Liver Transplantation

Dianne LaPointe Rudow RN, NP, MSN, CCTC and
Robert S. Brown Jr., MD, MPH

Ms. Rudow and Dr. Brown can be reached at
Center for Liver Disease and Transplantation
Columbia University College of Physicians and Surgeons
New York Presbyterian Hospital
(212) 305-0914
(877) LIVER MD toll free

Your physician may recommend a liver transplant when all other treatment options fail. The purpose is to replace your diseased liver with a healthy liver. Ideally, after a transplant you will be free from disease, and lead a fairly normal life as long as the transplant functions. Indications for liver transplant include:

  • Hepatitis B
  • Hepatitis C
  • Alcohol induced cirrhosis
  • Autoimmune Hepatitis
  • Cryptogenic cirrhosis
  • Congenital Hepatic Fibrosis
  • Primary Biliary Cirrhosis
  • Biliary Atresia
  • Primary Sclerosing Cholangitis
  • Alagille’s Syndrome
  • Familial Cholestasis
  • Drug induced liver failure
  • Acute/fulminant liver failure
  • Alpha 1 antitrypsin deficiency
  • Wilson’s Disease
  • Hemochromatosis
  • Tyrosinemia
  • Protoporphyria
  • Cystic fibrosis
  • Urea Cycle defects
  • Familial hypercholesterolemia II
  • Glycogen Storage Disease
  • Primary Hyperoxaluria type I
  • Crigler-Najjar syndrome type I
  • Neimann- Pick Disease
  • Familial Amyloidosis
  • Hepatocellular Carcinoma
  • Hepatoblastoma
  • Hemangioendothelioma
  • Non-Carcinoid neuro-endocrine tumor
  • Budd Chiari Syndrome

There are three options for liver transplantation: cadaver donor transplantation, living donor transplantation, and auxiliary transplantation.

Cadaver donor: The donor liver is obtained from a person who is diagnosed as brain dead whose family volunteers to donate the organ for transplantation. People who receive cadaver donors wait on the national computer list (UNOS Waiting List) until a suitable donor becomes available. The waiting times vary.

Living donor: A healthy family member, usually a parent, sibling, or child, or someone emotionally close to you, such as a spouse, volunteers to donate part of their liver for transplantation. The donor is carefully evaluated by the team to make sure no harm will come to the donor or recipient.

Auxiliary transplantation: Part of the liver of a healthy adult donor (living or cadaver) is transplanted into the recipient. The patient’s diseased liver remains intact until the auxiliary piece regenerates and assumes function. The diseased liver may then be removed.

Most liver transplants are successful.

The average success rate of a liver transplant at one and five years is 92 percent and 88 percent respectively. Once a Transplant Center determines that you are an appropriate candidate for transplantation, a suitable donor becomes available, and you have successfully completed the surgery, you have a good chance to lead a normal, healthy, active, life. However, to help insure successful outcomes, it is vital that you closely follow your physician’s recommendations. This will include taking immunosuppressive medications and monitoring your blood tests regularly.

The Transplant Evaluation

You need a thorough medical checkup before a transplant.

The Initial Consultation

During the consultation you will meet with members of the transplant team to review your past medical and social history to ascertain appropriate medical treatment.

You may meet various members of the Transplant Team:

Blood Tests

You may be asked to have your blood drawn to confirm your blood type, evaluate serum chemistries, hematology, coagulation, hepatitis screens, and viral studies. If you are being evaluated for a liver transplant you must sign consent to be tested for HIV (AIDS). All transplant centers are required to test all potential transplant recipients. The results of these tests are confidential and will not be released without your permission.

Radiology and Other Tests to Check your Liver

You may be required to have one or more of the following tests:

Cardiac Evaluation

The Transplant Team may require you to undergo a cardiac workup to make sure your heart is strong enough to withstand treatment.

Pulmonary Evaluation

If you were a smoker or have a lung disease you may need some of the following tests:

In addition to the medical tests used to determine the extent of your liver disease, a transplant evaluation requires additional assessments. These may include the following:

Social Work/Psychiatry

A social work/psychiatry consultation may be necessary to help you and your family with the many psychological and social issues involved with transplantation. It is vital that all potential transplant recipients have adequate support systems to help them through the process.

Alcohol/Drug Screening

All potential transplant recipients may be randomly tested for alcohol and illicit drugs throughout the transplant process. Use of these substances will forfeit a patient’s eligibility to be transplanted at our institution. You may be asked to sign a contract with our social worker regarding this matter.

Financing Transplantation

At the time of your initial consultation financial counselors may meet with you to verify your insurance coverage for transplantation. Many insurance companies require a letter from a Transplant Center confirming the medical necessity for you to undergo a transplant as well as the results of your transplant evaluation before they will approve a transplant.

It is very important that your pharmacy plan covers the transplant medications. As a potential candidate, you will be required to sign a pharmacy agreement stating that you will be responsible for all pharmacy expenses not covered by your insurance company.

Since the medications are very expensive, it is not uncommon for patients to have difficulty in affording them. If you do not have sufficient coverage, a finance counselor or transplant social worker will do their best to assist you in this matter.

Upon Completion of Your Evaluation

When your evaluation is completed, the transplant team will determine, based on the results, whether a transplant is necessary and if you are physically able to undergo the procedure.

Waiting for a Transplant

The waiting period varies depending on the type of transplant you require (cadaver, living, auxillary), your blood type, how sick your liver is, and your height and weight. You should ask the transplant team to estimate your approximate waiting time. During the waiting period, The Transplant Center will work with you closely to assist you in remaining as healthy as possible.

You will be followed by your primary referring physician who will confer with the transplant team when necessary. In addition, the Transplant Team will see you periodically.

Stress Management

Waiting for a transplant can trigger many feelings. It is essential to stay in tune with your feelings. It is important to talk with someone and get the support you need. Some people cope better when sharing their feelings with others going through the same thing as you are. There are many organizations that provide support groups. The following are a few but our social worker may be able to recommend what is appropriate for you:

There are many support groups that can help you and your family through the pre- and post-transplant periods.


Trio (Transplant Recipient Organization)
1000 16 Th ST., NW
Washington, DC 20036 (800) 874-6386

Lola (Latino Organization for Liver Awareness)
P.O. Box 842
Throggs Neck Station Bronx, NY 10465 (718) 892-8697

ALF (American Liver Foundation)
1425 Pompton Ave.
Cedar Grove, NJ 07009
(800) 223-0179

Children’s Liver Alliance
3835 Richmond Avenue Box 190
Staten Island NY 10312-0190
(718) 987-6200

American Council on Transplantation
P.O. Box 1709
Alexandria, Va 22313

Children’s Liver Foundation
76 South Orange Avenue, # 202
South Orange NJ 07079
(201) 761-1111

Eating Healthy

Fatigue, decreased appetite, nausea, vomiting, and food intolerances are sometimes associated with liver disease. Throughout the progression of the disease, development of ascites (increased fluid in the abdomen), hepatic encephalopathy (disorientation), increased diarrhea (from medications) and edema (fluid retention in the feet and legs) may leave you feeling further fatigued and depleted.

The goal of nutritional management of liver disease is to help you maintain or improve your nutritional status, achieve or maintain calories, and appropriate amounts of protein (without contributing to hepatic encephalopathy). It may be necessary to reduce your sodium and fluid intake. The nutritionist may provide you with a diet individually tailored to meet your nutritional needs and stay as healthy as possible while waiting for your transplant.

Keeping Active

The effects of a compromised liver such as malaise, decreased appetite, fatigue, and depression can take a toll on an individual’s ability to perform activities of daily living. This reduced activity can lead to a decrease in flexibility, and endurance, and eventually a decrease in cardiopulmonary performance resulting in an increased surgical risk.

A daily program consisting of regular exercise and normal activity can reduce complications and maximize your strength, flexibility, mobility, endurance, and breathing

The Surgery

At the time of transplant, you will be admitted into the hospital and prepared for surgery.

Regardless of the type of donor you have, an average donor operation lasts about 3.5 hour and an average transplant takes about 4.5 hours. The surgeon will notify your family when the procedure is completed. Immediate family may then see you for a few minutes after the surgery. It is important that those who are ill postpone visiting until they are well. Initially, you will be in the Intensive Care Unit where you can be watched very closely. You may be attached to a cardiac monitor, intravenous lines, tubes and drains. When your condition stabilizes, you will be transferred to a regular room where you will complete your recuperation process and learn how to care for yourself at home.
The average length of stay for liver transplantation is 7 to 12 days.

The Medications

After a liver transplant you will be required to take many medications. You will be put on a combination of the following drugs; Sandimmune®, Neoral®, Prograf®, prednisone, Imuran®, Cellcept®, Zenapax ®, or Simulect®. The purpose of these medications. is to prevent rejection of your transplanted liver. These medications have many side effects. They may include high blood pressure, excessive hair growth or loss, hand tremors, mood swings, weight gain, bone loss, and diabetes. Many side effects are temporary and some will continue as long as you are taking the medications. We do our best to minimize side effects and reduce dosages as quickly as possible to avoid complications.

Complications

As with any other surgical procedure, complications may arise after liver transplantation. Some of these complications include:

Life after a Liver Transplant

There are many new things a person will experience after a liver transplant. You will be instructed on how to care for yourself before you leave the hospital. Most patients recuperate fully within the first three months, return to work and have active lives. The goal is to provide excellent care and follow up in concurrence with your primary physicians in order to make the length and quality of life appreciably better than before.

Need more information about liver transplant? Send your email questions to Ms. Rudow

10/8/98

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