The liver is an important organ in the upper abdomen (belly). It helps fight infections and digest food, cleans the blood, and stores nutrients.
Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one. It’s used for end-stage liver disease (ESLD), acute fulminant liver failure, and unresectable hepatocellular carcinoma (liver cancer).
The most common reason in adults is cirrhosis. Cirrhosis destroys healthy liver cells and scars the liver. Viruses (hepatitis B and C), alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases can cause cirrhosis. In children, the most common reason is missing or damaged bile ducts (tubes that take bile out of the liver). Blocked bile ducts cause cirrhosis. Other reasons are liver cancer and hereditary diseases.
People feel tired or weak. They have nausea, weight loss, no appetite, and easy bruising or bleeding. Fluid builds up in the abdomen and causes bloating (ascites). Jaundice (yellow skin and eyes) may occur.
Many more people need a transplant than there are livers available. The nonprofit organization called United Network for Organ Sharing (UNOS) handles selection. The MELD scoring system is used for most people to decide who gets a transplant.
Liver transplantation generally isn’t done for people with other cancer; serious heart, lung, or nerve disease; persistent alcohol or illegal drug abuse; or severe infection.
Whole livers come from people who have died (cadaveric donor). Healthy living donors (usually family members) can also donate part of their liver. This can be done because the liver can regrow to normal size.
All livers are tested before surgery. Tests make sure that the liver is healthy, the right size, and that blood types match. The surgeon disconnects the diseased liver from bile ducts and blood vessels. The surgeon then puts in the healthy liver and reconnects it.
Return of the original disorder is the most common problem. Other complications include rejection, which can result in nausea, pain, fever, and jaundice. Rejection occurs when the immune (infection-fighting) system attacks the new liver. Medicines (corticosteroids, cyclosporine, tacrolimus) can stop rejection. A liver biopsy is often needed to confirm rejection. For a biopsy, the doctor takes a piece of liver to study with a microscope.
Hepatitis C and other infections may also hurt a new liver.
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