Liver Transplant

The liver is the body’s largest internal organ, weighing about 3 pounds in adults. It is located below the diaphragm on the right side of the abdomen.

The liver performs many complex functions in the body, including:

• Makes most proteins needed by the body
• Metabolizes, or breaks down, nutrients from food to make energy, when needed
• Prevents shortages of nutrients by storing certain vitamins, minerals, and sugar
• Makes bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K
• Makes most of the substances that regulate blood clotting
• Helps the body fight infection by removing bacteria from the blood
• Removes potentially toxic byproducts of certain medications

When Is a Liver Transplant Needed?

A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can happen suddenly (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection. Liver failure can also be the end result of a long-term problem. The following conditions may result in chronic liver failure:

• Chronic hepatitis with cirrhosis.
• Primary biliary cholangitis (previously called primary biliary cirrhosis, it isa rare condition where the immune system inappropriately attacks and destroys the bile ducts)
• Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver)
• Biliary atresia (a rare disease of the liver that affects newborns)
• Alcoholism
• Wilson’s disease (a rare inherited disease with abnormal levels of copper throughout the body, including the liver)
• Hemochromatosis (a common inherited disease where the body has too much iron)
• Alpha-1 antitrypsin deficiency (an abnormal buildup of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)

How Are Candidates for Liver Transplant Selected?

Specialists from a variety of fields are needed to determine if a liver transplant is appropriate. Many health care facilities assemble a team of such specialists to evaluate (review your medical history, do tests) and choose candidates for a liver transplant. The team may include the following professionals:

• Liver specialist (hepatologist)
• Transplant surgeons
• Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients (this person will be your primary contact with the transplant team)
• Social worker to discuss your support network of family and friends, employment history, and financial needs
• Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany a liver transplant
• Anesthesiologist to discuss potential anesthesia risks
• Chemical dependency specialist to aid those with history of alcohol or drug abuse
• Financial counselor to act as a liaison between a patient and his or her insurance companies

Types of Liver Transplant

There are three main ways a liver transplant can be carried out:

Deceased organ donation transplant – involves transplanting a liver that has been removed from a person who died recently

Living donor liver transplant – a section of liver is removed from a living donor; because the liver can regenerate itself, both the transplanted section and the remaining section of the donor’s liver are able to regrow into a normal-sized liver

Split donation transplant – a liver is removed from a person who died recently and is split into two pieces; each piece is transplanted into a different person, where they will grow to a normal size.

The Liver Transplant Process
The general procedure that takes place during a liver transplant is:

Step 1

The patient is put under general anesthesia to block and numb the pain

Step 2

Incision is made to open up the abdominal area to access the liver

Step 3

Evaluation of the abdomen for abnormalities to prevent liver transplant complications

Step 4

Mobilization of the native liver and isolation of important structures such as veins and arteries

Step 5

Transection of the structures attached and removal of the native, diseased liver

Step 6

New liver is attached, all blood vessels and bile ducts are connected before closing the incision

Step 7

Ensuring adequate control of bleeding and closure of the incision

Complications of Liver Transplant

Some of the main problems associated with liver transplants include: