Approximately 6,000 liver transplants are performed in the United States each year. However, more than 17,000 Americans are still waiting for a donated liver to become available for transplant. Recipients and people waiting for a transplant have countless questions about the transplant process and long-term outcomes. ALF answers frequently asked questions with Dr. Fredrick Gordon. Dr. Gordon is the Medical Director of Liver Transplantation and Hepatology at Lahey Hospital and Medical Center and an Associate Professor of Medicine at Tufts Medical School.
Assuming there are no complications, how long can the liver survive? Will the transplant patient eventually need another transplant?
When doctors perform a liver transplant, they expect it to last indefinitely. Even if the liver is transplanted, it has the ability to regenerate, so there is no expiration date. In some patients, the disease may return, which can damage the new liver. This is most common in people with hepatitis C. However, the good news is that there are better new treatments for hepatitis C, so far fewer patients are expected to need retransplantation.
What happens during liver transplant surgery?
In this surgery, the entire damaged liver is removed and a new liver is placed in its place. Surgery usually takes 3 to 7 hours. The surgeon spends the first 1 to 2 hours cutting the damaged liver blood vessels and bile ducts, then removing the entire liver. Over the next 2 to 5 hours, the new liver vein is first connected to the recipient, then the artery, and then the bile duct. The new liver usually starts producing healthy bile before the surgery is finished. The surgeon then closes the wound and the patient is taken to the recovery room.
Can transplant patients live a normal life?
Transplant recipients can live normal lives, but it is considered “normal” to take daily medications to prevent organ rejection and to see the transplant team every 3 to 12 months for the rest of their lives. It may not be possible. However, on a day-to-day basis, most patients should be able to lead a normal life.
Is there a special diet that transplant recipients must follow?
There is no special diet for transplant recipients, but patients may have other dietary restrictions. However, a healthy, balanced diet is beneficial for organ recipients and for everyone else.
Transplant recipients require a normal amount of protein in their diet. This usually means 1.2 to 1.5 grams of protein per kilogram of body weight. One kilogram is equal to 2.2 pounds, so the approximate daily protein intake is your body weight multiplied by 0.75.
Are there many medications to take to prevent new liver rejection? What are the side effects?
There are various drug options and combinations to prevent rejection. Patients who receive a liver transplant usually take high doses of two or three drugs for the first few months and then taper to one or two drugs indefinitely. Side effects vary and patients should discuss this with their doctor.
How is it decided who should receive a new liver?
This is a complex decision and will be reviewed by each transplant program's review committee. There are no universal rules, so each program can make its own decisions. All patients are evaluated by a medical team that includes surgeons, hepatologists, infectious disease specialists, psychiatrists, pharmacists, social workers, and nutritionists. Each specialist will determine if there is a reason why the patient is not a candidate for a transplant, or if there are any issues of concern that need to be addressed before a transplant can occur. Once a patient is accepted and added to the transplant list, they are ranked for transplantation by their MELD score.
The MELD score is calculated using three blood tests: total bilirubin, INR (International Normalized Ratio), and creatinine. The first two are liver tests and the third is kidney tests. MELD calculators can be found on the Internet. Range is 6-40. A MELD score of 6 means the liver is healthy and does not require a transplant. A MELD score of 40 indicates that the patient is severely ill and requires an urgent transplant.
Therefore, when a liver becomes available in the area, it will go to the person with the highest MELD score.
What causes liver damage severe enough to require a transplant?
There can be many reasons why the liver becomes severely damaged, and it can begin early in life. For example, some babies are born with a debilitating liver disease called biliary atresia and may eventually need a liver transplant. Others include hepatitis C, hepatitis B, fatty liver disease (now renamed fatty liver disease), alcoholic liver disease, alpha-1 antitrypsin deficiency, primary sclerosing cholangitis, and certain genetic disorders. The disease can accelerate liver damage if not treated early. Hundreds more.
These conditions can lead to progressive scarring, also known as fibrosis, where scar tissue forms within the liver and obstructs blood flow. This causes cirrhosis, which causes the liver to stop functioning properly.
Are liver cancer patients eligible for a new liver? If they have to take anti-rejection drugs, won't that affect their ability to fight the disease?
Some patients with liver cancer are candidates for liver transplantation. For a patient to be considered a candidate, the tumor must be within the Milan criteria. The criteria state that a single tumor must be 5 cm or less in size and there must be no evidence of spread outside the liver. . If there are two or three tumors, all tumors must be 3 cm or less in size and there must be no evidence that they have spread outside the liver. In fact, if a patient falls within the Milan criteria, they are given “exception points” to receive a liver transplant before their liver fails. If the tumor deviates from the Milan criteria, the immune system cannot prevent the cancer from coming back, so the cancer recurrence rate after liver transplantation is very high.
What is a living donor liver transplant? What is involved for the donor?
Living donor liver transplantation may be an option for patients who need a liver transplant but are not sick enough to have a high MELD score (i.e., cannot readily obtain a new liver). In this case, a healthy living donor (usually someone who is emotionally connected to the recipient) donates one of the liver lobes for the recipient. For small recipients, the smaller left lobe of the donor liver may be sufficient. For larger recipients, the right lobe of the donor will be required. The recipient's entire liver is removed and replaced with a partial organ. Both donor and recipient have livers of approximately normal size by 1 month after transplantation/donation.
Donors undergo extensive evaluations including independent physicians, psychiatrists, and social workers. Patients undergo various blood tests and an abdominal scan (CT scan or MRI). Donors must have an acceptable blood type match and be willing to donate “of their own free will, without coercion or financial reward.” Living donor liver transplants are rarely performed in emergency situations.
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How can I learn more about becoming an organ donor?
The easiest way to become a donor is to register with your state's organ donor registry. You can find it online at Donate Life.
Last updated: January 18, 2024 9:42am
