Currently (2012), more than 17,000 people in the United States are waiting for liver transplants. The liver is the second most commonly transplanted major organ, after the kidney, so it is clear that liver disease is a common and serious problem in this country.
Is a transplant for you? Well eventually your liver disease may progress to a point that transplant may be the only alternative for you to live. As you will come to understand after reading this page, there is a lot to consider before deciding to follow this path.
Liver transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotropic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Liver transplantation nowadays is a well-accepted treatment option for end-stage liver disease and acute liver failure. It is also one of the most expensive treatments in modern medicine.
Typically 3 surgeons and 1 anesthesiologist are involved, with up to 4 supporting nurses. The surgical procedure is very demanding and varies from 4 to 18 hours. Numerous sutures as well as many disconnections and reconnections of abdominal and hepatic tissue must be made for the transplant to succeed. By any standard, hepatic transplantation is a major surgical procedure with an appreciable degree of risk.
The first human liver transplant was performed in 1963 in Denver, Colorado. Several additional transplants were performed over the next few years before the first short-term success was achieved in 1967 with the first one-year survival post transplantation. Despite the development of better surgical techniques, liver transplantation remained experimental through the 1970s, with one-year patient survival in the vicinity of 25%.
The introduction of cyclosporine markedly improved patient outcomes. The 1980s saw recognition of liver transplantation as a standard clinical treatment for both adult and pediatric patients. Liver transplantation is now performed at over one hundred centers in the USA, as well as numerous centers in Europe and elsewhere. One-year patient survival is 80-85% and outcomes continue to improve, although liver transplantation remains a formidable procedure with frequent complications. Unfortunately, the supply of livers available from deceased donors is far short of the number of potential recipients, a reality that has spurred the development of living donor liver transplantation.