Liver Transplantation

Liver Transplantation

The liver is the body's largest internal organ, weighing about 3 pounds in adults. It is located below the diaphragm on the right side of the abdomen.

The liver performs many complex functions in the body, including:

• Makes most proteins needed by the body
• Metabolizes, or breaks down, nutrients from food to make energy, when needed
• Prevents shortages of nutrients by storing certain vitamins, minerals, and sugar
• Makes bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K
• Makes most of the substances that regulate blood clotting
• Helps the body fight infection by removing bacteria from the blood
• Removes potentially toxic byproducts of certain medications

When Is a Liver Transplant Needed?

A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can happen suddenly (acute liver failure) as a result of infection or complications from certain medications, for example. Liver failure can also be the end result of a long-term problem. The following conditions may result in chronic liver failure:

• Chronic hepatitis with cirrhosis.
• Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts)
• Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver)
• Biliary atresia (a rare disease of the liver that affects newborns)
• Alcoholism
• Wilson's disease (a rare inherited disease with abnormal levels of copper throughout the body, including the liver)
• Hemochromatosis (a common inherited disease where the body has too much iron)
• Alpha-1 antitrypsin deficiency (an abnormal buildup of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)
• Liver cancer

How Are Candidates for Liver Transplant Selected?

Specialists from a variety of fields are needed to determine if a liver transplant is appropriate. Many health care facilities assemble a team of such specialists to evaluate (review your medical history, do tests) and choose candidates for a liver transplant. The team may include the following professionals:

• Liver specialist (hepatologist)
• Transplant surgeons
• Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients (this person will be your primary contact with the transplant team)
• Social worker to discuss your support network of family and friends, employment history, and financial needs
• Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany a liver transplant
• Anesthesiologist to discuss potential anesthesia risks
• Chemical dependency specialist to aid those with history of alcohol or drug abuse
• Financial counselor to act as a liaison between a patient and his or her insurance companies

Which Tests Are Required Before Getting a Liver Transplant?

You will need to bring all previous doctor records, X-rays, liver biopsy slides, and a record of medications to your pre-evaluation for a liver transplant. To complement and update previous tests, some or all of the following studies are generally performed during an evaluation.

• Computed tomography, which uses X-rays and a computer to create pictures of the liver, showing its size and shape
• Doppler ultrasound to determine if the blood vessels to and from the liver are open
• Echocardiogram to help check the heart
• Pulmonary function studies to determine the lungs' ability to exchange oxygen and carbon dioxide
• Blood tests to determine blood type, clotting ability, and biochemical status of blood, and to gauge liver function. AIDS testing and hepatitis screening are also included.

If specific problems are identified, additional tests may be ordered.