A liver transplant is:
- Surgery that removes a patient's diseased liver and replaces it with:
- A healthy liver (from a deceased donor)
- Part of a healthy liver (from a live donor)
The liver is the largest organ in the body and it:
- Removes bacteria and toxins from the blood
- Prevents infection
- Regulates immune responses
- Processes nutrients, medications, and hormones
- Produces bile, which helps the body absorb fats, cholesterol and fat-soluble vitamins
- Makes proteins that help the blood clot
A person may need a liver transplant if they have:
- Acute alcoholic hepatitis (AAH)
- Fulminant (or acute) liver failure
- Cirrhosis
A. Acute Alcoholic Hepatitis (AAH)
AAH is when drinking alcohol destroys liver cells and causes the liver to swell.
- 35% of heavy drinkers (5 drinks a day for men, 4 drinks a day for women) have AAH.
- Patients with AAH can:
- recover without a transplant
- receive a liver transplant
- die
Symptoms of AAH are:
- Fever
- Jaundice
- Nausea
- Vomiting
- Belly pain and tenderness
- Fatigue
- Weakness
B. Fulminant (or Acute) Liver Failure
Fulminant (or acute) liver failure is:
- When the liver stops working very quickly, usually with no past liver problems.
- Fulminant liver failure is not as common as chronic liver failure. Chronic liver failure is slow and over time the liver stops working.
Fulminant liver failure is caused by:
- Acetaminophen (Tylenol) overdose
- Prescription medications and herbal supplements
- Hepatitis and other viruses
- Toxins (from like poisonous mushrooms)
- Autoimmune disease
- Blood clot that stops blood from going to the liver
- Rare metabolic diseases
- Cancer
- Shock
Symptoms of fulminant liver failure are:
- Yellow skin and eyeballs (jaundice)
- Pain in upper right abdomen
- Abdominal swelling
- Nausea
- Vomiting
- General sense of feeling not-well
- Disorientation or confusion
- Sleepiness
Fulminant Liver Failure is very serious and requires hospitalization. It can cause:
- Cerebral edema (too much fluid in the brain)
- Infection
- Bleeding and bleeding disorders
- Death
Patients with fulminant liver failure might:
- Heal
- Need a transplant to live
- Die
C. Cirrhosis (permanent liver scarring) is the most common cause for liver transplant and is caused by:
- Alcohol-related liver disease
- Nonalcoholic fatty liver disease
- Hepatitis B and/or C
- Genetic diseases, like hemochromatosis and Wilson's disease
- Cystic fibrosis
- Alpha-R antitrypsin deficiency
- Diseases that affect bile ducts (tubes that carry bile away from the liver), like primary biliary cirrhosis, primary sclerosing cholangitis, and biliary atresia
- Biliary atresia is the most common reason for liver transplant in children
When the liver stops working, other parts of the body stop working, leading to End-Stage Liver Disease.
Common symptoms of End-Stage Liver Disease are:
- Fatigue, feeling lethargic
- Not sleeping well
- Yellow, green, or gray skin and eyes (jaundice)
- Weight loss (including loss of muscle)
- Belly pain (usually right side, under the ribs)
- Swelling in the belly (ascites)
- Swelling in the legs or hands (edema)
- Bruising easily
- Nausea, vomiting, constipation, diarrhea
- Esophageal or gastric varices (enlarged veins connecting the stomach and throat that can burst and cause the patient to vomit blood)
- Hepatic Encephalopathy (poor brain function caused by liver disease)
D. Treatment Options for Patients with Liver Disease or Failure
Patients with end-stage liver disease or liver failure may need a liver transplant. A liver transplant can be received from a deceased (dead) donor or a living donor.
Liver Transplant Waitlist
The liver transplant waitlist uses the Model for End-stage Liver Disease (MELD-Na) score to determine the order in which patients receive a transplant. A MELD-Na is a score for patients on the liver transplant waitlist. The score (6 - 40+) shows how severe the liver disease is and how long the patient can live without a new liver. A higher score means the disease is more severe and the chance of survival without a new liver is lower. The score is based on 4 blood tests:
- INR (internal normalized ratio) shows if the liver is making proteins needed for blood to clot
- Creatinine shows how well the kidneys are working
- Bilirubin shows how well the liver is removing bile
- Serum sodium shows how well the body is balancing fluids
MELD score can change, so patients need frequent blood tests. MELD score calculator
When a patient has a MELD score of 15, they might become “active” on the liver transplant waiting list. Their MELD score affects their place on the waiting list.
All transplant patients are listed in a national donor computer system, managed by the United Network for Organ Sharing (UNOS). They are matched to donor livers according to:
- Blood type (O, A, B, or AB)
- Body size
- Severity of disease
When a liver is available, the patient with the highest MELD score (who also matches blood type and body size) receives it.
Ask your transplant team about increased-risk donors.
- Patients who accept organs from increased-risk donors usually wait less time for an organ.
- An increased-risk donor is a deceased donor with higher risk of spreading one of the following undiagnosed diseases to a transplant patient (Abara et al., 2019):
- human immunodeficiency virus (HIV)
- hepatitis B
- hepatitis C (HCV).
- Organs from increased-risk donors are not lower quality.
Living Donors
There are not enough deceased donor livers available for all the people waiting for liver transplant. How long a patient waits depends on their health and the location of their transplant center. No one can predict (or control) when a deceased donor liver will be available. Deceased donors must die before their liver is available. This is a frustrating, stressful, and discouraging time for patients and their caregivers.
Because a healthy liver can regenerate (regrow), living liver donation is also possible. First, a person must volunteer to be a living donor. Then, the patient must meet medical criteria to receive a living donor liver. Patients who are eligible for a living donor usually wait less time for a liver transplant. Ask your transplant team about living liver donation.
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