Successful liver transplants can lead to a longer, more active life for people with end-stage liver disease. The liver, the largest organ in your body, is located behind your rib cage on the right side. It has many functions including processing proteins, fats and carbohydrates, and breaking down toxic substances such as drugs and alcohol. The liver makes the chemical components that help your blood clot. If the liver fails, you lose the ability to clot blood and process nutrients needed for life.
The liver also excretes a yellow digestive juice called bile, which may accumulate if your liver is not functioning properly. Your eyes may become "jaundiced" or yellow andyour skin may itch from the accumulated bile. Some medications help treat symptoms of liver failure, but there are no drugs that "cure" liver failure.
If your liver begins to fail, you may be eligible for a liver transplant. A liver transplant may not be recommended if you have an infection outside the liver, a medical condition that poses a problem or if you are an active substance abuser. More information is available by request on the medical center's policy regarding liver transplants for patients with alcoholic liver disease.
People who have certain cancers — such as metastatic carcinoma and cancer of the bile ducts called cholangiocarcinoma — or have certain heart or lung conditions are not considered candidates for liver transplant.
End-Stage Liver Damage
Because the liver has so many functions, a number of different diseases and conditions can result in liver failure.
Congenital Liver Damage or Cirrhosis
Congenital or acquired end-stage liver damage, called cirrhosis, can be due to various factors such as nutritional deficiencies, poisons including alcohol or previous inflammation. These causes of liver damage include:
- Primary biliary cirrhosis, in which the bile becomes inflamed and destroyed.
- Secondary biliary cirrhosis resulting from prolonged bile duct obstruction.
- Chronic active hepatitis, a long-term inflammation caused by the Hepatitis virus.
- Cirrhosis of unknown origin or cryptogenic.
- Autoimmune cirrhosis in which the body's defensive mechanism against infection fights against itself.
- Inflammation of the bile ducts resulting in hardening of the tissue or sclerosing cholangitis.
- Biliary atresia, birth defects in which the bile ducts fail to develop or develop abnormally.
Physical and Chemical Changes
Liver-based disorders due to physical and chemical or metabolic changes in the body include:
- Tyrosinemia, a disease of tyrosine metabolism
- Galactosemia, an enzyme deficiency in children
- Primary oxalosis, overproduction of oxalic acid
- Glycogen storage disease
- Alpha-1-antitrypsin deficiency, an inhibitor of the enzyme trypsin
- Wilson's disease, an increase in copper absorption Protoporphyria, a disturbance of porphyrin metabolism Hemochromatosis, a disturbance of iron metabolism
Other conditions that can result in liver damage are:
- Budd-Chiari Syndrome, a blockage of the veins draining from the liver.
- Some liver cancers such as hepatoma and hepatoblastoma.
- Fast appearing or fulminant liver failure. Fulminant liver failure can occur during acute viral hepatitis, in reaction to mushroom poisoning or as a reaction to overdoses of medication such as acetaminophen.
The preliminary evaluation, called a Phase I Evaluation, is the first step in helping you and the transplant team determine if transplantation is an appropriate treatment option. It also enables the transplant team to assess the medical factors related to your liver failure.
The appointment will take a full day, from about 7 a.m. to 4 p.m., and can be very tiring. The following tips will help you prepare for this first appointment:
- You must have a family member oranother support person or people accompany you to help understand the significant amount of information you will receive about the transplant process.
- Because you will undergo many tests, do not eat or drink anything after midnight of the day before your appointment.
- Plan to bring a snack. Please bring any medications you are taking, 2 forms of identification, your health insurance information and your medical records if you have them.
As part of your evaluation, a series of tests will be conducted, including:
- Blood tests to help determine how well your liver is functioning, and to assess your kidney function.
- Ultrasound scan to view the blood flow to and from your liver, and locate any abnormal masses in the liver. A probe will be moved over your liver so that its image can be reflected and reviewed on a screen.
- Chest X-ray to help detect infection in your lungs and assess the status of your bones.
- Electrocardiogram to help identify any changes in your heart rhythm.
- Pulmonary function test to measure your lung capacity. You will be asked to breathe into a machine and blood will be drawn to determine how well oxygen is being absorbed from your lungs.
Every patient also is evaluated by a liver specialist, called a hepatologist, and a surgeon. The hepatologist will do a full exam, review your health history and discuss what it means to be on the transplant waiting list. The wait for a new liver can be up to three years and tests may need to be repeated prior to the transplant. You can discuss your test results with the hepatologist and surgeon and both will answer any questions.
Many patients find it helpful to write down questions before the appointment. You will meet with the financial counselor to review your insurance information. Patients with a history of drug or alcohol dependency are required to remain drug and alcohol free for six months prior to transplant and agree to random screening.
The Waiting List
Once the evaluation is complete, the transplant team meets to discuss each case and to decide whether to add you to the waiting list. Once on the waiting list, you will be notified and undergo further testing at your local doctor's office. Patients on the deceased donor waiting list will receive instructions about getting a pager and informing the team about changing health conditions.
If a liver transplant isn't in your best interest, a transplant team member will call to discuss other options. Before your operation, a social worker will talk to you to about your adjustment after the surgery. Weekly support groups led by social workers for current and former transplant recipients and their families address a broad range of issues. Individual counseling also is available during your hospital stay. If necessary, a social worker can arrange follow-up services and answer questions about disability.
Liver transplantation can be done with a deceased donor from someone who has died or by a living donor. To receive a deceased donor, you are put on a national waiting list until a donor becomes available. This can occur at any time, day or night. The wait is generally two to three years.
A living donor is usually someone in the family or a close friend. Living-donor liver transplantation in adults is a relatively new technique that evolved from the successes of living-donor liver transplantation in children and adult split-liver deceased transplantation.
A healthy liver has two lobes, one is about 60 percent of the total liver and the other is 40 percent. Either lobe can be transplanted and grow into a full healthy liver for the recipient. A liver donated from a person who has died can be split and used for two recipients. A living person can donate a portion of liver and still maintain liver health. Living-donor liver transplantation allows doctors to do the transplantation without the sometimes lengthy wait for a deceased liver. Both donor and recipient livers grow to full size after the transplant.
During a transplant evaluation, live donation will be discussed. Donor safety is a primary concern. Donors must be in good health, be of a compatible blood type to the recipient and be motivated to donate from altruistic reasons. If this is a feasible option for you, a donor evaluation will be started after the entire recipient testing is completed. If after testing the donor the transplant team determines the donation would work, a surgery date is scheduled for both you and the donor. This process usually takes up to four to six months.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.