Liver Transplant (Liver Transplantation, Hepatic Tranplantation)
A liver transplant is a surgical procedure to remove a damaged liver and replace it with an entire or partial healthy liver. The healthy liver comes from a donor. Donors are typically deceased; however, new technology has made it possible for a living person to donate a part of his or her healthy liver as well. Living donors are less common because the procedure of donating, like all surgeries, has risks. The liver is the second most commonly transplanted organ(after the kidneys).
Causes and Risk Factors
Chronic hepatitis C and cirrhosis leading to liver failure are the most common causes of needing a liver transplant in adults. The incomplete development of the bile ducts is the most common cause in children and adolescents.
Who is eligible for a liver transplant?
Not everyone who needs a liver transplant is eligible for one. Individuals who may be ineligible for a liver transplant are:
- those who drink alcohol or use drugs
- those with cancer outside the liver
- those with advanced lung or heart disease
- those with severe infections
- those with severe liver failure accompanied by brain injury
- those infected with HIV, AIDS
- those without psychosocial support
- those unable to follow a treatment regimen
How is need determined for a liver transplant?
The United Network for Organ Sharing (UNOS) uses clinical and laboratory methods to determine which patients are in the most critical need of transplantation. These are called the Model for End Stage Liver Disease (MELD)score, for adults,and the Pediatric End Stage Liver Disease (PELD) score for children and adolescents under the age of 18. Status 1 refers to the acute severe disease which is a recent development that requires admittance into an intensive care unit . The life expectancy of individuals with a Status 1 classification is less than 7 days.
The MELD score is based on the probability of death occurring within a three-month timeframe should the individual not receive a transplant. This score is based on lab data, for the sake of objectivity, factors in the bilirubin and creatinine, andan international normalized ratio score between 6 and 40.
In the event of a liver becoming available for two patients with the same blood type, the MELD score and amount of time on the waiting list will be the deciding factors.
Based on these classifications, donated livers are first offered to local patients with Status 1, and then to patients with the highest MELD or PELD score. If there are no local patients requiring a transplant, the liver will follow the same system regionally. If there are no regional patients awaiting transplant, the liver will be offered nationally.
A Status 7 classification means that the patient is temporarily ineligible for transplant.
How does a liver transplant work?
A liver transplant requires a portion of or a complete healthy liver removed from one body (donor) and placed into the body of the patient suffering from liver disease. Typically, liver donors are deceased; however, because of the liver’s ability to regenerate, liver donation from a living person is possible. Living donors are rare due to the potential risk of surgery to the donor. Living donors are often related to the patient; potential living donors should be of similar size and have a compatible blood type.
In the living donor transplantation process, a segment is removed from the healthy liver of the donor and placed where the damaged liver has been removed in the patient. Both donor and patient should experience liver regeneration to the approximate size of the original liver. The regenerated liver will not have the same shape, as individual lobes do not regenerate. Transplant patients should expect a 1-2 week hospital stay, while donors generally require a 1-week hospital stay.
A transplantation from a deceased donor occurs if the individual has expressed a willingness to donate organs after death. The liver is removed from the body of the deceased organ donor and stored in a sterile liquid and cooled, prior to transplantation. The liver is tested for hepatitis viruses and HIV. The liver must be transplanted within 24 hours of removal from the deceased donor. After transplantation occurs, transplant patients should expect a 1-2 week hospital stay.
A patient wishing to have transplantation will need to have many tests pertaining to the entire body, the mind, and nutritional habits prior to consideration for liver donation. After the transplantation, consistent, ongoing follow-ups should be expected.
How effective is a liver transplant?
Liver transplants are highly effective. An estimated 80-85% of transplanted livers continue to function one year after the operation.
Are there any side effects?
Side effects of liver transplant include: bleeding, bile duct damage, blood clots in liver blood vessels, infection, potential rejection of the new liver by the recipient's immune system, and side effects from immunosuppressive medications.
Which medications are used after a liver transplant?
Some examples of the medications used after a liver transplant include intravenous methylprednisolone, tacrolimus, sirolimus, and mycophenolate.
How much does a liver transplant cost?
Insurance may cover some of the costs for a transplant; contact your provider for more details. The cost of a liver transplantation operation without insurance total approximately $315,000- 580,000. In addition, anti-rejection medication costs approximately $21,000-36,000 in the first year after treatment.