Liver Transplant

Liver Transplant Program

If you or someone you know are considering a liver transplant, it is important that you completely understand the benefits, risks, and limitations of transplantation so you can make an informed decision.

Your success as a liver transplant recipient depends in part on your understanding of what to expect before, during, and after your transplant surgery.

The Healthy Liver

The liver is the largest solid organ in the body, weighing about three (3) pounds in the adult. It is located primarily on the right side of the body between the diaphragm and the bottom of the rib cage. The blood vessels that carry blood to the liver are the large portal vein and the smaller hepatic artery. The blood vessels that carry blood away from the liver are the hepatic veins. The liver performs several important functions, a few of which are:

  • Metabolism (breakdown) of nutrients from food for use by the body.
  • Manufacture of proteins necessary for blood clotting and restoring body protein, which your body continually breaks down.
  • Metabolism of drugs and hormones.
  • Manufacture of a protein called albumin, which helps the body keep blood volume and blood pressure normal.
  • Manufacture of bile, which helps the body digest fats.
  • All of these important liver functions are decreased or lost when the liver is irreversibly damaged from disease. Just as you cannot live without your other vital organs, you cannot live without your liver. Your liver is a vital organ, necessary to sustain life.

The Failing Liver

Cirrhosis is a chronic, progressive disease in which the functions of the liver are gradually lost as normal liver tissue is replaced by scar tissue. Common causes of cirrhosis in the adult are chronic hepatitis, sclerosing cholangitis, primary biliary cirrhosis, hepatic vein thrombosis, chronic alcohol abuse, and cryptogenic or unknown causes.

Damage to the liver occurs from a virus, a poison, or disease. As part of the healing process, scar tissue forms and replaces normal liver cells and tissue. As liver function is gradually lost, some or all of these signs of liver disease may appear:

  • Jaundice (yellow coloring of the skin and eyes)
  • Itching
  • Dark, tea-colored urine
  • Clay-colored stools
  • Weight loss and muscle wasting
  • Tendency to bruise and bleed easily
  • Ascites (fluid in the abdomen)
  • Decreased energy and fatigue
  • Mental confusion which may progress to coma
  • Vomiting blood or passing blood in the stools
  • Edema or swelling of your legs or other parts of your body

Risks of Liver Transplant

Liver transplantation has been a life-saving surgery for many individuals. Currently, the survival at 5 years after transplant is about 70-85%. Success is largely due to advances in drug therapy (immunosuppression) and surgical technique. Long-term survivors of liver transplantation can lead active and productive lives. However, there are significant risks associated with the surgery and the chronic use of immunosuppressive drugs. A member of the liver transplant team will discuss them with you individually.

Liver Transplant Waiting List

If it is determined that liver transplantation is the best treatment option for you, there will be a period of waiting for a compatible donor liver to become available.

Your Status on the List

Your name will be added to a list of other patients waiting for a liver transplant. The United Network for Organ Sharing (UNOS) is the national agency that regulates organ transplantation. LifeLink of Georgia, the organ recovery agency for this area, will coordinate efforts to locate a donor for you. Your priority for transplant is based on what's called the "UNOS MELD" score: Your bilirubin, prothrombin time (INR), and creatinine are used to stage your priority. It is critical that you have labs done when requested and ensure that they are sent to us, or your score may be dropped to lower levels by UNOS. Generally, as your MELD score increases, you move up on the list. However, if your score gets too high, you may be too sick for a transplant.

There is absolutely no way to predict when a donor will become available. The wait, depending on your UNOS priority score, could be a few hours to several months or even years.

Every effort will be made to find a donor quickly. The wait for a donor depends on your MELD score, blood type, body size, and the critical nature of your disease. To find a donor match for you, we look at three things:

  • You and the donor must have compatible blood types.
  • You and the donor must be close to the same weight.
  • You must not have antibodies that are incompatible with the donor.

The United Network for Organ Sharing (UNOS) provides a toll-free patient services line to help transplant candidates, recipients, and family members understand organ allocation practices and transplantation data. 

Anxiety While Waiting is Normal 

Helpful ways of coping with the stress of waiting for a liver may include:

  • Keeping up your normal daily routines as much as possible.
  • Talking with someone on your team to help sort out your feelings. This could include your transplant coordinator, social worker, or physician. While waiting for a transplant, just "checking in" with your coordinator on a regular basis allows you to get questions answered and talk about any anxiety you may be having.
  • Contacting the Georgia Transplant Foundation's Mentor Project. This program has been developed to match people who are new to the world of transplantation with people who are living with a transplant. You can get more information on the Mentor Project during your evaluation.

Liver Transplant Surgery

When a compatible liver donor is found, you will be notified by a member of the liver transplant team. At that time, you will be given instructions about coming to the hospital for your transplant. We advise you not to bring any valuables with you, such as jewelry, money, or expensive clothing. We will tell you that we have a potential donor and then ask how you have been feeling physically. If you have a fever, vomiting or diarrhea, we may not be able to do the transplant. The most important thing you can do while waiting for a transplant is to seek treatment quickly if you become ill, so that you will be ready at any time should a donor liver become available. The first call you get does not always mean the transplant will occur. We will tell you that we have a potential donor. The surgeon examines each donor organ and may find that the organ is not strong and healthy. If the donor organ is not functioning well, we will not do the transplant. This does not happen often, but it is a possibility.

Arriving at the Hospital 

When you arrive at the hospital, you will be prepared for surgery. This time will be very hectic. Several final procedures such as blood tests, chest X- ray and an EKG may need to be done. A transplant surgeon and an anesthesiologist will also talk with you, and you must sign a Consent for Surgical Operation.

Day of Surgery

On the same day or the next morning, you will be taken to the operating room. There, the anesthesiologist will insert intravenous needles for administration of medications and blood and for taking blood samples. Medications will be given to make you fall asleep. A catheter will be inserted into your bladder and will drain your urine, and a tube that goes into your lungs will be attached to a respirator to breathe for you during surgery and for a short period of time afterwards. The transplant surgeons will make an incision in your abdomen to remove your liver and replace it with your new one. Small tubes known as Jackson Pratt (JP) drains will come out of your incision to drain fluid from around your new liver. They will remain in place until the drainage stops. A nasogastric (NG) tube will be placed through your nose and into your stomach to keep it from filling with air until normal bowel functions return. Your family will be asked to wait for you in the Intensive Care Unit (ICU) waiting area. We will make every effort to keep them informed of your progress. If your family chooses to wait somewhere other than the ICU waiting area, they should inform the ICU nursing staff of their location. The surgery usually lasts from six to eight hours, but may take considerably longer in some patients. When the surgery is over, one of the surgeons will speak with your family. You will be taken directly to the ICU. Your family will be able to visit you for the first time about one hour after your arrival in the ICU. Each time your family members visit, they first will be asked to wash their hands at the sink inside your room. This is required of all visitors at all times. Hand washing is also required of all members of the liver transplant team. As you begin to recuperate and feel stronger, the tubes and catheters will be removed. 

After Liver Transplant Surgery

When you awaken in the ICU, the sights and sounds around you may be unfamiliar. Your recovery will be monitored and managed by highly skilled critical care nurses. 

The tube in your lungs will remain in place to help you breathe deeply and prevent pneumonia until the anesthesia is completely out of your system. Because this tube passes through your vocal cords, you will not be able to talk while it is in, which will make communicating a challenge. The nurse will ask you “yes” and “no” questions and help you write messages on a notepad. When the tube is removed, you will be asked to do exercises, such as coughing and deep breathing, to keep your lungs clear.

You will have “squeezing devices” or sequential compression devices on your legs to promote the circulation of blood in your legs while you are on bed rest. This helps to prevent the formation of blood clots in your legs.

You will probably look different to your family: you will be pale, possibly swollen and will feel cool to their touch. This will improve after just a few hours in the intensive care unit. You will also still be sleepy and may not remember the first time your family visits.

 A typical stay in the ICU is one to four days. Several times each day, various members of the transplant team will make rounds to monitor your progress. Please do not be alarmed at all of the attention you will be getting. This is normal and necessary for a safe recovery.

You will then be transferred to the surgical floor where our nurses and physical therapists will help you regain your strength, teach you how to care for yourself when you go home, and prepare you for discharge from the hospital. If all goes well, you can expect to spend five to seven days on the surgical floor before your discharge. During your recovery you will have both “good” and “not-so-good” days, but over time, you should get stronger and begin noticing differences in your body and abilities. Keep in mind that no two liver transplant patients recover at the same pace. You are an individual and comparing your progress with that of another transplant patient may only confuse and frustrate you. As you move closer to the time you will leave the hospital, your activity level will be increased. You will be encouraged to walk daily. Eventually, you will be able to venture outside the hospital. You will also be expected to know how and when to take your medications.

Deep Breathing and Coughing

Deep breathing and coughing will help expand your lungs and remove lung secretions that have settled during your surgery. A respiratory therapist will show you how to use an incentive spirometer, a device that will help you take deep breaths. It is a good idea to take the incentive spirometer home with you to use the first four to six weeks after surgery. 

Coughing may be painful, since you will have an incision. The nurse will teach you how to splint (decrease the pain by holding a pillow or your hands over your incision). Ask the nurse for pain medicine so you can breathe deeply and cough more easily and effectively.

Exercise and Activity 

You should begin to increase your physical activity soon after your surgery. A physical therapist will be available to you. Once you are feeling better, generally the third or fourth day after surgery, you should begin walking in your room and the hallway. Each day increase the time and distance you walk.