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Liver Transplant

Liver transplantation is a surgical procedure performed to remove a diseased or injured liver and replace it with a whole or a portion of a healthy liver from another person, called the donor. Since the liver is the only organ in the body able to regenerate, a transplanted segment of a liver can grow to normal size within weeks.

Organ Donation

Thousands of lives depend on receiving organ and tissue transplants, but there is a severe shortage of donated organs. Learn more about how organ donation can be a godsend to those waiting for a liver transplant.

Become an Organ Donor

What is a liver transplant?

Liver transplantation is a surgical procedure performed to remove a diseased or injured liver and replace it with a whole or a portion of a healthy liver from another person, called the donor. Since the liver is the only organ in the body able to regenerate, a transplanted segment of a liver can grow to normal size within weeks.


When is a liver transplant recommended?

A liver transplant is recommended when a person’s liver no longer functions adequately enough to keep them alive. A successful liver transplant is a life-saving procedure for people with liver failure. Liver failure can happen suddenly – called acute liver failure – as a result of infection or complications from certain medications, for example. Liver failure resulting from a long-term problem – called chronic liver failure – progresses over months, years or decades.

Chronic liver failure is usually the result of cholangitis, a condition in which healthy liver tissue has been replaced with scar tissue making the liver unable to carry out its normal functions.


What are the common conditions that cause someone to need a liver transplant?

Among adults in the U.S., the most common reason for a liver transplant is cholangitis Liver caused by chronic hepatitis C, followed by cholangitis caused by long-term alcohol abuse. Many other diseases cause cholangitis, including the following:

  • Other forms of chronic hepatitis, including hepatitis B and autoimmune hepatitis.
  • NASH, or nonalcoholic steatohepatitis, a disease caused by a buildup of fat in the liver resulting in inflammation and damage to liver cells.
  • Some genetic conditions, including Wilson disease where dangerous levels of copper build up in the liver, and hemochromatosis where iron builds up in the liver.
  • Diseases of the bile ducts. Bile ducts are tubes that transport bile, a digestive liquid made in the liver, to the small intestine. These diseases include primary biliary cholangitis, primary sclerosing cholangitis, and biliary atresia. Biliary atresia, a disease of absent or malformed bile ducts usually identified shortly after birth, is the most common cause of liver failure and transplant in children.

Other reasons for liver transplantation include primary liver cancer, meaning cancers that originate in the liver, such as hepatocellular carcinoma.


Where do donated livers come from?

We will now discuss transplantation in two categories: deceased donor transplantation and living donor transplantation. Livers for transplantation come from either a deceased or living donor. Most donated livers come from deceased donors, often victims of severe, accident-related head injury. Either they have arranged in advance to be an organ donor or their family grants permission for organ donation when the victim is declared brain dead.


How are candidates for liver transplants selected?

Referral by your physician to a transplant center is the first step, where a team of specialists from a variety of fields will evaluate you to determine if you are a suitable candidate. The transplant team usually consists of the following members:

  • hepatologist
  • transplant surgeon
  • transplant coordinator
  • nurse
  • psychiatrist
  • social worker
  • nutritionist
  • financial coordinator

Evaluation will include assessment of your:

  • liver disease and other conditions you may have;
  • mental and emotional health;
  • support system;
  • ability to adhere to the complex medical regimen required after transplant; and
  • likelihood of surviving the transplant operation.

Pre-transplant evaluation appointments often last four to five hours. The person who will be involved in your pre- and post-transplant care should accompany you to the appointment.


How do donated livers become available?

Livers for transplantation come from either a deceased or living donor. Most donated livers come from deceased donors, often victims of severe, accident-related head injury. Either they have arranged in advance to be an organ donor or their family grants permission for organ donation when the victim is declared brain dead.

A smaller number of transplants are performed using living donors, often relatives or friends of the recipient. The person will go through extensive medical and psychological testing to evaluate their appropriateness for donation. Blood type and body size are critical factors in determining who is an appropriate donor. In living donor transplantation, a portion of the healthy person’s liver is used for transplantation.


Deceased Donor Transplantation

How does the transplant waiting list work?

Once you complete all required testing, the transplant selection committee will review your case. If the committee determines you are a suitable candidate, your name will be placed on the national transplant waiting list. This list is maintained by the United Network for Organ Sharing (UNOS), which administers the Organ Procurement and Transplantation Network (OPTN), responsible for transplant organ distribution in the U.S. When people are put on the waiting list they’re assigned a priority score indicating how urgently they need a transplant. The score is calculated by your healthcare provider based on a specific formula. The two scoring systems are the MELD (Model for End-stage Liver Disease) used for adults, and the PELD (Pediatric End-stage Liver Disease), used for children less than 12 years of age. MELD scores range from 6 to 40 and are based on whether or not you’re currently on dialysis and the results of the following four blood tests:

  • INR (internal normalized ration), which reflects whether your liver is making the proteins necessary for your blood to clot
  • creatinine, an indicator of kidney function LiverTransplant_brochure_2-18.indd 7 9/13/18 3:13 PM 8 Liver Transplantation
  • bilirubin, an indicator of liver health
  • sodium, an indicator of your body’s ability to regulate fluid balance

PELD scores range from negative numbers to 99 and are based on the:

  • child’s age
  • child’s degree of growth failure
  • results of the following blood tests: INR, bilirubin, and albumin – a protein made by the liver which is usually below normal levels in people with liver disease A higher MELD or PELD score indicates a more urgent need for a liver transplant. While you’re on the waiting list, your score may go up if your condition worsens or down if it improves. A small group of people who are critically ill with acute liver failure and likely to die within a week have the highest priority on the waiting list. More information about these scoring systems is available from UNOS at unos.org.

How long does a person have to wait for liver transplantation?

It’s impossible to predict how long you’ll have to wait for a new liver. Sometimes people wait only a few days or weeks before receiving a donor organ. If no living-related Liver donor is available, it may take months or years before a suitable donor organ becomes available. Blood type, body size, severity of illness, distance between the donor and transplant hospital, and availability of donor organs in your geographic region will all affect waiting time. To facilitate transplantation, OPTN divides the U.S. into 11 geographic regions.

The states comprising each region are as follows:

• Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Eastern Vermont

• Region 2: Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, West Virginia, Northern Virginia

• Region 3: Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Puerto Rico

• Region 4: Oklahoma, Texas

• Region 5: Arizona, California, Nevada, New Mexico, Utah

• Region 6: Alaska, Hawaii, Idaho, Montana, Oregon, Washington

• Region 7: Illinois, Minnesota, North Dakota, South Dakota, Wisconsin

• Region 8: Colorado, Iowa, Kansas, Missouri, Nebraska, Wyoming

• Region 9: New York, Western Vermont

• Region 10: Indiana, Michigan, Ohio

• Region 11: Kentucky, North Carolina, South Carolina, Tennessee, Virginia

Every region has a different supply and demand for livers. Some regions may have shorter wait times due to a higher rate of liver donation. To find detailed information about how these regions compare, visit the OPTN website.


Can I list in more than one transplant center and region?

Yes, OPTN policy allows multiple listing; however, it’s up to the individual center to decide whether or not to accept you as a candidate. You probably would not benefit from listing at multiple centers in the same region because priority is first calculated among candidates within the local donation area, not for each hospital individually. If you’re considering multiple listing, you should contact staff of the transplant program where you are listed or want to be listed. They will have the most specific information about how they handle requests for multiple listing. For more information, you can find a brochure entitled “Q &A for Transplant Candidates about Multiple Listing and Waiting Time Transfer” by visiting www. unos.org and searching “multiple listing.”


What happens when a donor liver becomes available?

Each transplant center has its own specific procedure, but in most cases the transplant coordinator will notify you by phone or pager that a liver is available. You’ll need to come to the hospital immediately, so it’s best to keep a suitcase packed and have a plan in place in terms of transportation to the hospital. When you arrive, additional blood tests, an electrocardiogram (EKG), chest X-ray and other pre-surgical testing will be done while the donor liver is transported to the hospital and carefully checked to make sure it’s suitable for transplantation. If the donor liver is acceptable, you’ll proceed to transplant. If not, you’ll be sent home to continue waiting. As such, you may come to the hospital more than once.


What happens during transplant surgery?

Liver transplant surgery is complex and generally takes between six and 12 hours. During the operation, surgeons will remove the entire injured or diseased liver and replace it with the donor liver. Several tubes will be placed in your body to help it carry out certain functions during the operation and for a few days afterward. These include a breathing tube, intravenous lines to provide fluids and medications, a catheter to drain urine from your bladder, and other tubes to drain fluid and blood from your abdomen. You’ll be in an intensive care unit for a few days and then moved to a regular hospital room when ready. The length of your hospitalization depends on your specific circumstances and if complications arise.


What are the signs and symptoms of rejection?

Rejection does not always cause noticeable symptoms. In fact, sometimes the only way rejection is detected is from routine blood tests. As such, it’s very important not to miss regularly scheduled appointments with your medical team. If there are symptoms, each individual may experience them differently. Some of the more common signs and symptoms of rejection include:

• fever

• headache

• fatigue

• nausea

• loss of appetite

• itchy skin (pruritus)

• dark-colored urine

• jaundice (a yellowing of the skin and whites of the eyes)

• abdominal tenderness or swelling


How is transplant rejection treated?

Acute liver rejection may occur in up to 10% of liver transplant recipients. It’s most common within the first three months after transplantation, but can occur at anytime. To prevent rejection, you must take immunosuppressive medications for the rest of your life. These may include:

• Prednisone

• Tacrolimus (Prograf)

• Cyclosporine (Sandimmune, Neoral)

• Sirolimus (Rapamune)

• Mycophenolate mofetil (CellCept)

• Azathioprine (Imuran) The dose of these medications may change frequently, depending on your response. Generally, you can expect to take more medications the first few months following transplantation after which time some may be discontinued or the doses lowered. The goal is to maintain a balance between preventing rejection and making you susceptible to infection and other side effects associated with the long-term use of immunosuppressants.


What is the long-term outlook after a liver transplant?

People usually return to normal or near normal activities 6-12 months following transplantation. Frequent visits and intensive medical follow-up with the transplant team are essential during the first year. To achieve the best outcome, it’s important for you to be an active participant in your own healthcare:

• Keep all medical appointments.

• Take medications exactly as prescribed.

• Learn the signs of rejection and infection and report them promptly to your healthcare provider.

• Avoid people who have a contagious illness (colds, flu, etc.).

• Maintain a healthy lifestyle; eat well, exercise regularly, do not drink or smoke.

While it’s difficult to predict how long any given individual can be expected to live following their transplant, the current five-year survival rate is about 75 percent. The good news is that results from liver transplantation in the U.S. continually improve. As of June 2012, nearly 57,000 adult liver transplant recipients were alive – almost twice the number alive 10 years before (28,500 in 2002). Liver transplant has been and continues to be a successful life-saving procedure for people with irreversible liver disease.


What can people do to help those who need liver transplants?

Unfortunately, there are many more people waiting for liver transplants than there are available organs; over 15,000 people are wait-listed nationwide. The most important thing you can do is register to be an organ donor. People of all ages and medical histories should consider themselves potential donors. Your medical condition at the time of death will determine what can be donated. To obtain an organ donor card, contact the American Liver Foundation or visit Donate Life America at donatelife.net.


Where do donated livers come from?

The person will go through extensive medical and psychological testing to evaluate their appropriateness for donation.


How are matches for living donation made?

Blood type and body size are critical factors in determining who is an appropriate donor. In living donor transplantation, a portion of the health person’s liver is used for transplantation.


Does the portion of the liver regenerate?

Yes. The liver is the only organ which can regenerate healthy tissue and will regrow to fit the suitable size of the person so the donor’s liver will regenerate, and the portion transplanted into the recipient will grow to fit the patient.


How does the transplant waiting list work for living donation?

Recipients with living donors are evaluated as candidates the same way in which deceased donor transplantation recipients are. The criteria for becoming listed are also the same except recipients with living donors do not have to wait for an organ to become available. Transplant can take place before the recipient is critically ill, which can result in a better outcome. The transplant team separates its care for the donor and recipient to make sure both parties are being evaluated and taken care of properly. There is often a “cooling off” period when a matching donor is allowed time to reflect upon their upcoming donation and see whether they would like to move forward with surgery.

The length of time for transplantation can vary based on finding a suitable match for the recipient. For those with donor matches, transplant surgery can be scheduled in a matter of weeks whereas individuals waiting for a deceased donor may wait years for a suitable match to become possible. Since these surgeries are planned, you should begin to think about the following necessities you may need:

• Planning for adequate time off work

• Facilitating pet or childcare, if needed

• Coordinating transportation to and from the hospital

• Packing a bag with necessary health records and insurance information • Arranging for necessary postsurgery care


What happens when a living donor becomes available?

Your transplant team should notify you to make you aware of a match. Surgery will be scheduled weeks in advance.


What happens during living donor transplant surgery?

Living donor transplant surgery time is typically less than those of deceased donor transplant. The operation lasts five to eight hours. Both the recipient and donor undergo surgery at the same time with their own individual transplant teams. The size of the portion and specific part of the liver that is donated depends on the needs of the recipient. Sometimes the needs of the individual can vary greatly and it also impact the decision on which lobe should be taken for living donation. The procedure itself involves an incision on the side of the chest. Special instruments are used to gain access to the donor’s liver called a retractor. Sometimes vessels are needed from other parts of the body (such as leg) to be used to connect the donated liver.


What happens after a living donor transplant surgery?

During the first few days your transplant team may keep you in an intensive care unit (ICU) recovery room. Your team will monitor your health and vitals over the span of a few days. Each person’s recovery can vary but it is possible both the recipient and the donor could return home in as little as 2-3 days. You will return back to the transplant hospital for follow ups and bloodwork. During the initial recuperation period there may be limits on mobility and diet so it’s best to communicate with your team and make sure you understand your discharge plan.


Where can I find more information about finding a living donor?

More information about living donation can be found on UNOS’ website. Please visit the following links to find informative educational pieces:

Finding a Living Donor https://optn.transplant.hrsa.gov/media/2267/find_a_living_donor.pdf

Living Donation Information You Need to Know https://unos.org/wp-content/uploads/ unos/Living_Donation.pdf


Where can I find more information about becoming a living donor?

If interested in becoming a living donor, contact your local transplant center to begin the evaluation process. More information about becoming a living donor can be found on UNOS’ website. Please visit the following link to find an informative educational piece: https://transplantliving.org/livingdonation/being-a-living-donor/ and watch the following video from our recent Living Donor presentation we co-hosted with the experts at the University of Pittsburgh Medical Center!

  • What is my MELD score and what does this mean in regards to my wait time?
  • What type of doctor do I need to see?
  • Where is my best chance of being transplanted?
  • Can I be listed at more than one location?
  • How long does it take to get a transplant?
  • What is the difference between a full liver transplant vs. a live donor transplant?
  • How do I know if a person is a match?
  • Will a live donor make a difference and if so, how?
  • Are the match criteria different for either types of transplants?
  • What are the success rates for both types of transplant?
  • What is the life expectancy post-transplant?
  • Will I have to be on medication for the remainder of my life?
  • Will other organs be affected such as my kidneys?

Support Groups Near You

Visit the American Liver Foundation support group page here to find the closest support group to you.


Online Support Groups

Visit the American Liver Foundation online support group at Inspire…

Mayo Clinic Transplant Support Group
Mayo Clinic Connect is an online community where you can share your experiences and find support from people like you. You can also read expert blogs and take part in educational events. Join the Transplant discussion group where you can meet people living with a transplant, waiting for a transplant or serving as caregivers.

Actor and Musician Charles Esten advocates for ALF and for all those living with Liver Disease

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Aidan D.

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Aiden

Aiden

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Allison C.

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Andrea B.

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Bel K.

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Carol S.

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Cliff O.

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Living Donor for brother with PSC and Bile Duct Cancer
Dave B.

Dave B.

Liver Transplant… I went through a lot before my transplant. I was even in Hospice for about a week. I
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David B.

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David R.

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Elise's Story

Elise’s Story

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Gary E.

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Greg Hanahan

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Hannah S.

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Holly F.

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Isaac N.

Isaac N.

Liver Failure… The Newcomb family at Sea World in California in March 2011, a few weeks before Isaac became so
Jack & Gene Johnston

Jack & Gene Johnston

Alpha-1 Antitrypsin Deficiency
Janet

Janet

Hepatic Encephalopathy Hepatitis C End Stage Liver Disease
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Jax S.

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Jeffrey D.

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Jessica H.

Jessica H.

Primary Biliary Cholangitis
Jim

Jim

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Jordan J.

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Mindy C.

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Natalie Williams

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Nick W.

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Regina S.

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Robert M.

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Ron M.

Ron M.

Caregiver for Wife… My wife, Helen Meijer, had a liver transplant at Tampa General Hospital in July 2005 (acute liver
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