Why You Might Need a New Liver

Medically Reviewed by Minesh Khatri, MD on May 14, 2023
4 min read

When your liver isn't working the way it should, it affects your body in a big way. The organ does hundreds of important jobs, from filtering harmful things in your blood to helping you digest food.  If disease causes your liver to fail, you might need surgery to put a new one in.

When your liver starts to fail, it becomes inflamed. Inflammation can lead to scarring of your liver tissue, which your doctor may call liver fibrosis.

Scarred tissue can't work the way healthy tissue can. The healthy parts of your liver will start to work harder to cover for the scarred areas. This condition is called liver cirrhosis, and it's the most common cause of liver transplant.

Other changes can cause liver failure, such as tissue death due to a medication reaction or viral hepatitis.

When your liver starts to fail, you may notice symptoms like:

Jaundice. It's a yellowing of your skin that happens when your liver can no longer remove a substance called bilirubin from your blood. You may also have dark urine or pale gray stools.

Cholestasis. It's a condition where bile -- a liquid made in your liver that helps with digestion -- stops flowing normally. You might have itching, dark urine, pale stools, chills, fluid buildup in your belly, and pain.

Enlarged liver. When this happens, you may feel bloated and full.

Portal hypertension. It's high blood pressure in the vein that sends blood to the liver from your intestine and spleen. Because blood has a harder time passing through this vein, new veins grow. The blood in these new veins bypasses the liver, which means toxins don't get removed. This causes symptoms like fluid buildup, brain damage, kidney problems, and an enlarged spleen.

Esophageal varices. If your liver fails, it can cause a backup of blood and higher pressure in the veins in the esophagus, the tube that connects the throat and the stomach. These veins can burst and bleed.

Fluid buildup in the belly. This can lead to shortness of breath and pain.

Buildup of toxins in the blood. It can damage your brain and cause mood changes, confusion, disorientation, drowsiness, and sometimes coma.

If you aren't clear on the reasons why your liver might stop working like it should, you're not alone. A WebMD survey in collaboration with the University of Pittsburgh Medical Center shows that more than two-thirds of respondents say they aren't knowledgeable about liver disease.

The survey shows that even those diagnosed with liver disease and their caregivers could use some facts. Less than one-quarter of them say they feel knowledgeable about liver disease.

So here are some liver disease basics:

It's possible you need a new liver because of liver failure that comes on quickly and suddenly, which is called "acute" liver failure.

More commonly, liver failure happens over months and years, known as "chronic" liver failure. It can be caused by infection from a virus, injury from chemicals, or an attack from your immune system.

Some of the major causes of liver failure include:

Acute hepatic necrosis. A reaction to an infection, toxins in your blood, or drugs can cause tissue in your liver to die.

Hepatitis B or C. Both these viral infections, over the long term, can cause liver damage. Chronic hepatitis C is a common cause of liver transplants in the U.S.

Autoimmune hepatitis. This long-term disease makes your body's immune system attack your liver, causing damage and liver failure.

Genetic diseases. Sometimes the genes you're born with cause liver failure. Diseases that can affect your liver enough that you need a transplant include hemochromatosis, Wilson disease, certain metabolism disorders, cystic fibrosis, and congenital hepatic fibrosis.

Bile duct diseases. These ducts are tubes that carry bile, a dark green liquid that helps with digestion. A disorder called biliary atresia, which closes off the bile duct system in your body, is the most common reason for liver transplants in children. Other long-term bile diseases, such as primary biliary cholangitis and primary sclerosing cholangitis, injure and eventually destroy the small bile ducts in your liver. This causes bile buildup and liver failure.

Alcoholic liver disease. Heavy alcohol use over time can cause several different diseases of the liver, including fatty liver disease, alcoholic hepatitis, and cirrhosis.

Nonalcoholic fatty liver disease. This condition causes fat buildup in your liver. You're more likely to get it if you're obese, have a condition called metabolic syndrome, or have type 2 diabetes.

Liver cancer. Tumors in your liver, such as hepatoblastoma (common in children), hepatocellular carcinoma, or other hepatic tumors, may damage or block part of your liver.