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Liver Transplant

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Definition

This is a surgery to replace a diseased or damaged liver with a liver from a donor who has died. In some cases, a portion of the liver of a living, related donor may be used.
Normal vs. Diseased Liver
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Reasons for Procedure

A liver transplant is done to treat a liver that is not working and cannot be fixed. This may be caused by:
  • Cirrhosis
  • Hepatitis A , B , or C
  • Alcoholic liver disease
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis (disease of the bile ducts)
  • Sudden liver failure
  • Congenital defects (eg, biliary atresia)
  • Liver tumors
  • Metabolic defects (eg, Wilson's disease )
  • Poisoning or drug-induced damage
After the transplant, most patients are able to return to normal activities in 6-12 months.

Possible Complications

If you are planning to have liver transplant, your doctor will review a list of possible complications, which may include:
  • Rejection of transplanted liver
  • Bleeding
  • Infection
  • Damage to nearby organs
  • Bile-duct obstruction or bile leakage into the body
  • Complications from immunosuppressive drugs
  • Blood clots
Some factors that may increase the risk of complications include:
  • Smoking
  • Obesity
  • Alcoholism
  • Diabetes
  • Poor nutrition
  • Recent or long-term illness
  • Serious heart, lung, or kidney disease
  • Use of certain medicines
  • Cancer
  • Current infection
Be sure to discuss these risks with your doctor before the surgery.

What to Expect

Prior to Procedure

There is a shortage of donors. You may be on a transplant list for some time. You may need to carry a cell phone with you at all times. This is to allow the transplant team to reach you if a liver becomes available.
Your doctor will likely do the following:
  • Physical exam
  • Blood tests
  • Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
Leading up to your surgery:
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
  • Take medicines as directed. Do not take over-the-counter medicines without checking with your doctor.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • Arrange for someone to drive you home. Also, arrange for someone to help you at home.
  • If advised by your doctor, use an enema. The enema will clean out the intestines and prevent constipation after surgery.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

Description of the Procedure

The doctor will make an incision shaped like a boomerang on the upper part of the abdomen. The old liver will be removed. The doctor will leave portions of major blood vessels in place. The new liver will be inserted and attached to the blood vessels and bile ducts. To help with bile drainage, a tube will also be inserted into the bile duct during surgery. The doctor will then close the area with stitches.

Immediately After Procedure

You will be closely monitored in the intensive care unit (ICU) and will have the following devices:
  • Breathing tube until you can breathe on your own
  • IV fluids and medicine
  • Bladder catheter to drain urine

How Long Will It Take?

Several hours

How Much Will It Hurt?

Anesthesia will prevent pain during the surgery. You will have pain while recovering. Your doctor will give you pain medicine.

Average Hospital Stay

This surgery is done in a hospital setting. The usual length of stay is several weeks. Your doctor may choose to keep you longer if you shows signs of rejecting the new liver or have other problems.

Post-procedure Care

At the Hospital
While you are recovering at the hospital, you will:
  • Receive fluids and nutrition through an IV—You will slowly transition to eating.
  • Breathe deeply and cough 10-20 times every hour—This will help your lungs work better after surgery.
  • Take immunosuppressive drugs—You will need to take these for the rest of your life. These drugs reduce the chance that your body will reject the new liver. They also have potential side effects, like infection and cancer. Be sure to discuss these risks with your doctor.
At Home
When you return home, do the following to help ensure a smooth recovery:
  • Be sure to follow your doctor’s instructions .
  • Take proper care of the incision site. This will help to prevent an infection.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Work with a physical therapist. Exercises will help you to regain strength.
  • Monitor your temperature, blood pressure, pulse, and weight.
  • Follow a special diet. This diet will help to prevent water retention and to maintain a normal weight and blood pressure.
  • Take medicines as advised by doctor.
Recovery time varies. It depends, in part, on your health before the transplant.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills—You are at increased risk for infection because of the immunosuppressive drugs.
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain
  • Severe nausea or vomiting
  • Black or tarry stools, constipation, or diarrhea that does not go away after two loose stools
  • You are unable to take your medicines
  • Bruising
  • Red or rusty-brown urine
  • Any skin rash or sores in your mouth
  • Vaginal discharge (in women)
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Exposure to infections, such as mumps , measles , chickenpox , or shingles
  • Headache, confusion, dizziness, light-headedness, or loss of consciousness
  • Unusual weakness
  • Illness that requires emergency room treatment or hospitalization
In case of an emergency, call for medical help right away.

RESOURCES

American Liver Foundation http://www.liverfoundation.org/

United Network for Organ Sharing http://www.transplantliving.org/

CANADIAN RESOURCES

Canadian Liver Foundation http://www.liver.ca/

Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

References

Gee I, Alexander G. Liver transplantation for hepatitis C virus related liver disease. Postgrad Med J. 2005;81:765-771.

Liu CL, Fan ST. Adult-to-adult live-donor liver transplantation: the current status. J Hepatobiliary Pancreat Surg. 2006;13:110-116.

Liver transplant. American Liver Foundation website. Available at: http://www.liverfoundation.org/education/info/transplant/ . Updated September 2007. Accessed July 21, 2009.

Liver Transplant Program and Center for Liver Disease, University of Southern California website. Available at: http://www.surgery.usc.edu/divisions/hep/index.html .

Neuberger J. Developments in liver transplantation. Gut. 2004;53:759-768.

O’Grady JG. Liver tansplantation alcohol related liver disease: (deliberately) stirring a hornet’s nest! Gut. 2006;55:1529-1531.

What I need to know about liver transplantation. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/livertransplant%5Fez/ . Updated March 2003. Accessed July 21, 2009.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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