Pros and Cons of Living-Donor Liver Transplants

Reviewed by Hansa D. Bhargava, MD on October 28, 2020

You probably have lots of questions if you’re faced with the decision to donate part of your liver or get one from a living donor. Just like any medical procedure, there are risks and benefits. Here are some of the things you should consider.

Pro: You’ll regrow the part you donated.

The liver is the only organ in your body that can regenerate, or regrow lost tissue. Your liver will start to work like normal 2-4 weeks after surgery. About 2 months later, it’ll be back to the size it was before the donation.

Con: Both sides can have complications.

Your chance of problems after surgery depends on how much of your liver you’re donating. As a donor, there’s a chance you could get an infection after surgery. It’s not common, but you could also have serious complications. These include:

  • Bleeding
  • Injury to the rest of your liver
  • Bile leak or fluid in your belly
  • A hernia (when part of an organ sticks out through an opening) where the doctor cut you

Continued

It’s rare, but liver donors sometimes end up needing a new liver themselves after donation.

If you get a living-donor liver transplant, there’s a chance your body won’t accept the new organ. You’re also at risk for:

  • Blood clots
  • A leaking or narrowed bile duct
  • Tumor
  • Infection

Pro: It improves your short-term outcome.

People who get a liver transplant from a living donor tend to have a higher rate of short-term survival than those who get their liver from a donor who has died. Doctors can’t say whether long-term survival rates are better for living-donor recipients. That’s because living-donor recipients are usually in better health than deceased-donor recipients at the time of surgery. They usually haven’t been waiting as long.

Con: Recipients take meds for life.

Along with other medications to help keep complications at bay, you’ll have to take immunosuppressant drugs for the rest of your life. Immunosuppressants keep your body from attacking your new organ. These drugs weaken your immune system, so you’re at a higher risk for infection when you’re on them.

Life on Anti-Rejection MedicationAnti-rejection medication blocks your immune system’s response to a new liver. See what life will be like after your transplant.157

[MUSIC PLAYING]

RAM SUBRAMANIAN: After a liver

transplant,

it is really important

to be taking

your anti-rejection medications.

The new liver is a foreign organ

to the body

and one's immune system

recognizes that organ as foreign

so it has the potential

to reject that organ.

So the anti-rejection meds

are targeted at preventing

that rejection.



These anti-rejection medications

are targeted at blocking

those immune mechanisms that can

potentially cause rejection

of the new liver.



So the anti-rejection

medications are given

intravenously at the time

of transplantation,

and after that, they are given

by capsule so it is a readily

administered form of medicine.



The risk of rejection

is maximum right

after transplantation--

in the first six months

to a year--

so that is when we check

the liver enzymes regularly.

In fact, in the first couple

of months, we check their labs

even three times a week.

The good news is that as they

move farther and farther away

from liver transplantation,

the risk of rejection decreases,

so the frequency of labs

decreases as well.

Also, the amount

of immunosuppression that we

need to give them also

can be weaned over time

because the risk of rejection

decreases.

It never goes to off

but it still can be decreased

over time.



The anti-rejection meds that we

have at our disposal do

have side effects.



So as you block

the immune system, you increase

the risk of developing

infections as well,

and that is why we are very

vigilant about watching

for infection complications

in these patients.

So they have any symptoms,

such as a cough, abdominal pain,

diarrhea,

we have a very low threshold

to screen them

for infectious complications.



The second

is that these medications can

have effects on different organ

systems

independent of infection.



It can commonly cause kidney

problems.

It can cause neurologic or brain

problems.

It can increase the risk

of high blood pressure.

So even though these medications

are very effective in preventing

rejection, we also have to watch

for these other complications

that comes as a side effect

of these medications.



One of the remarkable things

about a liver and liver

transplantation

is that it can be lifesaving

and provide a recipient

with many more years of life.

For example, I saw somebody

in clinic yesterday who was

25 years post-liver transplant.

An important requirement

for achieving that degree

of success with liver

transplantation is the patient

needs to be compliant

with their anti-rejection

medications.

Ram Subramanian, MD/delivery/45/99/4599ca77-65ed-434b-90cf-5722fbeb91b9/funded-expert-feature-anti-rejection-medicine_,400k,1000k,4500k,2500k,750k,.mp410/9/2018 1:43:00 PM650350life on anti rejection medication video/webmd/consumer_assets/site_images/article_thumbnails/video/life_on_anti_rejection_medication_video/650x350_life_on_anti_rejection_medication_video.jpg091e9c5e81aedad0

Continued

Pro: You’ll have a faster recovery.

Living-donor recipients have shorter hospital stays after surgery than deceased-donor recipients. You’re also less likely to need a blood transfusion or dialysis.

Con: Recovery still takes time.

Liver transplant is a major surgery, for both the donor and the recipient. You’ll both need to stay in the hospital afterward. Right after surgery, you’ll both go to the intensive care unit (ICU) for monitoring. The donor can usually go home in 4-7 days. Recipients typically stay 1-2 weeks or longer. Your doctor will watch for signs of rejection during this time.

Even after you’re home, it may take a few more weeks to get back to normal. You may have some pain where the doctor cut you. If you’re a donor, recovery may take about 3-6 weeks. If you’re a recipient, it may take about 3-6 months. Everyone is different -- it depends on things like your age and overall health.

Continued

Pro: Insurance covers donation.

The recipient’s insurance should cover the biggest costs of liver transplant. These include:

  • Pretransplant evaluations
  • Surgery
  • In-hospital recovery
  • Follow-up care

Con: There are still some costs to consider.

You’ll need to think about how much other parts of the donation process will cost. These can include:

  • Travel expenses
  • Hotels stays for yourself or family before the surgery
  • Missed pay from time off work
  • Pain medications

Pro: You’ll have a shorter wait for a liver.

More than 17,500 people in the U.S. are on the waitlist for a new liver. A living-donor donation can come from a family or loved one. This means you’ll spend less time on the waitlist, if you even need to be on it at all. This lowers your odds of getting very sick from liver disease. It also improves your chance of a successful transplant and higher quality of life after surgery.

 

WebMD Medical Reference

Sources

SOURCES:

Beth Israel Lahey Health: “Benefits and Risks of Live Donor Liver Transplants.”

Mayo Clinic: “Living-Donor transplant.”

Medscape: “What are the most common complications of liver transplantation?”

Columbia University Irving Medical Center: “FAQs: What You Should Know About Living Donor Transplants.”

Johns Hopkins Medicine: “Liver Transplant,” “Living Donor Liver Transplant.”

UW Health: “Living Liver Donation.”

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