Liver Transplantation

A liver transplant is a surgical procedure which involves replacing a diseased or damaged liver with a healthy one. Liver transplants are commonly performed in the UK, at approximately 700 per year, with an 88 percent survival rate. The liver is the body's largest gland and organ, located under the ribs on the right-hand side of the body. The liver’s main function is to keep the body healthy and combat infections, which it does through the use of enzymes and protein production to eliminate toxins, regulate chemical and hormones and to digest and store nutrients, minerals and vitamins.

When are liver transplants necessary?

People who have liver disease with liver function failure and the following symptoms usually need transplants:

• Hepatic encephalopathy, which affects brain function, causing mental confusion and reduced consciousness.
• Frequent shortness of breath and chronic fatigue.
• Abdominal swelling or “ascites” and untreatable liver pain with skin itchiness.

Liver diseases include Alcoholic Cirrhosis, Fibrosis, Biliary Cirrhosis, Biliary atresia, Hepatitis B and C, Autoimmune Hepatitis, Tumours, Cancer, Budd Chiari, Haemochromatosis, Gilbert's Disease, Wilson's Disease and primary sclerosing cholangitis. Medications can extent the life of the person living with liver disease, but no medical device can sustain liver function. The only way to cure liver failure is with a liver transplant.

Who qualifies for liver transplants?

In the UK eligibility for liver transplant is determined through interviews, tests and a scoring system, in order to ascertain life expectancy without the transplant and life quality and lifespan with and without transplant. A score above 49 infers that a person should be placed on a waiting list for liver transplant. The higher the score the higher priority, with the patient likely to die without the transplant if listed towards the higher end of the scale. The likelihood of survival is measured through lung function, electrocardiogram (ECG), stress echo, X-ray, pulse oximetry, coronary angiography, endoscopy, MRI, CT scan, liver biopsy and duplex ultrasonography tests.

The aim is to determine the quality of survival after transplant. The criteria also looks at the ability of the person to manage associated medical conditions, their age, physical and mental health, and the health of the donated liver. A person will not qualify with absolute contraindication, such as irreversible brain damage, infection, multiple organ failure, cancer, HIV, chronic heart or lung disease, chronic mental health, alcohol or drug abuse. Those with relative contraindication are unlikely to be considered because of kidney failure, terminal liver cancer, Hepatitis B infection, malnutrition or extensive weight loss.

Are there different types of liver transplants?

Three types of liver transplants exist: a living organ section transplant from a living donor, a deceased organ transplant from someone who has recently passed away and a split donation from a deceased person to service as two transplants for two different people.

What preparation is necessary for liver transplant?

Preparatory tests are carried out over a week in hospital with local anaesthetic. These tests are used to assess the patient’s suitability for liver transplant. These tests include interview assessments and those listed above are carried out through liver transplant centres. While on a waiting list patients are recommended to follow a healthy diet, maintain a regular exercise regime and abstain from alcohol and smoking. The average waiting period is about 85 days for children and 150 days for adults. During this time patients can access medical help and support.

What happens during the liver transplant?

When a healthy donated liver is available and of suitable blood group and size, preparatory tests are done before transplant operation. During an Orthotopic/Deceased, Living or Split Donor Transplant, your own liver will be removed through surgery via abdominal incision and the new donor liver transplanted and attached to functioning vessels and ducts. Thereafter sutures will be used to seal the incisions, leaving remaining drainage tubes for about a week after surgery for fluids to drain. Patients will then remain in Intensive Care (ICU) for ventilator breathing, monitoring and recovery.  Liver organs are able to grow and regenerate by approximately 85 percent over several days.

What risks are associated with liver transplants?

A number of risks are associated with liver transplants and these include acute liver rejection, infection, fungal infections, cytomegalovirus (CMV) infection, diabetes, kidney failure, cancer, graft failure and post-transplant lymphoproliferative disorder (PTLD). Each condition manifests with different symptoms. Medical advice is given prior to transplant operation about risks, associated complications and necessary actions.

What aftercare is necessary after liver transplant?

While in ICU for two to three weeks patients do experience pain and are provided with painkillers. Recovery takes time to slowly build up strength and better health. Around six months after the transplant operation, patients are able to resume their usual leisure and work activities. Aftercare includes taking immunosuppressants, such as corticosteroids or calcineurin inhibitors, for about three months to raise immunity and reduce risk of infection.

What is the expected survival rate after liver transplant?

A range of factors influence survival rate after liver transplant, such as state of health, age, cause of liver failure, post transplant complications or associated disease. The expectancy is that approximately 76 percent of people survive for at least five years after their liver transplant and 90 percent for at least a year. To prevent complications and for successful recovery it is vital that the patient is committed to improving their health and wellbeing prior to and after the liver transplant operation.