The Liver Transplant Procedure

Liver Transplant Procedure

Definition

The removal of a diseased liver and replacement with a healthy liver from a donor who has died. In some cases, a portion of the liver of a living, related donor may be used.

Normal vs. Diseased Liver



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Parts of the Body Involved

* Abdomen
* Liver
* Blood vessels and bile ducts attached to the liver

Reasons for Procedure

A liver transplant is done to treat end-stage liver failure, which may be caused by:

* Cirrhosis
* Hepatitis A , B , and C ; autoimmune causes
* Alcoholic liver disease
* Primary biliary cirrhosis
* Primary sclerosing cholangitis
* Acute liver failure
* Congenital defects (such as biliary atresia)
* Liver tumors ( cancerous or benign)
* Metabolic defects (such as Wilson's disease)
* Poisoning or drug-induced damage

Risk Factors for Complications During the Procedure

* Infancy
* Smoking
* Obesity
* Poor nutrition
* Recent or chronic illness
* Use of certain medications
* Serious heart, lung, or kidney disease
* Diabetes
* Cancer
* Infection ( osteomyelitis , tuberculosis )
* Liver disease caused by alcoholism

What to Expect

Prior to Procedure

Because of a shortage of donors, you may be on a transplant list for some time. You may need to carry a pager or cellular phone at all times so that the transplant team can reach you if a donor liver becomes available.

Your doctor will likely do the following:

* Physical exam
* Blood test
* Chest x-ray
* Electrocardiogram (ECG, EKG) -a test that records the heart's activity by measuring electrical currents through the heart muscle
* Possibly other tests

The days before and the day of your procedure:

* Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor. You may also need to stop taking blood-thinning medications. Examples include clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor.
* Your stomach must be empty prior to surgery, so do not eat or drink anything after midnight, or once you learn a liver is available.
* You may be given an enema to clean out the intestines and prevent constipation following surgery.
* Your chest and abdomen will be shaved to prevent infection.

During Procedure

* IV fluids and medications, sedative, and anesthesia will be administered
* A tube will be inserted to help you breathe

Anesthesia

General anesthesia is used for a liver transplant.

Description of the Procedure

The surgeon makes an incision shaped like a boomerang on the upper part of the abdomen. The old liver is removed, leaving portions of major blood vessels in place. The new liver is inserted and attached to the blood vessels and bile ducts. To help with bile drainage, a tube will also be inserted in the bile duct during surgery. The skin is closed with stitches.

After Procedure

You'll be closely monitored in the intensive care unit, and will have the following devices:

* Breathing tube until you can breathe independently
* IV fluids and medication
* Bladder catheter to drain urine

How Long Will It Take?

The surgery will take several hours.

Will It Hurt?

Anesthesia prevents pain during surgery. You'll likely experience pain during recovery but you will receive drugs to relieve this discomfort.

Possible Complications

* Rejection of transplanted liver
* Excessive bleeding
* Infection
* Bile-duct obstruction or leakiness
* Allergy to anesthesia
* Complications from the antirejection drugs that must be taken for life after such a transplant (such complications can include severe infection, cancer)
* Blood clots in the major arteries
* Neurological complications, such as seizures

Average Hospital Stay

This varies and can be several weeks.

Postoperative Care

* At first you will receive fluids and nutrition intravenously, but will eventually be transitioned to a normal diet.
* You will receive physical therapy to regain muscle strength.
* Once home, you may be directed by your doctor to monitor your temperature, blood pressure, pulse, and weight.
* You will have regular follow-up visits for check-ups and lab tests.
* You will be started on drugs to suppress your immune function and therefore decrease the risk that your body will reject your new liver.
* You may be prescribed a special diet to prevent water retention and to maintain a normal weight and blood pressure.

Outcome

Recovery time varies and may depend, in part, on your overall health before the transplant. Most patients are able to return to normal or near-normal activities 6 to 12 months after transplantation.

To reduce the chance that your body will reject the donor liver, you will need to take immunosuppressive drugs for the rest of your life. These medications have potential side effects, so be sure to discuss special precautions with your doctor.

Call Your Doctor If Any of the Following Occurs

* Signs of infection, including fever and chills; you are more susceptible to infections while taking immunosuppressive medications
* Redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site
* Cough, shortness of breath, chest pain, or severe nausea or vomiting
* Cough that produces a yellowish or greenish substance
* Dry cough that continues for more than one week
* Prolonged nausea, vomiting, or diarrhea
* Inability to take prescribed medication
* Bruising
* Black stools
* Red or rusty-brown urine
* A rash or other skin changes
* Pain, discharge, or swelling at the site of the drainage tube
* Vaginal discharge, in women
* Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
* Exposure to mumps, measles, chickenpox, or shingles
* Unusual weakness or light-headedness
* Illness that requires emergency room treatment or hospitalization

RESOURCES:

American Liver Foundation
http://www.liverfoundation.org

United Network for Organ Sharing
http://www.transplantliving.org

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca/Home.aspx

Toronto General Hospital
http://www.torontotransplant.org/patients/liver.cfm

References:

American Liver Foundation website. Available at: http://www.liverfoundation.org. .

Gee I, Alexander G. Liver transplantation for hepatitis C virus related liver disease. Postgrad Med J . 2005;81:765-771.

Liu CL, Fan ST. Adult-to-adult live-donor liver transplantation: the current status. J Hepatobiliary Pancreat Surg . 2006;13: 110-6.

Liver Transplant Program and Center for Liver Disease, University of Southern California website. Available at: http://www.surgery.usc.edu/divisions/hep/index.html .

Luu L. Liver transplants (June 30, 2006). eMedicine website. Available at: http://www.emedicine.com .

Neuberger J. Developments in liver transplantation. Gut . 2004;53:759-68.

O’Grady JG. Liver tansplantation alcohol related liver disease: (deliberately) stirring a hornet’s nest! Gut . 2006;55: 1529-31

Liver Transplant Procedure

Liver Transplant Procedure - Patient Guide

Liver Transplant Procedure

When a potential liver has been identified, the transplant coordinator calls patients and instructs them to come to the hospital right away. Patients are admitted to the 4 Rhoads patient unit and receive a chest X-ray, electrocardiogram, urine test, blood work and a physical exam to assess health status. An intravenous (IV) line is started and preoperative medications are administered. A surgery consent form is signed at this time and patients may also be asked to participate in a research study, which is always optional.

Unfortunately, not all donor livers are suitable for transplant and sometimes the transplant team does not know this until they physically evaluate the organ. We regret when this happens, but it is sometimes necessary to cancel the procedure at this point. The Penn Transplant Institute has strict quality standards for transplant organs.

Once the decision is made to operate, the patient is taken to the operating room and given anesthesia. The average liver transplant takes between four and six hours, although it may take longer if the patient has had previous abdominal surgery. During the procedure, patients’ family and friends can wait in the surgical waiting area on 2 Dulles, or in the intensive care unit (ICU) waiting area. After the procedure is completed, the transplant surgeon finds them to discuss the surgery.

Liver Transplant Procedure

Liver Transplant Procedure

Liver Transplant Procedure

During your two-day evaluation (to determine if a liver transplant is recommended), you will meet with several members of the multi-disciplinary team, which includes:

* clinical nurse specialist
* social worker
* pediatric transplant coordinators
* transplant surgeons
* cardiology
* gastroenterology
* anesthesiology
* nutrition

After consultation with the team and review of test results, the transplant surgeons will discuss their recommendation with you. If liver transplantation is recommended, Children’s is able to provide you with the most up-to-date advances in transplantation. The transplant surgeons will discuss and assist you in pursuing all of options available based on your child’s needs.

These options include:

* Cadeveric donor transplantation – whole liver, split liver or reduced liver transplants
* Living donor transplantation

Waiting

Once your child is placed on the liver transplant list, we will work with your local physician in caring for your child. It is important that you and your local physician keep the transplant team informed of your child’s medical condition. This information could affect your child’s status on the national transplant waiting list.

Children’s recognizes that waiting is often the most difficult time for families. Your transplant coordinator will assist you in making the all necessary travel arrangements, and are available to address your questions and concerns at all times. A pager will be provided free of charge upon request.

A pediatric coordinator will contact you when an organ becomes available for your child.

Call for Transplant

During this time you will again see the members of the multidisciplinary team that you met during the evaluation phase.

The liver transplant coordinator will ensure the hospital is prepared for your arrival, while the social worker will assist you in obtaining housing\sleeping arrangements. Sleeping rooms are available in the hospital.

Because your child will be in the pediatric intensive care unit during the immediate post-operative period, you will be given priority for a sleep room upon admission.

Your child will be admitted to the liver transplant unit prior to surgery, and will return to the liver transplant unit after a brief stay in the intensive care unit. The unit is specialized in caring for liver transplant recipients and is staffed with transplant-dedicated personnel.

Follow-up Care

Discharge teaching begins on admission. The goal of the transplant team is to provide you with every opportunity possible to allow you to care for your child after their liver transplant.

Many hours will be spent in providing you with information that will be important for you to know once you are discharged from the hospital such as medication administration, organ transplant infection and rejection. The clinical nurse specialist and nursing staff will assist you in devising a schedule specialized to meet your child’s needs.

Once you are discharged, your liver transplant coordinator will provide a follow-up routine and continue to be your link with the transplant team, as well as your local physician. A transplant coordinator is available on a 24-hour basis for emergency situations.

Liver Transplant Procedure