Definition and Overview
The liver is one of the largest vital organs in the body. Its main function is to filter the blood that comes from the digestive tract (via the portal vein), ensuring that it is free from bacteria and toxins to prevent infection. The liver is also responsible for the production of bile, a chemical that helps the stomach digest and absorb fats.
Meanwhile, liver transplantation is the surgical removal of a diseased liver and replacing it with a healthy one. It is only considered when all signs point to end-stage liver disease, which can be caused by the following conditions:
Chronic hepatitis – There are many types of hepatitis viruses but only Hepatitis B and C can cause chronic hepatitis. These strains of the hepatitis virus cause inflammation in the liver where they thrive. The repeated occurrence of such attacks may eventually cause liver failure.
Alcohol abuse – Alcoholism is one of the most common causes of liver disease. The amount of alcohol that has to be filtered by the liver in people who drink excessively can be greatly destructive.
Genetic liver disease – These include hemochromatosis (too much iron in the liver) and abnormal metabolism disorders like Wilson’s disease.
Liver damage from medications or poisoning
Who Should Undergo & Expected Results
As previously mentioned, liver transplantation is only considered when there is no other option to prolong the life of the patient with end-stage liver disease.
Possible candidates include:
- Patients with acute liver failure
- Patients who are suffering from acetaminophen overdose
- Patients with severe infections
- Patients who ingested poisonous substances
Those who suffer from chronic liver failure may also benefit from liver transplantation. This condition means that the liver has gone through a cyclical process of injury and repair, leading to cirrhosis or scarring, leaving the liver unable to heal or take care of itself.
However, not all patients who need a liver transplant are able to undergo the procedure because the supply of good, healthy livers does not meet the demand.
Here is a step-by-step procedure on how patients get on the waiting list for new livers.
- The patient will be referred by his doctor to a transplant center where he will undergo an initial evaluation. The patient’s application will be assessed based on the following factors:
- The extent of the patient’s liver disease
- If the person will survive the liver transplant procedure
- If the person has the ability to religiously follow the medical protocol after the transplant procedure
- The person’s mental and emotional stability
Once the transplant team approves the application, the patient will be placed on the waiting list.
The patient will then be further evaluated using the end-stage liver failure scoring system. The scores are based on the results of the patient’s blood tests and are indicative of the patient’s longevity. A higher score means the urgency is dire. Scores may go up or go down depending on the condition of the patient.
When a donor liver becomes available, priority is given to the highest ranking patient and the surgery is scheduled as soon as possible.
Meanwhile, patients who have the following conditions are automatically not included in the waiting list:
- Osteomyelitis and tuberculosis
- Heart or lung diseases
- History of cancer
- Active hepatitis infection
- Risky lifestyle habits
How Does the Procedure Work?
The procedure, which typically takes up to 12 hours, begins as the patient is prepped for surgery while waiting for the donor liver to arrive. The healthy liver may come from a deceased or live donor. If the donor is deceased, the liver can be dispatched immediately. If the liver is coming from a live donor, another surgery will be performed to “harvest” the healthy liver.
The liver transplant starts with the separation of the liver from the abdomen. The blood vessels (inferior vena cava, portal vein and hepatic artery) and the bile duct are separated to remove the diseased or injured liver from the body.
The new liver is then attached by reconnecting the inferior vena cava and the portal veins. The hepatic arteries are also reconnected and the common bile ducts are sewn together. The patient is more likely to require a large amount of blood through transfusion. The surgeon then makes sure that everything is in proper order before closing up the incision.
Regardless of the outcome of the procedure, the patient will be placed under close monitoring and will be scheduled for a series of follow-ups.
Possible Complications and Risks
The immediate complications of a liver transplant are either the rejection of the new liver by the immune system or the loss of function of the new liver. In some cases, the body perceives the new liver as “foreign” and will then attack it in self-defense. To avoid this from happening, all transplant recipients are placed on immunosuppressive therapy for the rest of their lives. However, this therapy poses its own risks as it makes the patient more susceptible to developing cancer, high blood pressure, diabetes, and high cholesterol. For this reason, patients are advised to undergo health screening on a regular basis.
In cases where the new liver fails to function normally, the patient will be required to undergo another liver transplant.
Keefe EB. Hepatic failure and liver transplantation. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 157.
Martin P, Rosen HR. Liver transplantation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:chap 95.