It is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. Most liver transplant operations use livers from deceased donors, though a liver may also come from a living donor.
The donor, who donates the liver, can continue the rest of the live healthy without the effect of donated part of the liver. It is because the part of the liver that is taken can be regenerated with a few weeks in the body of the donor, as it is the only organ that can be regenerated by itself in the body.
A healthy liver performs more than 400 jobs each day, including:
- Making bile, which is important in digestion
- Making proteins that help with blood clotting
- Removing or changing bacteria, medications, and toxins in the blood
- Storing sugars, fats, iron, copper, and vitamins
The most common reason for a liver transplant in children is biliary atresia.
The most common reason for a liver transplant in adults is cirrhosis
. Cirrhosis is scarring of the liver that prevents the liver from working well. It can worsen to liver failure. The most common causes of cirrhosis are:
- Long-term infection with hepatitis B or hepatitis C
- Long-term alcohol abuse (See: Alcoholic liver disease)
Other illnesses that may cause cirrhosis and liver failure include:
- Autoimmune hepatitis
- Hepatic vein blood clot (thrombosis)
- Liver damage from poisoning or medications
- Problems with the drainage system of the liver (the biliary tract), such as primary biliary cirrhosis or primary sclerosing cholangitis
- Metabolic disorders of copper or iron (Wilson's disease and hemochromatosis)
Liver transplant surgery is often not recommended for patients who have:
- Certain infections, such as tuberculosis or osteomyelitis.
- Difficulty taking medications several times each day for the rest of their lives.
- Heart, lung, or liver disease (or other life-threatening diseases).
- History of cancer
- Infections such as hepatitis that are considered to be active.
- Smoking, alcohol or drug abuse, or other risky lifestyle habits.
Your doctor will refer you to a transplant center. The transplant team will want to make sure that you are a good candidate for a liver transplant. You will make a few visits over several weeks or months. You will need to have blood drawn and x-rays taken. If you are the one getting the new liver, the following tests will be done before the procedure:
- Tissue and blood typing to make sure your body will not reject the donated liver
- Blood tests or skin tests to check for infection
- Heart tests such as an EKG, echocardiogram, or cardiac catheterization
- Tests to look for early cancer
- Tests to look at your liver, gallbladder, pancreas, small intestine, and the blood vessels around the liver
- Colonoscopy, depending on your age
A liver transplant involves the removal of and preparation of the donor liver, removal of the diseased liver, and implantation of the new organ. The liver has several key connections that must be re-established for the new organ to receive blood flow and to drain bile from the liver. The structures that must be reconnected are the inferior vena cava, the portal vein, the hepatic artery, and the bile duct. The exact method of connecting these structures varies depending on specific donor and anatomy or recipient anatomic issues and, in some cases, the recipient disease.
For someone undergoing liver transplantation, the sequence of events in the operating room is as follows:
2. Evaluation of the abdomen for abnormalities that would preclude liver transplantation (for example: undiagnosed infection or malignancy)
3. Mobilization of the native liver (dissection of the liver attachments to the abdominal cavity)
4. Isolation of important structures (the inferior vena cava above, behind, and below the liver; the portal vein; the common bile duct; the hepatic artery)
5. Transection of the above mentioned structures and removal of the native, diseased liver.
6. Sewing in the new liver: First, venous blood flow is re-established by connecting the donor's and the recipient's inferior vena cava and portal veins. Next, arterial flow is re-established by sewing the donor's and recipient's hepatic arteries. Finally, biliary drainage is achieved by sewing the donor's and recipient's common bile ducts.
7. Ensuring adequate control of bleeding
8. Closure of the incision
If you received a donated liver, you will likely need to stay in the hospital for a week or longer. After that, you will need to be closely followed up by a doctor for the rest of your life. You will have regular blood tests after the transplant.
The recovery period is about 6 - 12 months. Your transplant team may ask you to stay close to the hospital for the first 3 months. You will need to have regular check-ups, with blood tests and x-rays for many years.
Liver transplant surgery and management after surgery carry major risks. There is an increased risk of infection because you must take medications that suppress the immune system to prevent transplant rejection. Signs of infection include: