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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 8 to 15 hours. Many people die while waiting for a suitable liver, but 85 to 90% of liver transplant recipients survive for at least 1 year. Most recipients are people whose liver has been destroyed by primary biliary cirrhosis, hepatitis, or drug toxicity (such as high doses of acetaminophen). 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. About 86% of patients who receive a transplant to treat cancer are still alive after 1 year. Although viral hepatitis 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 4½ hours or more, and the hospital stay is 7 to 12 days.
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.
Last full review/revision September 2008 by Martin Hertl, MD, PhD; James F. Markmann, MD, PhD; Paul S. Russell, MD; Heidi Yeh, MD
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