Treatments & Procedures

Liver Transplant

Liver Transplant – an Overview

Liver Transplant is a surgery that replaces a diseased liver that is failing, with a healthy one from a donor. Patients who receive a donated liver have exhausted all other treatment options and are critically unwell. Patients typically have acute liver failure, chronic end-stage liver disease, or liver cancer.

The donated liver may come from a deceased person, or part of a liver can be donated by a living donor. In the case of living donors, the livers of both the donor and recipient can grow back to their full size after the transplantation. This process is called regeneration. Regeneration of the liver to a fully functional organ usually occurs in 2 - 6 weeks. Both deceased and living donor transplants are very complex operations and can be only performed by expert surgical and medical teams.

When is a Liver Transplant Needed?

When a patient’s liver begins to fail, the patient becomes critically ill. A liver transplant can be the only option to save somebody experiencing liver failure. Transplants are usually considered a last resort and are offered to patients who have:

Acute liver failure: The liver has become damaged by an infection or poisoning. Sometimes the liver can recover, but other times it stops working. If this happens, patients usually die within a few days.
Chronic liver failure: The end-stage of liver disease, when there is too much scar tissue (cirrhosis), and the liver can no longer function.
Liver cancer: If the cancer has begun in the liver (primary liver cancer or hepatocellular carcinoma) and has not spread to other parts of the body, it can be cured by removing the liver completely, or by removing the cancerous part. Other types of cancers such as cholangiocarcinoma, liver metastasis from colon cancer, neuroendocrine tumors and other more rare tumors can also be cured by liver transplantation.

Some liver diseases can’t be cured by a liver transplant, but as the disease progresses slowly, a new liver can slow progression.

How Common are Liver Transplants?

Liver transplant surgeries are rare because there is a shortage of liver donations. Most liver transplants are from deceased donors, but more and more living donor transplants are taking place. The Liver Transplant Program at Cleveland Clinic Abu Dhabi performed the first living-related liver transplant in the UAE and it is one of the largest in the region.

What to Expect: Before a Liver Transplant

Every patient’s transplant journey will be different, depending on many factors such as their individual health and requirements. In general, ahead of liver transplant surgery, a patient can expect:

Referral: You will be referred to a specialist facility such as the Liver Transplant Program. Due to the high demand for liver transplants, and shortage of donors, a thorough evaluation is carried out to ensure that you meet the criteria for a transplant to ensure a successful outcome. Criteria include:

Signs of liver failure or diagnosed with primary liver cancer
Being well enough to undergo the surgery
Having no signs of future alcohol abuse.

Transplant Evaluation: Thorough medical and physical evaluations will be carried out to ensure you will benefit from a liver transplant. The team will assess any other conditions that you may have, to ensure they can be treated first and not compromise the transplant.

Waiting List: If you are considered a candidate for a liver transplant, you will be added to a waiting list by transplant coordinators. The more urgent the case, the higher on the list you will be placed. Most people of the waiting list for a liver transplant have liver cancer or chronic liver disease, and a scoring system is used to rank each patient’s condition. The scoring system is called MELD (Model for End Stage Liver Disease), which is based on the results of a blood test. The test measures certain chemicals in your blood that indicate how well the liver is functioning, including:

Bilirubin: High levels mean bile is leaking into the blood.
Prothrombin time: How long it takes for the blood to clot.
Creatinine: A measure of kidney function in adults.
Albumin: A measure of kidney function in children.
Sodium level: This is correlated with the severity of the liver disease.

Matching: Donor livers are matched according to several factors, including blood type and body size. These factors are important to reduce the risk of the donor liver being rejected. Geography is also important to ensure the liver can be delivered quickly. Usually, whole livers are transplanted, but sometimes, a donor liver can be shared between two recipients. The liver can regenerate itself after transplantation, so one ‘lobe’ of the liver can be enough for transplantation.

What to Expect: During a Liver Transplant

Liver transplants can be from deceased or living donors, but the liver must still be fully functional. This means that donor livers from deceased people must have an active blood supply (the heart must still be beating). Donors are usually people who have brain injuries that they cannot survive. Once a deceased match is found, the surgery must happen immediately. You will be called to the hospital and told not to eat. Screening tests will take place and the operation will begin as soon as the donor liver arrives.

Living donors are usually family members or relatives who are compatible and choose to donate a part of their liver. This allows recipients to avoid the waiting lists. Thorough screening (physical and psychological) is done ahead of the surgery to ensure not only compatibility, but to evaluate the health of the donor and their liver. The transplantation of living donor organs can be planned in advance and will be done at the same time. This type of donation increases the chances of receiving a healthy donor liver and improves recovery.

Surgery: Liver transplants are very complex surgeries lasting anywhere between 6 and 12 hours. You will be put under general anesthesia and tubes and machines will help to support your normal bodily functions. These include:

IV catheter to deliver medication and fluids
IV in a vein to monitor blood pressure
Tubes to drain fluid from around the liver
A tube into your windpipe attached to a ventilator to help you breathe
A tube into the stomach (through the nose) to drain the stomach
A catheter to drain urine.

The liver is then carefully separated, and the bile ducts and blood vessels connected to it are clamped. The new liver is placed in the body and the clamped bile ducts and blood vessels are attached.

Removal of the liver or part of it (hepatectomy) is a very complex operation and the liver naturally bleeds a lot. Highly skilled surgeons manage the bleeding and patients may require blood transfusions during the surgery.

What to Expect: After a Liver Transplant

Immediately after a liver transplant, the patient will be in the ICU for close observation for several days. Medical teams will monitor for any complications and take blood samples to see how the new liver is functioning.

When stable, the patient is moved to a recovery room and the tubes can be removed. If the patient is coming from home, usually the hospital stay is about 2-3 weeks. This can be longer if the patient is very sick at the time of the transplant.

When it’s time to return home, the transplant team works closely with the patient to educate them on their medication requirements and to ensure a healthy recovery. Blood tests and checkups will continue regularly to assess the function of the liver.

The transplant team will make sure the patient:

Understands how to care for their wound
How and when to take medications
How to check their blood pressure and pulse.
How to recognize signs of infection and organ rejection and what to do if this happens.

Transplant patients will need to take immunosuppressants for the rest of their lives. These help to prevent your immune system from attacking the new organ and your body rejecting the organ. But as immunosuppressants weaken the immune system, they also put you at an increased risk of infection.

Life After a Heart Transplant

Most patients return to normal life within a couple of months of receiving a liver transplant. Regular checkups are essential during your recovery.

Liver transplants are successful for most patients, meaning the new liver is functional one year after surgery. Your overall health and other conditions may affect success rates. Some patients may see a return of liver disease, while many others live for many years after a liver transplant.