Liver Transplant Our Philosophy of Care At the University of Rochester Medical Center, we believe a liver transplant is a lifelong commitment for you and for us. We will stay involved with you and your family through the entire transplant process. We get to know you very well and recognize that preparing for and living with a transplant will affect your lifestyle in many ways. We will help you maintain and resume many of your activities and even become involved in new ones. We are committed to the time, effort, and resources required to make your transplant a success. Our definition of success extends far beyond the operating room. We will work with you to make your life after the transplant as successful as possible. What Does the Liver Do? The liver is one of the largest organs in the body and is located in the upper right portion of the abdominal cavity immediately below the diaphragm and behind the lower right part of the ribs. It is divided into five sections or “lobes” and has many important, complex functions. Among them are: Removing or neutralizing toxins (poisons), germs, and bacteria from the blood Making immune agents to control infection Making proteins that regulate blood clotting Making bile, a fluid that aids digestion by helping to absorb fats and fat-soluble vitamins (bile ducts carry bile from the liver to the intestine) Storing vitamins and other nutrients the body needs, including sugars to produce energy You can’t live without a functioning liver. Liver Diseases Several diseases can injure the liver and stop it from working correctly. These include: Cirrhosis: Scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should; a major cause of cirrhosis is excessive alcohol consumption. Hepatitis: Inflammation or swelling of the liver, usually caused by a virus. There are several types of viral hepatitis; the most common are known as: Hepatitis A Hepatitis B Hepatitis C (Hepatitis C is the most serious) Cancer: Cells in the liver reproduce faster than they should, creating growths called tumors; liver cancer can be fatal. Wilson Disease: An inherited metabolic disorder in which the body has too much copper. Non-cancerous tumors Problems with the major blood vessels that supply the liver These diseases, and others, can be treated in a number of ways. But if they have progressed far enough and a liver is damaged badly enough, and if other treatments have been unsuccessful, a liver transplant may be the best treatment option. Your primary doctor will make the referral to the URMC Division of Solid Organ Transplantation. What is a Liver Transplant? In a liver transplant, the patient’s diseased liver is surgically removed and replaced by a healthy liver from a donor. Usually, healthy livers come from donors who have recently died but did not have liver injury. This is called deceased donor transplantation. However, segments of liver can be taken from a living organ donor who may be a family member or friend. This procedure is called living donor transplantation. Is a Liver Transplant Right For You? A liver transplant is offered only to people who have irreversible, chronic liver failure. Usually, other medical or surgical treatments have been tried before a transplant is considered. Age is not necessarily a factor in deciding if you're a candidate for liver transplant. Newborns, infants, children, and adults past the age of 70 have all had successful liver transplants. What is important is your general health and suitability for major surgery. For example, you can't have a transplant if you have: Cancer in another part of your body Serious heart, lung, kidney, or nerve disease that would make the operation too risky Active alcoholism or illegal drug abuse An active, severe infection that can’t be completely treated or cured, such as tuberculosis An inability to follow your doctor’s instructions Of course, all major surgery carries risks, and a transplant is no exception. The risks associated with surgery in general are: Reactions to anesthesia Problems breathing Bleeding Infection Transplants carry additional problems, such as: Rejection (the body considers the transplanted organ to be a foreign substance and uses its natural immune system to destroy it) Life-long need to take medicines (immunosuppressive drugs) that prevent rejection by suppressing the immune system and weakening the body’s ability to fight infections Finding a healthy organ Cost Despite these risks, a transplant may be the best treatment option for your condition. Liver transplants do save lives. About 75% of people survive at least 3 years or more after the transplant. The Transplant Process In addition to the information that follows, you can get a brochure about liver transplants at URMC. You can read the complete brochure by calling us at (585) 275-5875. Model for End-Stage Liver Disease (MELD) A new system, the Model for End-stage Liver Disease (MELD) has recently replaced the previous one. The MELD system is based on three simple to measure laboratory tests, and the MELD score is predictive of death within 3 months (the higher the score, the higher the risk of death). Candidates with sudden, acute liver failure are still allocated organs ahead of all other waiting patients. Transplant Surgery You’ll be contacted when a liver is available. If your new liver is from a living donor, both you and the donor will be in surgery at the same time. If your new liver is from a person who has recently died, your surgery starts as soon as the new liver arrives at the hospital. The liver must be transplanted within 12 to 18 hours. The surgery can take from 4 to 14 hours. You will be given general anesthesia. While the surgeon removes your diseased liver, other doctors prepare the new liver. The surgeon makes an incision in the upper part of your abdomen and then disconnects your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver. Recovery Your total hospital stay after surgery will likely be between one and three weeks. Immediately after surgery, you’ll be taken to the Surgical Intensive Care Unit (SICU), where the average post-transplant patient with no complications stays for about two days. Your primary care doctor and/or gastroenterologist will be given information about your surgery and current condition. From the SICU you’ll go to the Inpatient Transplant Unit. Here, you'll take medicines to prevent infections and rejection of your new liver. Your doctor will check for bleeding and other problems. You’ll slowly start eating again. You'll begin with clear liquids, then switch to solid food as your new liver starts to work. You'll also be prepared for your return home. You'll be given a schedule for follow-up visits and routine blood draws, and a 24-hour phone number for emergencies or other problems. You’ll learn how to deal with the medicines you’ll be taking and their side effects, recognize rejection symptoms, plan proper diets and generally take responsibility for your recovery at home. The transplant coordinator, social worker, and psychiatrist are all available when needed. The social worker will help arrange your discharge needs, such as rehabilitation or long-term placement, chemical dependency counseling, and transportation home. You’ll also be offered a referral to a community health nurse who can help you at home.