay is common after a transplant. During this time, your doctor will evaluate the success of your operation, as well as determine your needs for homecare.
It may take up to one year until you feel healthier. Let your doctor know what your mental health and emotional health needs are before you’re discharged.
The greatest risk of this operation is transplant failure. In such a case, your body rejects the new liver, often for reasons doctors can’t determine. A liver transplant also puts you at a high risk for infection. Other long-term complications can include:
- damage to the bile ducts
- blood clots
- side effects from medications taken to allow your immune system to accept the new liver — including high blood sugar from steroids
According to the American Liver Foundation, people who have a liver transplant have an 86 percent chance of living after one year. The three-year survival rate is 78 percent. Sometimes the transplanted liver can fail, or the original disease may return.
It’s important that your doctor monitors your recovery long after the transplant to detect any potential problems. You’ll likely need regular blood tests. According to John Hopkins, you’ll also need to take antirejection medications for the rest of your life.
After a liver transplant, your doctor may recommend lifestyle changes, including regular exercise and a healthy diet. You can incorporate habits like these at any stage to boost your strength and overall health. Being physically healthy may reduce your chances for transplant rejection.
You can also limit risk factors that contribute to liver disease. Among the most common are:
- alcohol abuse
- acetaminophen overdose
- obesity and high cholesterol