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Liver Transplantation

by Martin Hertl, MD, PhD, Paul S. Russell, MD

Liver transplantation is the only option for people whose liver no longer functions. A whole liver can be obtained only from a person who has died, but a living donor can provide a part of the liver. A donated liver can be stored for up to 18 hours. Many people die while waiting for a suitable liver, but about 86 to 90% of liver transplant recipients survive for at least 1 year.

Most recipients are people whose liver has been destroyed by cirrhosis (replacement of liver tissue with scar tissue), often due to hepatitis C. Other reasons for liver transplantation include primary sclerosing cholangitis (scarring of the bile ducts, causing cirrhosis), autoimmune liver disorders, and, in children, partial or complete destruction of the bile ducts (biliary atresia) and metabolic disorders. People whose liver has been destroyed by alcoholism can receive a transplant if they stop drinking. Liver transplantation is also done for some people who have liver cancer that is not too far advanced. Although hepatitis C and autoimmune disorders tend to recur in the transplanted liver, survival is still good.

The damaged liver is removed through an incision in the abdomen, and the new liver is connected to the recipient’s blood vessels and bile ducts. Usually, blood transfusions are required. Typically, the operation lasts 4 1/2 hours or more, and the hospital stay is 7 to 12 days.

Complications

Liver transplants are rejected somewhat less vigorously than transplants of other organs, such as the kidney and heart. Nonetheless, immunosuppressants must be taken after transplantation. If the recipient develops an enlarged liver, nausea, pain, fever, jaundice, or abnormal liver function (detected by blood tests), doctors may do a biopsy using a needle. Biopsy results help doctors determine whether the liver is being rejected and whether immunosuppressant therapy should be adjusted.

Rejection can be treated with corticosteroids or, if they are ineffective, other immunosuppressants (such as antithymocyte globulin). Another liver, if available, may be transplanted if drugs are ineffective.