Liver Transplant Step-by-Step Guide
If you or someone you love needs a transplant, understanding the following four steps will help:1. Pre-transplant Evaluation
After you have discussed liver transplantation with your doctor and decided that you may need a transplant, your doctor may refer you to Baylor. Here, you will get a full medical evaluation to determine the extent of your disease. The evaluation, which typically takes four to five days, is usually done on an outpatient basis. Depending on your diagnosis, the evaluation may include extensive laboratory tests, consultations, group meetings, and X-ray studies. Who needs a liver transplant?
In general, people who are referred to the transplant team have the following health problems:
End-stage liver disease (which could be caused by cirrhosis or scarring of the liver from diagnoses such as viral hepatitis )
- No reasonable alternative treatment for liver disease
- Life-threatening upper gastrointestinal bleeding
- Development of hepatorenal syndrome
- Recurrent encephalopathy that can't be managed with conventional therapy
- Liver cancer without evidence of metastases (spreading)
- Narrowing of the bile ducts
2. Patient Selection Process
Liver transplantation may offer hope to patients with irreversible liver failure. Those who need a transplant must qualify as a candidate for the surgery before being placed on the waiting list.
Where does the donor liver come from?
The donor liver can come from a person who has just died (a cadaveric donor) or from a family member whose liver is compatible with yours (a living donor). Donated organs are distributed by organizations around the world--the organ procurement organization (OPO) for Baylor University Medical Center is the Southwest Transplant Alliance. LifeGift is the OPO for Baylor All Saints Medical Center. These organizations control the medical management, recovery, and transportation of donated organs.
When you are placed on the waiting list, you receive a status code that reflects your medical condition (this status code changes as your medical condition changes). Donated organs go to candidates based on the Mayo Endstage Liver Disease (MELD) scoring system under the direction of the United Network for Organ Sharing (UNOS). The MELD scoring system takes into account your medical criteria, suitability and your condition. Other factors include your size and blood type.
Once a suitable donor is located, Baylor's transplant coordinator will notify you.
Who qualifies to become a candidate for a liver transplant?
To qualify as a candidate for a liver transplant, you must be able to undergo surgery, be reliable and compliant, and have a support system at home to help you stick to post-transplant treatment.
Some problems may disqualify you from receiving a liver transplant:
- Alcohol or other chemical abuse interfering with work or normal activities within six months before consideration for the list
- Metastatic (spreading) malignancy of the liver or other primary malignancy
- Other serious diseases, such as infection, heart disease, or lung disease
- History of noncompliance with your medical regimen
- Inadequate support from family or friends
- HIV-positive status
- A history of multiple upper abdominal surgeries
- Advanced age
3. Transplant
Surgery
Of all organ transplant surgeries, liver transplantation is considered to be the most complex. In the five- to eight-hour surgery, the surgeon must connect the four blood vessels that link the liver to the rest of the body. Next, the recipient's bile duct is connected to the bile duct of the new liver.
The ICU
Once the surgery is complete, you will be sent to the Intensive Care Unit (ICU). The transplant team will visit the ICU twice a day to give you and your family a status update. Length of time spent in the ICU largely depends on your medical condition before surgery and how well you tolerate the procedure.
Discomfort
The physicians and nurses address any discomforts that you may be feeling. Overall, those who have undergone liver transplantation say that there was not as much pain involved as they anticipated. This may be due, in part, to the type of incision that is made, as well as the use of steroid medications. The steroids are given both during and after surgery to reduce internal swelling and pain.
4. Post-transplant Care
Depending on the patient, a typical length of stay following a liver transplant is approximately ten days. After the surgery, you will take immunosuppressive drugs for the rest of your life to help prevent your body from rejecting your new liver.
After discharge from the hospital, patients are monitored closely by their hepatologist (liver specialist), and they visit an outpatient clinic several times a week. Visits decrease as the patient's health improves. Long-term care is coordinated between the transplant team and the primary care provider.
After a period of stability, patients usually only need to return for a checkup once a year.