Liver transplant

Definition

Liver transplant is surgery to replace a diseased liver with a healthy liver.

Alternative Names

Hepatic transplant; Transplant - liver

Description

Liver transplants have become common operations worldwide.

A healthy liver is usually obtained from a donor who has recently died, but has not had liver injury. The donor liver is transported in a cooled salt-water (saline) solution that preserves the organ for up to 8 hours. This allows the necessary tests to match the donor with the recipient.

The diseased liver is removed through a surgical cut in the upper abdomen. The donor liver is put in place and attached to the patient's blood vessels and bile ducts. The operation may take up to 12 hours and requires that the patient receive a large amount of blood through a transfusion.

In some cases, a living donor may donate a section of liver for transplant to a family member or friend. This poses some risk to the donor because of the nature of the operation. However, the liver can regrow itself to some extent. Both people usually end up with fully functioning livers after a successful transplant.

Indications

A liver transplant may be recommended for:

• Birth defects of the liver or bile ducts (such as biliary atresia)
• Hepatic vein clot (thrombosis)
• Liver damage (such as cirrhosis or primary biliary cirrhosis)
• Long-term active infection (hepatitis)
• Metabolic disorders associated with liver failure (such as Wilson's disease)

Liver transplant surgery is not recommended for patients who have:

• Heart, lung, or kidney disease
• Type 1 diabetes
• Other life-threatening diseases

Risks

Risks for any anesthesia are:

• Problems breathing
• Reactions to medications

Risks for any surgery are:

• Bleeding
• Infection

Liver transplants carry major risks. There is an increased risk of infection because the patient must take medications that suppress the immune system to prevent transplant rejection. Call your doctor if your condition worsens or you have any of these signs of infection:

• Diarrhea
• Drainage
• Fever
• Jaundice
• Redness
• Swelling
• Tenderness

Expectations after surgery

Liver transplants can save the lives of people who might otherwise die. Approximately 75% of patients survive 3 years or more after the transplant. Major problems with any transplant include:

• Cost
• Finding a healthy organ
• Life-long need for drugs that suppress the immune system (immunosuppressive drugs), which weaken the body's ability to fight infections
• Transplant rejection

Convalescence

The recovery period averages 12 weeks.

Move your legs often to reduce the risk of deep vein thrombosis. Resume your normal activities as soon as possible, but check with your doctor first.

References

Ahmed A. Current indications and contraindications for liver transplantation. Clin Liver Dis. 2007;11:227-247.