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.
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