Liver Transplantation 101

liver411

Liver Transplantation 101 Michael Abecassis, MD, Northwestern Memorial Hospital The liver can take a good deal of abuse and still manage to perform its thousands of functions in the body. But when the liver hits end-game, the progression from normal health to dire straits can be quick. People with end-stage liver disease are often candidates for transplantation. Below, the director of the liver transplantation program at Northwestern Memorial Hospital will discuss who is eligible for a transplant, and how likely are they to get one. When is a liver transplant necessary? MICHAEL ABECASSIS, MD: There are a couple situations that mandate a liver transplant. First, there are people with no history of liver disease who suddenly experience acute liver failure. There are multiple causes for this type of failure, including viruses or Tylenol overdoses, and these people usually require transplant urgently. The second group of patients who require transplants are those with chronic liver disease, which can be caused by viral hepatitis, hepatitis-B, hepatitis-C, cirrhosis, alcohol, cholestatic diseases and sclerosing cholangitis. There are pages and pages of possible causes of chronic liver disease. These people develop chronic liver disease and then develop complications, which might include bleeding varices (abnormally swollen blood vessels), fluid buildup in the abdomen, or liver cancer. When is a liver transplant not an option? A liver transplant is not considered an option when the patient is too far gone and has developed complications that are not reversible with a transplantation, or when the patients have other medical conditions that would preempt them from getting a transplant. For example, those with advanced heart disease, advanced lung disease, or metastatic cancer are not candidates. Certain psychosocial issues can also affect a person's eligibility. If the patient is an active alcoholic, an active intravenous drug abuser or any type of recreational drug user, then that patient is typically not considered for a transplant. Describe the actual process of signing up for a liver transplant. When a patient is evaluated at a transplant center and deemed to be a potential recipient for liver transplantation, then that transplant center will list the patient with a national organization called UNOS, or United Network for Organ Sharing. There are approximately sixty organ procurement organizations in the country that divide up the country into eleven regions. The patient will be listed with this national organization, but they will also be listed at a local level. How long does the wait for a transplant take? It depends on the severity of illness. About 20-30% of patients waiting for a liver transplant will die waiting. If the patient is in the intensive care unit and has less than a week to live, then that patient may get a liver allocated within the week, but often the patients will die before a liver becomes available. So in that status, for example, waiting times could be as long as a month. If patients are stable and have no real need for an urgent liver transplant, the waiting time could be as long as two or three years.