Frequently Asked Questions About Liver Transplantation
What diseases are treated by liver transplantation?
A large number of diseases are capable of interfering with the liver's function to threaten the life of the patient. Most of these diseases are potentially treatable by liver transplantation.
Which liver diseases are most common?
In adults, cirrhosis is the most common disease for which liver transplantation is performed. In children, the disease most often treated by liver transplantation is biliary atresia (a failure of bile ducts to develop normally and drain bile from the liver).
What about alcohol-related liver disease?
Most people who develop cirrhosis of the liver due to excessive use of alcohol do not need a liver transplant. Abstinence from alcohol and treatment of complications will usually allow them to live for prolonged periods without a transplant. For patients with advanced liver disease, where prolonged abstinence and medical treatment fails to restore health, transplant is a consideration. All patients must be alcohol free for at least 6 months before being listed for liver transplant.
And cancer of the liver?
Most cancers of the liver begin somewhere else in the body and spread to the liver. These are not curable with a liver transplant. Likewise, the tumors that start in the liver have usually spread to other organs by the time they are detected, and are rarely cured by liver transplantation.
Transplantation at an early stage of liver cancer results in long-term survival for patients with less than four tumors, each of which are less than 5 cm. in size.
Are there alternative treatments for liver diseases?
There are effective medicines for some liver diseases, while for others only medical treatment of complications is available. Treatment of complications may be all that is required if the liver is not failing. Frequently medical treatment delays, but does not eliminate, the need for transplantation.
Is liver transplantation a treatment of last resort, when everything else has failed?
Yes and no. If medical treatment is likely to allow prolonged survival with good quality of life, transplantation would be reserved for the future. However, ideally the surgery is undertaken before the terminal stage of the disease when the person is too ill to withstand major surgery and will not survive until a suitable donor liver is available.
How is the decision made to transplant?
This is a decision made in consultation with all individuals involved in the patient's care, including the patient and/or family. The patient and family's input is vital and they must clearly understand the risks involved in proceeding to transplantation.
What are the major risks?
Before surgery, the risks are mainly the development of some acute complication of the disease which might render the patient an unacceptable risk for surgery. With the surgery, there are risks common to all forms of major surgery, as well as technical difficulties in removing the diseased liver and implanting the donor liver, and consequences of being without any liver function briefly. Immediately after the operation, risks include bleeding, poor function of the grafted liver, and infections. The patient is carefully monitored for several weeks for signs of rejection of the liver.
What are the overall chances of surviving a liver transplant?
This depends on many factors but overall, 80% to 95% of adult patients and 90% of children survive and are discharged from the hospital. For national survival data, see the Scientific Registry of Transplant Recipients Web site.
How long does it take to recover?
Recovery depends in part on how ill the individual was prior to the surgery. Most patients should count on spending a few days in an intensive care unit and a minimum of about 11 days in the hospital. (Although the range is five days to six weeks.)
What happens during this recovery period?
Initially in the intensive care unit there is very careful monitoring of all body functions including the liver. Once patients are transferred to the ward, the frequency of blood testing etc. is decreased, eating is allowed and physical therapy is used to regain muscle strength. The medicine to prevent rejection is initially given by vein, but later by mouth. During the first six weeks after transplantation, frequent tests are done to monitor liver function and detect any evidence of rejection.
Read our Liver Discharge Manual (pdf file) for more details on liver transplant recovery.
If a transplanted liver fails to function, or is rejected, what can be done?
There are varying degrees of liver failure and even with imperfect function, patients can remain quite well. Occasionally, when circumstances and time permit, a failing transplanted liver can be replaced by a second (or even third) transplant. You can discuss with your doctor the possibility of new liver support devices that can postpone the need for transplant or possibly improve the likelihood of a successful transplant.
What side effects do patients commonly experience from the medicines uses to treat or prevent rejection?
All the drugs used for rejection increase a patient's susceptibility to infections (and possibly the development of tumors). Various medicines are used and each has its own effects. Cortisone-like drugs produce some fluid retention and puffiness of the face, and carry a risk of worsening diabetes and osteoporosis (a loss of mineral from bone). Cyclosporine produces some tendency of high blood pressure and growth of body hair. The dose of cyclorosporine must be very carefully regulated. Kidney damage can occur from cyclosporine, but this can usually be avoided by monitoring the drug levels in the blood. Prograf and CellCept are the most commonly used medications at California Pacific.
Do liver transplant recipients have to take these medicines for the rest of their lives?
Yes. However, as the body adjusts to the transplanted liver, the amount of medicine needed to control rejection is reduced.
How frequent is the medical follow-up?
Routine follow-up consists of monthly blood tests, including blood tests and blood pressure by a local physician with annual or semiannual checkups at the transplant center.
Are patients more susceptible to other infections?
Recipients should avoid exposure to infections as the immune system is depressed. Illness should be reported to the doctor immediately and over-the-counter of prescription medications taken only under medical supervision.
What about physical activity after a liver transplant?
Most patients are able to return to a normal or near-normal lifestyle and can participate in fairly vigorous physical exercise six to twelve months after a successful liver transplant.
What about sexual activity?
As with other physical activities, sexual activity may be resumed when desired.
Can there be a recurrence of the original disease in the transplanted liver?
If the liver disease was caused by hepatitis B or C viruses, recurrence is likely. For other types of liver disease, recurrence is less likely, but is a possibility.
From the description, patients with successful liver transplants seem very healthy. How long can this good health last?
Although this question is difficult to predict, there is every indication that those who are well at one year following liver transplantation remain so indefinitely.
Where do the donated livers come from?
Livers are donated, with the consent of the next of kin, from individuals who have brain death, usually as the result of a head injury or brain hemorrhage. When such a donor is identified, transplant centers are contacted by a computer network and arrangements are made to retrieve whatever organs may be donated. Frequently, this involves a team from transplant centers flying to the donor hospital to remove the organs and return with them for the transplant operation.
Do the donor and recipient have to be matched by tissue type, sex, age, etc.?
No. For liver transplants, the only requirements are that the donor and recipient need to be approximately the same size and of compatible blood types. No other matching is necessary.
What happens if there are two suitable recipients for a donated liver?
This is unusual in practice but the decision would be to transplant the patient with the more urgent need.
How can I donate my organs?
If you wish to be an organ donor, place your name on California's registry at www.donatelifecalifornia.org. You can also carry an organ donor card and place an organ donor sticker on your medical identification card. It is important to discuss organ donation with family members since they will have to give consent. For further information, contact the United Network for Organ Sharing (UNOS) at www.unos.org or by phone at 1-888-894- 6361 or the California Transplant Donor Network at www.ctdn.org or by phone at 1-800-553-6667.