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Transplant Education


Liver transplantation is a wonderful life-saving surgery, but this complicated procedure can raise a lot of questions for someone learning about it for the first time.

The information provided does not constitute medical advice and it should not be relied upon as such. The New York Center for Liver Transplantation (the Center) does not engage in the practice of medicine. The Center, under no circumstances, recommends particular treatments for individuals and, in all cases, recommends that you consult your physician before pursuing any course of treatment.

What does the liver do?The liver, the largest organ in the body, can be found behind the ribs in the right upper abdomen. The functions of the liver include:
  • Stores vitamins, sugars, fats and other nutrients from the food we eat
  • Builds chemicals that the body needs to stay healthy
  • Breaks down harmful substances, like alcohol and other toxic (poisonous) chemicals
  • Removes waste products from the blood
  • Makes sure that the body has just the right amount of other chemicals that it needs
Although the liver can regenerate itself, there are illnesses that can cause permanent damage to the liver. Liver transplantation is a possible treatment for a patient whose liver no longer functions well and whose life is threatened.

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What is a liver transplant?

A liver transplant is the replacement of the patient liver with one that has been donated by someone else. The donated liver can be obtained in two ways:
  • Some families decide to donate the organs of a loved one who has died. The main matching requirements are that the donor be of a compatible blood type and the donor liver be an appropriate size for the potential recipient. Unfortunately there are not enough donors for every waiting recipient. The choice of who gets a new liver depends on how critically ill the patient is.
  • Because the liver can regenerate itself, it is possible that a living donor can give a part of their liver to a recipient. Both the segment that was donated and the remaining section of the donor liver will grow to normal size within a short period of time. Parents, siblings and other relatives may be able to donate organs to family members. Unrelated donors may also donate a portion of their liver if they prove to be a match for the recipient.
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When is a liver transplant considered?
If all other forms of treatment have been unsuccessful, and there is a high risk of death because the liver is not functioning, the patient has end stage liver disease. At this point, liver transplantation is considered. Although there are many diseases that have been treated with liver transplants, there are several common ones treated with this procedure:
  • Chronic viral hepatitis B and C

    Cirrhosis due to hepatitis C is the leading cause for liver transplantation

  • Alcohol related liver disease

    Alcoholism is a common cause of end stage liver disease. To be considered for transplantation, patients suffering from alcoholism must have a psychological evaluation and must prove they have stopped drinking for six months. There must also be a strong indication the patient will continue to avoid alcohol after transplant because a transplanted liver will become severely damaged by alcohol just like the old one.

  • Autoimmune hepatitis
  • Primary sclerosing cholangitis
  • Primary biliary cirrhosis
  • Steatohepatitis
  • Liver disorders inherited or present at birth
  • Drug induced liver damage
  • Biliary artresia

    The most common cause of liver failure in children is biliary atresia, often found at birth. The bile ducts that carry bile from the liver to the intestine fail to develop. The bile backs up in the liver and causes damage.

  • Cancer
  • A primary liver cancer or hepatoma is a cancer that develops first in the liver. When a primary liver cancer is identified early, a liver transplant will be performed. However, many cancers begin other places in the body and then spread to the liver — these cancers are not treated by liver transplantation.

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Can anyone get a liver transplant?

No. Liver transplant is major surgery and not everyone can survive it. In some cases, the doctor might decide that a liver transplant won't work. Some things that might prevent a patient from getting a liver transplant are:
  • Having advanced cancer of the liver
  • Having another kind of cancer in the past 3 to 5 years
  • Having severe heart, lung or kidney disease
  • Having advanced HIV disease (AIDS)
  • Severe hardening of the arteries
  • Continuing use of alcohol or illegal drugs
  • Being at high risk of using drugs or alcohol again after the surgery
  • Being unable to follow doctor's instructions, like taking medicine when needed
  • Having too little support from people at home to care for the patient after the operation
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What are the risks?

Before surgery, the patient's liver disease can cause complications that can make liver transplantation surgery unacceptable.

After surgery, one of the major risks is not having any liver function for a short time. Bleeding and infections are also risks at this time. Over a lifetime, patients are tracked to watch for signs that the body is rejecting the new liver. One year survival rates for liver transplant recipients are 85.3% - 88.1%.

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What are the side effects?
Drugs are used to treat or prevent the body's rejection of the new liver. These drugs can make a patient more open to infection. Cortisone drugs produce some fluid retention, puffiness of the face, and a risk of osteoporosis due to loss of calcium. The use of immunosuppressants can lead to high blood pressure, kidney damage and the growth of body hair. Careful regulation of these drugs can help with some of the potential side effects.

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What are the lifestyle changes?
Most patients experience positive changes in lifestyle compared to living with end stage liver disease. However the following are simple changes a patient may need to become used to:
  • Exposure to infections is dangerous for transplant recipients and should be avoided. Illness should be reported to the doctor immediately.
  • Monthly blood tests with local physician and semi-annual checkups at the transplant center are required.
  • Patients should maintain a balanced, low-salt diet.
  • Within a year after a successful liver transplant most patients are able to return to fairly vigorous physical exercise.
  • Women who conceive have to be monitored carefully because of a higher incidence of premature births.
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What can I do to keep healthy before and after a liver transplant?
  • Make sure you follow your doctor's advice to try to treat your liver disease
  • Eat well-balanced, healthy meals
  • Lose weight, if your doctor tells you to
  • Do not use alcohol or illegal drugs
  • Get treatment for your substance abuse problem if you need it
  • Get treatment for any mental illness or behavioral problems
  • Get treated for any other health problems (diabetes, blood pressure, cholesterol)
  • Stop smoking or chewing tobacco
  • Talk to your doctor before you use any other prescription or over the counter medicine
  • Talk to your doctor before using any vitamins, supplements or natural or herbal remedies

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