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Liver Transplant

Alternate Names

  • hepatic transplant
  • transplantation of the liver
  • Biliary System

Definition

In liver transplantation, a healthy liver is removed from a donor who is brain dead and implanted into a person whose own liver is failing.

Who is a candidate for the procedure?

Liver transplantation is only offered to persons with severe liver failure.
The reasons for liver transplantation include:
  • cirrhosis, a chronic disease of the liver
  • biliary atresia, an obstruction of the bile ducts caused by their failure to develop normally before birth
  • certain metabolic disorders such as Wilson disease, an inherited disorder in which the body has too much copper
  • viral hepatitis (B, C, or D)
  • cancerous tumors of the liver or bile duct
  • noncancerous tumors of the liver
  • sudden liver failure
  • problems with the major blood vessels that supply the liver
  • drug-induced liver injury
A person is evaluated by a team of healthcare professionals to see if he or she is a good candidate for a liver transplant. This team includes surgeons, liver specialists known as hepatologists, social workers, nurses, and transplant coordinators.
A few conditions would disqualify a person from receiving a liver transplant. These include:
  • cancer within the past five years
  • certain infections, such as tuberculosis or osteomyelitis, a bone infection
  • severe lung or kidney problems that would make the operation too risky
  • alcoholic liver disease, especially if there is ongoing alcohol abuse
A candidate for a liver transplant needs to know that he or she will need to take medications to keep the body from "rejecting" the transplant. That is, the body's immune system would normally attack the new liver because it is something foreign. Immunosuppressants are medications that keep the immune system from attacking the new liver. These medications need to be taken for as long as the new liver functions.
The person will also need lifelong follow-up with healthcare professionals. If a person is found to be a good candidate for the transplant, the person's name is placed on a waiting list. It can sometimes take years for a recipient to receive a liver from a donor, because there are many more candidates for transplanted livers than there are available donors.

How is the procedure performed?

Usually many organs (heart, lungs, kidneys, pancreas, and liver) are being removed from the brain dead donor at once, sometimes by two or three teams at the same time. After the organs are removed, they are packed for transport to the recipient. The donor's chest and abdomen are sewn up and normal preparations for a funeral take place.
A liver can be preserved safely for up to 12 to 18 hours. The transplant surgery needs to take place within this timeframe. The recipient is given general anesthesia. The transplant operation is carried out in three stages:
  • The diseased liver is cut away from the structures and blood vessels that hold it in place in the abdomen. This part of the operation may be very difficult and may result in a lot of bleeding.
  • The new healthy liver is then put in place. The 4 major blood vessels - the suprahepatic vena cava, infrahepatic vena cava, portal vein, and hepatic artery - are connected to the liver and blood flow is restored. The surgeon checks carefully to see if there is major bleeding and makes sure that the liver is getting an adequate supply of blood.
  • The final connection is made to the bile duct. This small tube carries bile made in the liver to the intestines. Once the connections are complete, the incision is closed and the recipient is taken to the intensive care unit for recovery.

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