Liver transplant: Intervention for end-stage liver disease

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Liver transplant: Treating end-stage liver disease

When liver failure occurs, often the only choice is a liver transplant. Learn about what's involved.

The liver has a remarkable ability to regenerate itself, but it sometimes sustains severe damage that can't be reversed. In such cases, a liver transplant may be an option for some people. Although a liver transplant may be needed for sudden liver failure caused by toxins or severe infection, it's more often a final treatment option for long-term, progressive liver disease. Because many people must wait more than two years for a liver transplant, your doctor may begin discussing transplantation with you long before you actually need it.

The transplant journey: Taking the first steps

If your doctor recommends a liver transplant, you'll likely be referred to a transplant center for an evaluation. Discuss with your health insurance provider which transplant centers are covered under your insurance plan. Most transplant programs offer the services of social workers and financial coordinators, who can help you work through financial issues associated with transplant surgery.

When selecting a transplant center, take into account the number of liver transplants the center performs each year and the recipient survival rates. You can compare transplant center statistics through a database maintained by the Scientific Registry of Transplant Recipients.

In addition, consider support services provided by a transplant center. Many centers coordinate support groups, assist you with travel arrangements, help you find local housing for your recovery period or direct you to organizations that can help with these concerns.

Once you select a liver transplant center, expect to undergo an evaluation to determine whether you meet the transplant center's eligibility requirements. The evaluation will assess whether you:

  • Have a medical condition that would benefit from a transplant
  • Aren't likely to benefit from other treatment options
  • Are healthy enough to undergo surgery and post-transplant treatments
  • Are willing and able to take medications as directed
  • Have sufficient emotional stamina to undergo the wait for a donor organ and have a supportive network of family and friends to help you during this stressful time

If liver failure is the result of alcohol or drug abuse, you'll be evaluated to determine whether you currently abstain from use, have received adequate chemical dependency treatment and are at risk of using alcohol or drugs after the transplant.

Preparing for a liver transplant

A liver transplant from a deceased donor (cadaver) needs to occur within 12 to 24 hours after the liver is removed from the donor for the organ to remain viable. The transplant center will most likely provide you with a pager or cell phone to notify you when a potential donor organ is available.

When you arrive at the hospital, a team will prepare you for surgery. The surgeon will also do a final assessment of the donor liver to ensure it's healthy and a good match.

The surgery

A liver transplant often takes three to five hours, but the time can vary significantly. The diseased liver is removed through an incision in your upper abdomen. The donor liver is then placed inside your abdomen, and blood vessels from your body are attached to those of the new liver. The bile duct of the donor liver is attached to your bile duct or to a segment of intestine so that bile can drain into your small intestine.

After the surgery, you'll have some pain, which will be treated with medications. Recovery often involves a five- to 10-day hospital stay, depending on how well you and your new liver are doing. You'll also undergo frequent assessments during the following two to four weeks and will be expected to have living accommodations within a relatively short commute of the transplant center.

What if your new liver fails?

Some transplanted livers lose their ability to function. Your new liver may fail because of organ rejection, because the underlying causes of liver disease damaged the new organ or because of other factors that couldn't be controlled.

If this happens, you can be considered for a second transplant, or you may choose to discontinue treatment. These decisions will depend on your current health and ability to undergo surgery. Discussions with your transplant team, doctor and family should address your expectations and preferences for treatment.

Last Updated: 12/15/2006
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