Liver Transplant: Basic Information

Organ transplant is probably one of the best discoveries in medicine. There are statistics to show that there is a high success rate with liver transplants for instance. Recipients can live a normal life 30 years or more after the transplant. According to the UNOS (United Network for Organ Sharing), there has been a 20% increase in organ transplants in the last 5 years, and there were over 33,000 successful organ transplants in the U.S in 2016 alone.Despite this impressive improvement, over 118,000 people still need organ transplants and are on the UNOS waiting list. This article will provide basic information about liver donation and transportation.

A brief history of liver transplantation

The first successful liver transplant was done at the University of Colorado led by the late Dr. Thomas Starzl in 1967. In 1988, Viaspan, a cold storage solution was approved by the FDA. This solution has been instrumental in the preservation of donated livers. The first successful living-related liver transplant was done at the University of Chicago Medical Center led by Dr. Christoph Broelsch from Germany in 1989. The first baboon to human liver transplant was done at the University of Pittsburgh Medical Center in 1992. The late Dr. Thomas Starzl directed it, and it was performed by 3 doctors, Dr. John Fung, Dr. Satoru Todo, and Andreas Tzakis.

Types of liver transplants

After delving into the history of liver transplants, let us look at the various types of liver transplants. There are basically 3 types of liver transplants. Let’s look at them briefly.

  1. Orthotopic – this is where the donor is deceased, usually, the whole liver is transplanted. The donor usually pledges his or her organs for donation prior to death. The organs should not have illnesses or cancers that may be transmitted to the recipient.
  2. A living donor transplant – where the donor is alive. The left or right lobe is removed and given to someone else.
  3. A split type transplant – here, a liver from a recently deceased person is divided between two individuals.

When does a liver transplant become necessary?

A liver transplant becomes necessary when the liver functions are too damaged, to the extent that the body is unable to regenerate (liver failure). Liver disease, tumors or generalized diseases could result in liver failure. The reasons for a liver transplant vary with the patient’s age and severity of the disease.

Determining whether one is a suitable liver transplant candidate

A liver transplant should only be done after very careful examination and consideration. A team is usually brought together to aid in making this vital decision. The team comprises specialists from a variety of fields to help in evaluation. They will review your medical history and carry out appropriate tests. Depending on their findings, they could choose the patient as a liver transplant candidate or not.

The team is usually made up of transplant surgeons, a social worker, an anesthesiologist, a financial counselor, a liver specialist (hepatologist), a transplant coordinator, a psychiatrist, and a chemical dependency specialist.

How is a donor found?

If the aforementioned team of specialists concludes that one is an active liver transplant candidate, they place their name on a waiting list. The patient’s body size, blood type and how ill they are will determine their priority on the waiting list. Three simple blood tests are used to give the patient a priority score. In adults, the score is referred to as the model of end-stage liver disease (MELD) and pediatric end-stage liver disease in children (PELD).

Patients with high PELD or MELD scores are given higher priority on the waiting list. The score rises as the patient becomes sicker.

Is the liver from the donor screened?

If the donor is living, they are usually required to fill some documents and ask any questions that they have. The transplant coordinator could also ask questions. The documents help to determine whether they are a suitable candidate. They then go through thorough medical screening. The donor is required to volunteer for the medical screening, no coercion is used.

After the tests are done, the results are given to the transplant coordinator. If the donor is still deemed healthy, they are scheduled for an evaluation appointment. If they are not healthy enough to be donors, they will be informed by the transplant coordinator.

If the donor is deceased, a medical and social history interview is conducted with the deceased donor’s next of kin, according to the OPTN, Organ Procurement and Transportation Network policy. The interview may also involve other people who knew the deceased. The interviews help in gathering information about behaviors that could have exposed the potential donor to certain diseases, and also his or her medical history.

What about graft failure?

According to a research published on the NCBI (National Center for Biotechnology Information), it is important for several factors to be considered to minimize graft failure and the need for re-transplantation. This is why donor screening is important. In addition, graft, recipient and donor factors also need to be considered. Proper matching of donor and recipient matters.

Factors like age are important. Liver grafts from young adults are usually of excellent quality and are usually used in split-type transplants. Liver grafts between the same genders seem to have less risk of graft failure.

Despite taking the above precautions, the body’s immune system tends to reject the transplanted liver. Around 65% of liver recipients will have some degree of organ rejection within the first 90 days after the transplantation. Anti-rejection medication is usually administered to manage that.

How long does it take before one is discharged?

After the transplant, you will stay in the hospital for 2 to 3 weeks. It could be longer or shorter, depending on any complications that may arise.

Any follow ups after the transplant?

Your first appointment after discharge will be about 1 or 2 weeks after the discharge. You will return 5 months after the operation, where the T-tube will be removed if it was inserted. You will return 1 year later after the transplant and every year after.