_ Where do the livers that are donated for liver transplantation surgery come from? Livers are donated from individuals who have had brain death. Brain death is usually the result of a head injury or a brain hemorrhage. When such a donor is identified, a network of skilled professionals connected by computers contact the transplant centers and makes arrangements to retrieve whatever organs may be donated. Frequently, this involves a team of skilled professionals from transplant centers flying to the donor hospital to remove the organs and return with them for the transplant operation. Take a look at our "Organ/Tissue Donation" section for a more complete picture of the entire donation process.
Do the patient who is donating the liver and the patient who will receive the liver have to be matched by tissue type, sex, age, etc.? No. At this time for liver transplantation, the only requirements are that the donor and recipient need to be approximately the same size and have compatible blood types. No other matching is necessary such as gender or age.
How can individuals donate their organs? If you wish to be an organ donor, carry an organ donor card and place an organ donor sticker on your medical identification card. It is important to discuss organ donation with family members since they will have to give consent for the donation.Take a look at our "Organ/Tissue Donation" section for more information on how to become a donor.
What happens if two suitable candidates exist to receive a liver that has been donated? This is unusual in practice. But, the decision would be made to transplant the patient who is more ill or with more urgent need. The very last criteria for liver allocation is how long the candidate has been waiting for an organ.
Which diseases are treated by liver transplantation? A large number of diseases are capable of decreasing or interfering with the liver's function that's sufficient to threaten the life of the patient, like you. Most of these diseases are potentially treatable with liver transplantation. In adults, cirrhosis-which is a heavy accumulation of scar tissue due to the death of liver cells because of chronic viral hepatitis such as hepatitis C-is the most common disease for which liver transplantation is performed. In children, the disease most often treated by liver transplantation is biliary atresia, this is a failure of bile ducts to develop normally and drain bile from the liver.
Is liver transplantation a common treatment for cancer of the liver? Most cancers of the liver begin somewhere else in the body and spread to the liver. Most commonly, colon cancer, but of course there are a number of other cancers that also can be metastatic to the liver. Typically these are not curable with a liver transplant and thus these patients are not transplant candidates. Liver tumors that start in the liver, such as hepatocellular carcinoma, that have not spread to other organs can be cured by transplantation. However, if the liver cancer has spread outside the liver, the patient is not a candidate for liver transplantation. In patients with a single tumor that is less than 5 cm in size or have not more than three tumors all less than 3 cm in size can be cured with liver transplantation and have excellent long-term survival.
Are treatments other than liver transplantation used for liver diseases? There are a number of effective medications that exist to treat a variety of liver diseases, while for other liver diseases medical treatment of complications is really all we can do especially in patients with true end-stage liver disease. Treatment of complications may be all that is required if the liver is not failing and liver transplantation may not be required in many cases. Otherwise, medical treatment delays but does not eliminate the patient's need for a liver transplantation.
Is liver transplantation a treatment of last resort, when everything else has failed? Well, yes and no. Medical treatment is likely to allow a patient's prolonged survival with good quality of life, and then transplantation would be reserved for the future. However, ideally we like to undertake liver transplant surgery before the patient's disease is at the terminal stage when he or she is too ill to withstand major surgery and will not survive until a suitable donor liver is available.
How is the decision made to transplant a patient's liver? The decision to transplant a patient's liver is made in consultation with all individuals involved in the patient's care, including the patient, referring physician, and the patient's family. The patient's and family's input is vital in this decision making process; they must clearly understand the risks involved in proceeding to transplantation and the post-transplant care.
What are the major risks in liver transplantation? Before liver transplantation, risks to the patient are mainly those who develop acute complications of liver failure or progressive complications of chronic liver failure that might render the patient an unacceptable risk for surgery. With surgery, the risks are those that are common to all forms of major surgery, or involve technical difficulties in removing the diseased liver, involve implanting the donor liver, and/or involve consequences of being without liver function briefly. Immediately after the operation, risks include bleeding, poor function of the grafted liver, bile leaks and infections. We monitor the patient carefully for several weeks after surgery for signs that the patient is rejecting the new liver as well.
What are the overall chances of surviving a liver transplant? The answer to this question depends on many factors. But, overall, 87% to 95% of adult patients at CPMC (California Pacific Medical Center) and 90% of children overall survive and are discharged from the hospital after liver transplantation.
How long does it take to recover from liver transplantation? Recovery after liver transplantation depends in part on how ill the patient was prior to surgery. Most patients need to count on spending a few days in the hospital in the intensive care unit and another few days on the ward about a minimum of 6 days in the hospital is our estimate. The range of days spent in the hospitalization is from five days to maybe even six weeks.
What happens during the recovery period after liver transplantation in the intensive care unit and nursing unit in the hospital? Initially when the patient is in the intensive care unit, the staff will closely monitor the patient's bodily functions, including the liver function, very carefully. Once the patient has been transferred to the floor-nursing unit, they will decrease the frequency of blood testing, allowing eating, and initiate physical therapy and activity to help regain muscle strength.
Some of the medicines to prevent rejection are initially given intravenously or by vein, but others are given by mouth immediately and eventually all medications are given by mouth. During the first six weeks after liver transplantation, the patient have frequent blood tests and other exams to monitor liver function and detect any evidence of rejection or infection in the new liver.
Do individuals who have received a transplanted liver have to take medicines to treat or prevent rejection for the rest of their lives? Yes, in general that is true, although every patient who has been involved with liver transplantation has often heard of that special case of someone who was able to stop the medication. Importantly, almost all patients who have to take these medicines long term can also undergo dose reduction as the body adjusts to the transplanted liver and the amount of medicine needed to control or prevent rejection is reduced.
How frequent is the medical follow-up of a patient after liver transplantation? The first few months after transplant requires very close monitoring of the patient's blood work. During this time frame you will be asked to provide blood samples starting at 2 or 3 times a week, gradually tapering to once a month. Your recovery from surgery is also closely monitored to ensure that infections are avoided. Special attention is given to avoidance of any type of infection during this time frame.
Routine follow-up after the first few months from the time of liver transplantation consists of monthly blood tests. These blood tests and also a check of blood pressure by local physicians allows us to look for or prevent complications of liver transplantation. Patients need to return to the transplant center once or twice a year where the transplant was performed.
Are patients who have received a transplanted liver more susceptible to other infections? Individuals who have received a liver transplant need to avoid exposure to infections as their immune system is suppressed. Also, they need to report illnesses to their doctor immediately especially fevers, and take over-the-counter medications and supplements or prescription medications only under their doctor's direct supervision. It may be their local doctor or their doctor at their transplant center.
Can individuals have physical activity after receiving a new liver? Sexual activity? Most patients can return to a normal or near-normal existence and participate in fairly vigorous physical exercise 6 to 12 months after successful liver transplant. Often patients can drive again in as little as 2 to 3 months after liver transplantation. As with other physical activities, sexual activity may be resumed when desired and physical recovery has progressed.
Can a patient's original liver disease that caused the need for transplantation reoccur in the new, transplanted liver? If a patient's liver disease was caused by hepatitis B or C viruses, then recurrence is possible. Hepatitis B right now only reoccurs in 5% or less of patients since we have mastered controlling this disease with an immune globulin medicine and an oral medication. Hepatitis C reoccurs in almost all patients and is progressive in maybe a quarter to half of patients in the first 5 to 10 years. Primary Biliary Cirrhosis (PBC) is also likely to reoccur. After liver transplant, the recurrence rate may be as high as 18% at 5 years, and up to 30% at 10 years. There is no consensus on risk factors for recurrence of the disease. Recurrence of Primary Sclerosing Cholangitis (PSC) following liver transplantation has been suggested; however, it has not been fully defined because of numerous complicating factors and the lack of diagnostic criteria. For other types of liver disease, recurrence is less likely, but is still a possibility.
From the description, patients with successful liver transplants seem very healthy. How long can this good health last? There is every indication that those who are well one year after a liver transplant have an excellent chance at long-term survival.
If a patient's transplanted liver fails to function or is rejected, what can be done? There are varying degrees of failure of the liver; even with imperfect function, patients can remain quite well. Occasionally, when circumstances and time permit, a patient's transplanted liver that is failing can be replaced by a second or even a third transplant. With new advances in medicine, you may want to discuss with your doctor the possibility of a new liver support device that can postpone the need for transplantation or possibly improve the likelihood of a successful transplant. These devices are still in research but are often discussed with patients when they are admitted to the hospital.
What side effects do patients who have had liver transplantation commonly experience from the medicines they take to treat or prevent rejection? All the medications used for rejection or to prevent rejection increase a patient's susceptibility to infections and possibly even though this is more remote the development of tumors. Various medicines are used, and each has its own set of effects and side effects. Cortisone-like drugs like prednisone produce some fluid retention and puffiness of the face, and they carry a risk of worsening or bringing out diabetes and osteoporosis. Osteoporosis as you know is a loss of mineral from the bone. Prograf also called Tacrolimus and Cyclosporine, which goes under a number of different names including Gengraf, produces some tendency of high blood pressure, and Cyclosporine can cause growth of body hair as well as periodontal disease or dental disease in your mouth. The dose of Cyclosporine must be very carefully regulated as that of the Prograf. Kidney damage can occur from Cyclosporine or Prograf, but this can usually be avoided by monitoring the medications levels in the patient's blood. Prograf and CellCept are the most commonly used medications at California Pacific Medical Center and CellCept can cause ulcers of the stomach and potentially although this is remote, CMV infections. This is a special type of virus that occurs in patients who are immunosuppressed.
What is the connection between alcohol-related liver disease and liver transplantation? Most people who develop cirrhosis of the liver due to excessive alcohol use do not need a liver transplant; they just need to stop drinking. Abstinence from alcohol and treatment of complications of alcohol-induced cirrhosis usually allow them to live for a long period of time without a liver transplant, potentially forever. For patients with advanced liver disease, where prolonged abstinence and medical treatment fail to restore health and liver disease is progressive then we discuss liver transplantation. All patients in this setting must be alcohol free for at least 6 months before they can be listed for a liver transplant.
Is receiving a liver donated by a living relative an option in transplantation? Yes. To explore this option, review California Pacific Medical Center's special information on living-related liver transplantation and discuss this issue with your surgeon and your hepatologist. Also see our "Living Donor Option" section for additional information.