What is a Liver Transplant

Liver transplantation is a surgical procedure where a person’s own diseased or malfunctioning liver is removed and replaced by a functioning donor liver.

Steps of a liver transplant surgery:

A liver transplant is a complex surgical procedure lasting between 6-8 hours that involves removal of the recipient’s own liver followed by implantation of the new donor liver.  This requires the following structures to first all be divided and then reconnected:

  • Portal vein: passes the blood from the intestines and pancreas through the liver

  • Hepatic veins: return blood from the liver to the heart

  • Hepatic artery: brings oxygenated blood to the liver

  • Bile duct: drains bile from the liver into the intestine

Common complications of a liver transplant may include:

  • Blood Transfusion

  • Infection

  • Re-operation or intervention due to:
    • Bleeding
    • Bile duct leak or stricture
    • Hepatic artery stenosis or thrombosis
    • Portal vein stenosis or thrombosis
    • Hepatic vein stenosis
    • Hernia
  • Rejection

  • Non-function

  • Ascites

  • Pleural effusion

Where do donor livers come from?

  • Most transplants are performed using a liver donated by a person who has died either from brain or heart injury: this is known as deceased donor liver transplantation.

  • A carefully selected healthy person can also donate a portion of their liver for transplantation: this is known as living donor liver transplantation.

Evaluation for a liver transplant:

When a person is referred for consideration for a liver transplant, they are seen by a multi-disciplinary team of health care professionals including:

  • Transplant Hepatologist: a medical doctor specializing in the diagnosis and treatment of liver disease and its complications.

  • Transplant Surgeon: a medical doctor specializing in the surgical treatment of liver disease and its complications.

  • Pre-Transplant Coordinator: a nurse responsible for the overall coordination and management of a person being considered for a liver transplant. 

  • Social Worker: a health care professional responsible for evaluating a person’s behavioral habits, living environment, and support network to ensure the success of a transplant

  • Financial Coordinator:

  • Psychologist or Psychiatrist:

  • Other Healthcare Professionals:
    • Cardiology
    • Anesthesiology
    • Interventional Radiology
    • Infectious Disease

A person being evaluated for a liver transplant will also undergo numerous laboratory tests and medical examinations including:

  • Blood testing: to determine blood type, blood counts, blood clotting, liver function, kidney function, evidence for infections including viral hepatitis or HIV.

  • Radiology testing: to make sure there are no tumors in the liver and to assess the health and configuration of blood vessels to and around the liver

  • Cardiac testing: to assess the function of the heart and look for any disease or abnormality of the blood vessels or valves of the heart needing treatment

Phases of Liver Transplantation:

  • Evaluation Phase: the time when we are gathering all the information including consultations, laboratory, and medical examinations necessary to determine whether a liver transplant is indicated and possible.

    • Candidate Conference: the meeting where all a patient’s information is reviewed by the liver transplant team and one of the following decisions is made:

      • List for Liver Transplant: the patient is placed on the national deceased donor liver transplant waiting list by our center

      • Decline for Liver Transplant: the patient is not a candidate for placement on the national deceased donor liver transplant waiting list by our center but may be considered by other liver transplant centers

      • Defer for Liver Transplant: the patient is not suitable for placement on the national decease donor liver transplant waiting list by our center at this time but may be reconsidered after additional requirements are met

  • Members of the liver transplant team participating in candidate conference include: 

o   Transplant Hepatologists

o   Psychologists

o   Transplant Surgeons

o   Financial Coordinators

o   Transplant Coordinators

o   Anesthesiologists

o   Social Workers

o   Cardiologists

o   Psychiatrists

o   Infectious Disease Physicians

  • Waitlist Phase: the time when a patient is awaiting a match to a suitable donor liver.  How long someone waits for a liver transplant is variable. In general, patients awaiting a liver transplant are prioritized base on how sick they are and their likelihood of dying without a liver transplant.
    • Degree of Illness: Degree of illness is based on a modified Model for End-stage Liver Disease (MELD) score which is calculated based on the following information:

      • Bilirubin: a blood test measuring your level of jaundice

      • INR: a blood test measuring your blood’s ability to clot and stop bleeding

      • Creatinine: a blood test measuring your kidney function

      • Albumin: a blood test assessing your liver’s ability to produce blood proteins

      • Sex: your sex at birth

  • In certain cases when the MELD score does not accurately reflect the risk of dying an exception score can be granted.  Examples of this include:

      • Hepatocellular Carcinoma

      • Hilar Cholangiocarcinoma

      • Hepatopulmonary Syndrome

      • Portopulmonary Hypertension

      • Polycystic Liver Disease

      • Hepatic Artery Thrombosis

      • Recurrent Cholangitis

    • Proximity to the Donor: Some amount of prioritization is given when the donor is closer to the transplant hospital. 

    • Blood Type: Patients awaiting a liver transplant are grouped in lists based on blood type compatibility.
        
    • Consent to Receive A:
      • DCD Liver
      • Partial Liver
      • Liver from a donor infected with Hepatitis B or C
      • Liver from a donor at increased risk of transmitting a communicable disease

  • Liver Transplant Phase:

    • Deceased Donor: Once a donor organ is available the patient will be notified and asked to come to the hospital immediately. The patient will be admitted by the care team and will undergo an initial exam to make sure they’re fit for the procedure.

    • Living Donor: If the patient is receiving a liver transplant from a living donor, the surgery will be scheduled in advance. Surgeons will first operate on the donor, removing the portion of the liver being transplanted. Surgeons will then remove the patient’s liver and replace with the donated liver.

The surgeon will remove the patient’s liver and replace with the donor liver. They will then reconnect the blood vessels and bile ducts to the donor liver. Once the new liver is in place, the surgeon uses stitches and staples to close the surgical incision. Surgery can take up to 12 hours. Once completed patients will be send to the intensive care unit to begin recovery. 

  • Post-Transplant Phase:

    • After a liver transplant, patients can expect to stay in the intensive care unit for a few days. Doctors and nurses will monitor progress and watch for signs of complications. They will also test liver function frequently for signs that the new liver is working.

    • Most patients will spend 5 to 10 days in the hospital. Once stable, patients are taken to a transplant recovery area to continue recuperating.

    • The transplant care team designs a checkup schedule for each patient. Patients may undergo blood tests and other labs a few times each week at first and then less often over time.

    • Transplant patients will be on medications for the rest of their lives. Drugs called immunosuppressants help keep the immune system from attacking the new liver and are essential to a successful transplant. Other drugs help reduce the risk of other complications after transplantation.

    • Patients should expect six months or more of recovery time before feeling fully healed. Total recovery time and return to normal activity varies patient to patient and is dependent on illness acuity prior to transplantation.