Digestive Diseases: 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:

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

When Is a Liver Transplant Needed?

Liver transplantation is considered when the liver no longer functions adequately (liver failure). Liver failure can occur suddenly (acute liver failure) as a result of infection or complications from certain medications or it can be the end result of a long-term problem. The following conditions may result in liver failure:

• Chronic hepatitis with cirrhosis.
• Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts causing liver failure).
• Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver causing the backup of bile in the liver which can lead to liver failure).
• Biliary atresia (malformation of the bile ducts).
• Alcoholism.
• Wilson's disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail).
• Hemochromatosis (a common inherited disease where the body is overwhelmed with iron).
• Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).
• Liver cancer.

How Are Candidates for Liver Transplant Determined?

Evaluations by specialists from a variety of fields are needed to determine if transplantation is appropriate. The evaluation includes a review of your medical history and a variety of tests. Many healthcare facilities offer an interdisciplinary approach to evaluate and to select candidates for liver transplantation. This interdisciplinary healthcare 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 the liver transplantation.
• 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 of your previous doctor records, X-rays, liver biopsy slides and a record of medications to your pre-evaluation. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation.

• Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape.
• Doppler ultrasound to determine if the blood vessels to and from your liver are open.
• Echocardiogram to help evaluate your heart.
• Pulmonary function studies to determine your 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.