Liver transplant – Mayo Clinic

Overview

The liver

The liver, located above the stomach

The liver

The liver is your largest internal organ. About the size of a football, it ‘s located chiefly in the upper correct helping of your abdomen, beneath the diaphragm and above your stomach .

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A liver transplant is a surgical routine that removes a liver that no longer functions properly ( liver failure ) and replaces it with a healthy liver-colored from a die donor or a fortune of a healthy liver from a be donor.

Your liver is your largest internal organ and performs respective critical functions, including :

  • Processing nutrients, medications and hormones
  • Producing bile, which helps the body absorb fats, cholesterol and fat-soluble vitamins
  • Making proteins that help the blood clot
  • Removing bacteria and toxins from the blood
  • Preventing infection and regulating immune responses

Liver transfer is normally reserved as a discussion choice for people who have significant complications ascribable to end-stage chronic liver disease. Liver transfer may besides be a treatment choice in rare cases of sudden failure of a previously healthy liver .
The number of people waiting for a liver transplant greatly exceeds the number of available deceased-donor livers .
Living-donor liver-colored transplant is an alternative to waiting for a deceased-donor liver to become available. Living-donor liver transplant is possible because the homo liver-colored regenerates and returns to its convention size shortly after surgical removal of function of the organ .
In 2017, about 8,000 liver transplants were performed in the U.S. among both adults and children. Of those, approximately 360 involve livers from living donors. At the lapp time, approximately 11,500 people were registered on the waiting number for a liver transplant .

Types

Why it’s done

Normal liver vs. liver cirrhosis

Normal liver and liver cirrhosis

Normal liver vs. liver cirrhosis

A normal liver ( left ) shows no signs of scarring. In cirrhosis ( right field ), scratch weave replaces normal liver-colored tissue .
Liver transplant is a discussion option for people with liver failure whose condition ca n’t be controlled with other treatments and for some people with liver-colored cancer .
Liver failure may happen quickly or over a long period of time. Liver failure that occurs quickly, in a matter of weeks, is called acuate liver-colored failure. Acute liver failure is an uncommon condition that is normally the result of complications from certain medications .
Although a liver-colored transplant may treat acuate liver failure, it is more often used to treat chronic liver bankruptcy. Chronic liver failure occurs slowly over months and years .
Chronic liver-colored failure may be caused by a variety of conditions. The most common lawsuit of chronic liver failure is scarring of the liver ( cirrhosis ). When cirrhosis occurs, scar tissue replaces normal liver weave and causes the liver to not function by rights. cirrhosis is the most frequently reason for a liver transplant .
major causes of cirrhosis leading to liver failure and liver transplant include :

  • Hepatitis B and C.
  • Alcoholic liver disease, which causes damage to the liver due to excessive alcohol consumption.
  • Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver, causing inflammation or liver cell damage.
  • Genetic diseases affecting the liver, including hemochromatosis, which causes excessive iron buildup in the liver, and Wilson’s disease, which causes excessive copper buildup in the liver.
  • Diseases that affect the bile ducts (the tubes that carry bile away from the liver), such as primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia. Biliary atresia is the most common reason for liver transplant among children.

Liver graft may besides treat certain cancers that originate in the liver .

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Risks

Complications of the procedure

Liver transplant operation carries a gamble of significant complications. There are risks associated with the operation itself equally well as with the drugs necessity to prevent rejection of the donor liver after the transfer .
Risks associated with the routine include :

  • Bile duct complications, including bile duct leaks or shrinking of the bile ducts
  • Bleeding
  • Blood clots
  • Failure of donated liver
  • Infection
  • Rejection of donated liver
  • Mental confusion or seizures

long-run complications may besides include recurrence of liver disease in the transfer liver .

Anti-rejection medication side effects

After a liver transplant, you ‘ll take medications for the remainder of your life to help prevent your body from rejecting the donated liver. These anti-rejection medications can cause a variety show of side effects, including :

  • Bone thinning
  • Diabetes
  • Diarrhea
  • Headaches
  • High blood pressure
  • High cholesterol

Because anti-rejection drugs work by suppressing the immune system, they besides increase your gamble of infection. Your repair may give you medications to help you fight infections .

How you prepare

Choosing a transplant center

If your repair recommends a liver transplant, you may be referred to a graft center. You ‘re besides exempt to select a transplant center on your own or choose a center from your policy company ‘s list of prefer providers .
When you ‘re considering transfer centers, you may want to :

  • Learn about the number and type of transplants the center performs each year.
  • Ask about the transplant center’s liver transplant survival rates.
  • Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients.
  • Understand the costs that will be incurred before, during and after your transplant. Costs will include tests, organ procurement, surgery, hospital stays, and transportation to and from the center for the procedure and follow-up appointments.
  • Consider additional services provided by the transplant center, such as coordinating support groups, assisting with travel arrangements, helping with local housing for your recovery period and offering referrals to other resources.
  • Assess the center’s commitment to keeping up with the latest transplant technology and techniques, which indicates that the program is growing.

After you ‘ve selected a transplant center, you ‘ll need an evaluation to determine whether you meet the concentrate ‘s eligibility requirements. Each transplant center has its own eligibility criteria. If you are n’t accepted at one transplant kernel, you may undergo evaluation at another center .
The goals of the evaluation work are to determine whether you :

  • Are healthy enough to have surgery and tolerate lifelong post-transplant medications
  • Have any medical conditions that would interfere with transplant success
  • Are willing and able to take medications as directed and follow the suggestions of the transplant team

specific tests, procedures and consultations you may undergo include :

  • Laboratory tests, such as blood and urine tests to assess the health of your organs, including your liver
  • Imaging tests, such as an ultrasound of your liver
  • Heart tests to determine the health of your cardiovascular system
  • A general health exam, including routine cancer screening tests, to evaluate your overall health and to check for any other illnesses that may impact the success of your transplant

Your evaluation may besides include :

  • Nutrition counseling with dietitians who assess your diet and make recommendations on how to plan healthy meals before and after your transplant
  • Psychological evaluation to assess and treat any underlying issues, such as depression or anxiety, and determine whether you fully understand the risks of a liver transplant
  • Meetings with social workers who assess your support network to determine whether you have friends or family to help care for you after transplant
  • Addiction counseling to help people who are struggling with how to quit alcohol, drug or tobacco
  • Financial counseling to help you understand the cost of a transplant and post-transplant care and to determine what costs are covered by your insurance

once these tests and consultations are completed, the graft center ‘s survival committee meets to discuss your situation. The committee determines whether a liver-colored transplant is the best discussion for you and whether you ‘re healthy enough to undergo a transfer .
If the answer to both questions is yes, then you ‘re placed on the liver transplant waiting list .

What you can expect

Before the procedure

Being placed on the waiting list

Doctors will use the results of your liver function tests and other factors to assess the austereness of your illness, how urgently you need a transplant and your seat on the liver transplant waiting list .
Your transplant waiting tilt precedence is determined by two scoring systems called Model for End-Stage Liver Disease ( MELD ) for adults and Pediatric End-Stage Liver Disease ( PELD ) for children younger than old age 12.

Your doctor will use a specific formula to determine your MELD scores, which can range from 6 to 40. The scores estimate the hazard of death within 90 days without a transplant. A eminent MELD sexual conquest indicates the pressing motivation of a transplant .
As deceased-donor organs become available, they are allocated according to MELD scores and classified by blood type. People with higher meld scores are generally offered donated livers beginning. Time exhausted on the liver-colored graft waiting list is used to break ties among people with the same MELD scores and lineage type .
Some liver-colored conditions, such as liver cancer, may not result in a person getting a high MELD mark. The transplant center can request extra MELD points for people with particular diseases if they meet specify exception criteria .
In addition, adults with acute liver failure are exempted from the MELD-based donor harmonium prioritization system and may be placed higher on the transplant waiting list according to the severity of their disease .

Waiting for a new liver

The delay for a donor liver-colored can vary greatly. Some people wait days, while others wait months or may never receive a deceased-donor liver .
As you wait for a fresh liver, your sophisticate will treat the complications of your liver-colored bankruptcy to make you angstrom comfortable as possible .
Complications of end-stage liver-colored failure are serious, and you may be frequently hospitalized. If your liver deteriorates, your MELD sexual conquest is updated .

Living liver donors

Living-donor liver transplants using a modest part of a liver from a healthy, living person account for a small percentage of liver transplants each class. Living-donor liver transplants were initially used for children needing a liver transplant because desirable deceased-donor organs are barely. now, it is besides an option for adults who have end-stage liver disease .
Living-donor liver-colored transplants offer an alternate to waiting for a deceased-donor liver-colored, and allow the electric organ recipient to avoid possible health complications of waiting for a graft. The first mistreat is to identify a exist donor who is healthy and able to safely undergo a major surgical procedure. The donor ‘s age, lineage type and organ size besides are critical considerations in determining whether you and the donor are a meet for living-donor liver transplant .
Most populate liver donors are close family members or friends of the liver transplant candidate. If you have a family member or acquaintance who is willing to donate share of his or her liver-colored to you, talk to your transfer team about this option .
Living-donor transplants have good results, merely as transplants using livers from dead person donors. But finding a living donor may be unmanageable. Living liver donors go through across-the-board evaluation to ensure they are a match with the organ recipient role and to assess their forcible and genial health. The operating room besides carries meaning risks for the donor .
Your graft team can discuss the benefits and risks with you and the potential donor .

Domino liver transplant

Another, less common, type of living-donor liver transplant is called a domino liver graft. In a domino liver transplant, you receive a liver from a be donor who has a disease called familial amyloidosis. familial amyloidosis is a identical rare perturb in which an abnormal protein accumulates and finally damages the body ‘s internal organs .
The donor with familial amyloidosis receives a liver transplant to treat his or her condition. then, the donor can give his or her liver to you in a domino liver transplant because the liver still functions well. You may finally develop symptoms of amyloidosis, but these symptoms normally take decades to develop .
Doctors normally select recipients who are 55 years previous or older and who are n’t expected to develop symptoms before the conclusion of their natural life anticipation. After your graft, doctors will monitor you for signs of the condition .
Doctors will evaluate you to determine if you may be a campaigner for a domino liver transplant or if another discussion choice would be more appropriate for your condition .

Staying healthy

Whether you ‘re waiting for a donate liver or your transplant operating room is already scheduled, shape to stay healthy. Being healthy and equally active as you ‘re able can make it more probably you ‘ll be ready for the graft operation when the clock comes. It may besides help speed your recovery from operation. work to :

  • Take your medications as prescribed
  • Follow your diet and exercise guidelines
  • Keep all appointments with your health care team
  • Stay involved in healthy activities, including relaxing and spending time with family and friends

Stay in touch with your transplant team, and let them know of any significant changes in your health. If you ‘re waiting for a donate liver, make sure the transplant team knows how to reach you at all times. Keep your carry hospital udder handy, and make arrangements for transportation system to the transfer center in advance .

During the procedure

Living liver donor procedure

Living liver donor procedure

Living liver donor procedure

During living-liver contribution, surgeons remove approximately 40 % to 70 % of the donor liver and space it into the recipient role .

Living-donor liver organ regeneration

Living-donor liver organ regeneration

Living-donor liver organ regeneration

Within a copulate of months after living-donor liver operation, the donor ‘s liver typically grows back to its normal size, bulk and capacity .

Deceased-donor liver transplant

If you ‘re notified that a liver from a die donor is available, you ‘ll be asked to come to the hospital immediately. Your health wish team will admit you to the hospital, and you ‘ll undergo an examination to make surely you ‘re goodly adequate for the operation .
Liver transfer surgery is done using cosmopolitan anesthesia, so you ‘ll be sedated during the procedure .
The transplant surgeon makes a long incision across your abdomen to access your liver. The location and size of your incision varies according to your surgeon ‘s border on and your own anatomy .
The surgeon removes the diseased liver-colored and places the donor liver in your body. then the surgeon connects your rake vessels and bile ducts to the donor liver. operating room can take up to 12 hours, depending on your site .
once your modern liver is in target, the surgeon uses stitches and staples to close the surgical incision. You ‘re then taken to the intensive worry whole to begin recovery .

Living-donor liver transplant

If you ‘re receiving a liver graft from a life donor, your surgery will be scheduled in gain .
Surgeons beginning operate on the donor, removing the fortune of the liver for graft. then surgeons remove your diseased liver-colored and place the donated liver-colored share in your body. They then connect your lineage vessels and bile ducts to the fresh liver .
The transplanted liver part in your body and the share left behind in the donor ‘s body regenerate quickly, reaching convention volume within a several weeks .

After the procedure

After a liver transplant

After your liver graft, you can expect to :

  • Possibly stay in the intensive care unit for a few days. Doctors and nurses will monitor your condition to watch for signs of complications. They’ll also test your liver function frequently for signs that your new liver is working.
  • Spend 5 to 10 days in the hospital. Once you’re stable, you’re taken to a transplant recovery area to continue recuperating.
  • Have frequent checkups as you continue recovering at home. Your transplant team designs a checkup schedule for you. You may undergo blood tests a few times each week at first and then less often over time.
  • Take medications for the rest of your life. You’ll take a number of medications after your liver transplant, many for the rest of your life. Drugs called immunosuppressants help keep your immune system from attacking your new liver. Other drugs help reduce the risk of other complications after your transplant.

Expect six months or more recovery time before you ‘ll feel in full healed after your liver transfer operation. You may be able to resume convention activities or go back to work a few months after operating room. How farseeing it takes you to recover may depend on how ailment you were before your liver-colored transfer .

Results

Liver transplant survival rates

Your chances of a successful liver graft and long-run survival depend on your particular situation .
In general, about 75 % of people who undergo liver transplant alive for at least five years. That means that for every 100 people who receive a liver transfer for any argue, about 75 will live for five years and 25 will die within five years .
People who receive a liver from a living donor often have better short-run survival rates than those who receive a deceased-donor liver. But comparing long-run results is unmanageable because people who have a support donor normally have a shorter delay for a transplant and are n’t arsenic ill as those who receive a deceased-donor liver .
survival rates among liver transplant recipients besides vary among U.S. transplant centers and can be found on-line at the Scientific Registry of Transplant Recipients .

Clinical trials

explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or wangle conditions .

Coping and Support

It ‘s convention to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. Seeking the back of friends and family members can help you cope during this nerve-racking time .
Your graft team can besides assist you with early useful resources and coping strategies throughout the transplant process, such as :

  • Joining a support group for transplant recipients. Talking with others who have shared your experience can ease fears and anxiety.
  • Sharing your experiences on social media. Engaging with others who have had a similar experience may help you adjust to your changing situation.
  • Finding rehabilitation services. If you’re returning to work, your social worker may be able to connect you with rehabilitation services provided by your home state’s department of vocational rehabilitation.
  • Setting realistic goals and expectations. Recognize that life after transplant may not be exactly the same as life before transplant. Having realistic expectations about results and recovery time can help reduce stress.
  • Educating yourself. Learn as much as you can about your procedure and ask questions about things you don’t understand. Knowledge is empowering.

Diet and nutrition

After your liver-colored transplant, it is specially important to eat a well-adjusted diet to help you recover and keep your liver-colored healthy .
Your transplant team includes a nutrition specialist ( dietician ) who can discuss your nutriment and diet needs and answer any questions you have after your transplant .
In general, your diet after liver-colored transfer should be first gear in salt, cholesterol, fat and carbohydrate .
To prevent damaging your new liver, it ‘s important to avoid alcohol. Do not drink alcoholic beverages or use alcohol in cooking .
Your dietician will besides provide you with several healthy food options and ideas to use in your nutrition plan. Your dietician ‘s recommendations may include :

  • Eating at least five servings of fruits and vegetables each day
  • Avoiding grapefruit and grapefruit juice because of their effect on a group of immunosuppression medications
  • Having enough fiber in your daily diet
  • Choosing whole-grain foods over processed ones
  • Drinking low-fat or fat-free dairy products, which is important to maintain optimal calcium and phosphorus levels

Your dietician may besides recommend :

  • Eating lean meats, poultry and fish
  • Following food safety guidelines
  • Staying hydrated by drinking adequate water and other fluids each day

Exercise

practice and physical activeness should be a regular part of your life after a liver transplant to continue improving your overall physical and mental health.

soon after your transplant, you should walk a much as you can. then, depending on your build up, you can start incorporating more physical natural process into your daily life sentence .
Walking, bicycle, liquid, low-impact force coach and other physical activities you enjoy can all be a part of a goodly, active life style after transplant. But be sure to check in with your transplant team before starting or changing your post-transplant practice act .

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