What You Need to Know about a Liver Transplant

This information will help you understand the risks, benefits and possible complications involved in a liver transplant. Please read it carefully. Ask questions about anything you do not understand.

Evaluation

Before you can have a liver transplant, you must be evaluated to see if:

  • A liver transplant is the right treatment for you.

  • Another treatment besides a liver transplant could help you.

  • You are well enough to have liver transplant surgery.

Testing

An evaluation for a liver transplant involves many tests. More tests may be needed based on the results of these tests. As part of the evaluation, you may get one or more of the following:

  • Blood tests. These tests can help show:

    • How much liver disease you have and what may have caused it.

    • How healthy you are overall.

    • Your blood and tissue type, to help find a matching donor liver.

    • Whether you have certain viruses, such as hepatitis or HIV.

  • A chest X-ray. This helps show any problems with your lungs.

  • A urine test. This helps us tell if you have any urinary disease. It can also show if you have any alcohol or drugs in your body.

  • Heart tests. An electrocardiogram (EKG) shows if you have any heart rhythms that are not normal. An echocardiogram uses sound waves to look at how well your heart is working. A stress test shows how well your heart works under stress. These tests can help your doctors decide if your heart is strong enough for transplant surgery. They can also help your doctors decide if another test, such as an angiogram, is needed. (An angiogram tests to see if one of your blood vessels is blocked.).

  • Breathing tests. Breathing tests (called pulmonary function tests) show how well your lungs are working. They may be needed if you have a history of smoking or lung disease.

  • CT scan or MRI. These tests give us images of the inside of your body. If you have liver cancer, we will do a CT scan or MRI to see how much cancer you have. It will also tell us how well blood is flowing to your liver.

  • Liver biopsy. We may do a liver biopsy to see how much liver disease you have and what may have caused it. You will not need to stay overnight for this procedure.

  • Ultrasound. We will look at your liver using ultrasound. This helps us see the size and shape of your liver. It can also show if there are any tumors on your liver

  • Bone scan. If you have liver cancer, we will scan your bones to make sure the cancer has not spread.

  • Cancer screening. You may get a colonoscopy, mammogram, Pap smear or other cancer test as needed.

  • Chemical dependency. If you have a history of drug or alcohol abuse, you may need to be assessed for chemical dependence. You may also need to join a rehab program and abstain from drugs and alcohol before and after being listed for a transplant.

Meetings with the transplant team

As part of the evaluation, you will also meet with members of the transplant team, including:

  • Transplant coordinator. The transplant coordinator will explain the transplant and what you will need to do before and afterwards. And you will attend a class on liver transplant.

  • Transplant surgeon. The transplant surgeon will talk with you about whether a transplant is the right treatment for you. The surgeon will discuss the risks, benefits and possible complications of a liver transplant.

  • Hepatologist (liver doctor). A hepatologist will help you manage your liver disease and will review your tests to make sure a transplant is right for you.

  • Social worker. A social worker will evaluate how well you can cope with a transplant and follow a treatment plan. The social worker will also help you put together a support network.

  • Financial coordinator. A financial coordinator will talk with you about the cost of the transplant and the medicines you will need. The financial coordinator will help determine how much of these costs your insurance will cover. All of your costs may not be covered by insurance.

  • Registered dietitian. A registered dietitian will help make sure that you get proper nutrition before, during and after the transplant.

  • Psychologist. A psychologist may evaluate your mental and emotional health.

Some patients may need to be referred to other specialists—for example, a nephrologist (kidney doctor), a pulmonologist (lung doctor), a cardiologist (heart doctor) or an oncologist (cancer doctor).

Surgery

Liver transplantation can be a life-saving therapy. However, the benefits depend not only on successful surgery but also on following a rigorous treatment plan. The potential complications of a liver transplant can result in serious injury and even death.

We cannot predict exactly how your body will respond to a liver transplant. This is partly because we can never know for sure how the condition that caused your liver disease will affect your new liver. The operation is complex, and the risks are high. The overall success rate is about 85 to 90 percent. This means that nearly 9 out of 10 patients survive with a transplanted liver for at least one year. But this also means that 10 to 15 percent of patients die in the first year. The success rate varies according to how sick you are before the surgery. The sicker you are, the lower your chance of a successful outcome.

The United Network for Organ Sharing (UNOS) sets the policy for allocating donor organs. Livers are primarily allocated according to how sick a patient is. Being put on the waiting list for a liver transplant does not guarantee that a liver is available or that you will get one.

The operation

We will call you as soon as a donor organ is available. You must come to the hospital right away. Your doctor will review with you the risks of using this organ versus waiting for another donor. You always have the option to refuse an organ.

During the transplant surgery you will be put under general anesthesia. This means we will give you medicine to put you to sleep, block pain and paralyze parts of your body. You will also be placed on a machine to help you breathe. The transplant surgeon will make an incision (cut) in your abdomen. Your liver and gallbladder will be taken out through this incision, and a donated liver (without a gallbladder) will be placed into your abdomen.

During the surgery, we may need to stop the flow of blood to your liver. To do this, the surgeon will make a cut (incision) in your underarm, neck or groin and hook tubes up to your veins. This is called a veno-veno bypass. These tubes will be connected to a machine that will allow your blood to bypass your liver.

Drains will be put into your body to remove fluids and help you heal. Special mechanical boots or sleeves will be put around your legs to prevent blood clots. You will be in the operating room from 4 to 12 hours.

After the operation

After the surgery you will be taken to the intensive care unit (ICU) where you will be closely watched. You will be on a machine to help you breathe, and you will have many tubes and drains in your body. You will have pressure boots or sleeves around your legs to prevent blood clots.

Immediately following the surgery, you will feel pain. This will be carefully watched and controlled. Usually, the pain goes down considerably within two to three weeks after surgery.

When your medical condition is stable, we will move you to the transplant floor. You will stay in the hospital for as long as your doctors feel it is necessary. How quickly you recover depends on how sick you were before the surgery and whether you have any complications after surgery.

Risks of surgery

  • General anesthesia. The transplant surgery will be done under general anesthesia. This means that we will give you medicine to keep you from waking up or feeling pain during the surgery. There are risks with general anesthesia. The doctor who will give you this medicine (anesthesiologist) will explain these risks to you.

  • Blood and blood products. If your blood count is low, you may need blood before your surgery. You may also need blood if there is bleeding during or after surgery. Blood and blood products can contain bacteria and viruses that can cause infection. Such infections are rare but can include human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV), among others. You will be asked to sign a separate consent form for blood (transfusion) at the time of surgery.

  • Complications. All surgeries have a risk of complications. Many complications are minor and get better on their own. But in some cases the complications are serious enough to require another surgery or even cause death. Patients having any surgery can have a heart attack or stroke or get pneumonia. Other possible complications include:

    • Blood clots in the legs. Even if compression boots or stockings are used, blood clots can form in the legs and move through the heart to the lungs. In the lungs, the clots can affect breathing, which can lead to death. Blood clots can be treated with blood-thinning drugs. These drugs may need to be taken for a long time after surgery.

    • Problems with transplanted blood vessels. A blood clot (thrombosis) can form in the artery that connects to the liver (hepatic artery). This can cause the transplant to fail. It can also cause abscesses on the liver or blockages in the bile ducts. If a clot forms in the hepatic artery, you will need another operation. You may even need another transplant.

    • Infection. Infections from bacteria, viruses, and funguses are possible.

    • Urinary problems. Some patients have urinary or bladder problems, such as leaking or narrowing (strictures). If this happens, we may need to put tubes through your skin to help you heal. Some patients have strictures that can take a long time to go away. In some cases, another surgery is needed to fix the problem.

    • Hernia. If the cut made during surgery (incision) does not heal well, tissue can bulge or stick out. This is called a hernia. More surgery may be needed to fix this.

    • Nerve damage. Although this rarely happens, nerves may be damaged during surgery. Nerve damage can cause numbness, weakness, an inability to move (paralysis) or pain. In most cases, these symptoms are temporary. But in rare cases they can last for a long time or even be permanent.

    • Other rare but possible complications include injury to the abdomen, sores on the skin (pressure ulcers), burns caused by the use of electrical equipment during surgery, damage to arteries and veins, and permanent scarring at the incision.

    The doctors and nurses will watch you very closely after surgery. They will look for problems with bleeding, blood flow to the liver, healing or glucose (blood sugar) control. If a problem develops, you may need to go back into surgery.

    Many patients ask whether they can die from a liver transplant. The answer is yes. As with any surgery, complications can develop. Most deaths, however, are caused by other medical problems, such as heart disease, diabetes and high blood pressure.

  • Rejection. After your transplant, your body will try to reject your new organ. This is normal. You must take anti-rejection medicine and keep all appointments to lower the risk that your body will reject the new organ. The risk of rejection never goes away. We will talk with you about the signs and symptoms of rejection while you are in the hospital. We may need to do a biopsy to diagnose or confirm organ rejection. If your liver stops working because you do not take your anti-rejection medication, you may not be considered for another transplant.

  • Side effects of anti-rejection drugs. Anti-rejection medicines can cause kidney, stomach, intestinal and blood problems; nerve damage; high blood pressure; diabetes; and high cholesterol.

  • Infection. The risk of infection is higher for transplant than for other surgeries because the medicine needed to keep your body from rejecting your new organ makes it harder for you to fight an infection. Liver disease also makes it harder for you to fight an infection. Incisions and sites in your body where tubes are placed (to help you breathe, to put fluids in your body, to monitor how your body is working) are likely places for an infection. These can include pneumonia and blood infections.

  • Leaking or narrowing bile ducts. Bile ducts can leak after transplant surgery. Most leaks get better without more surgery. But sometimes tubes need to be placed through the skin to aid healing. And sometimes more surgery is needed. Bile ducts can also narrow after transplant surgery. This is called a stricture. Some strictures can be fixed without surgery. This might involve inserting tubes. But some strictures will need more surgery to fix. Some patients may have a long-term problem with strictures.

  • Cancer. Transplant patients have a slightly higher risk of getting some cancers because of the anti-rejection drugs. These include skin cancer and lymphoma. If you had cancer in your liver, the cancer can come back. We will do lab tests and scans to watch for this.

  • An organ that fails to work after surgery. It is possible that your new liver may fail to work right after surgery. This can make your hospital stay longer and increase the risk of complications. This happens in about 3 out of 100 transplants. It is also possible that your transplanted liver will not work at all. If this happens, you will need another transplant. You will be placed on the UNOS waiting list at the highest priority allowed. If you cannot get a second liver, you may die.

  • Recurrence of liver disease. Some liver diseases can return. These include autoimmune disease, hepatocellular carcinoma (HCC) and hepatitis B. Some diseases, such as hepatitis C, will always return. If this happens, a second transplant may be possible. But not all patients are good candidates for a second transplant. In some cases, we may choose to transplant a liver from a donor with a history of hepatitis B or hepatitis C. We usually offer this to patients who already have hepatitis B or hepatitis C themselves.

  • Psychological and social problems. A serious illness can stress you and your family. It is important that you choose one or more people to support you before, during and after your surgery. Your supporter(s) will help you with such things as taking medicines and getting to appointments. If you are from out of town, you will need to stay in the area for a while after you get out of the hospital. After your transplant, there will be many ups and downs in both your physical and emotional condition. Some patients will experience depression, post-traumatic stress disorder (PTSD), anxiety and other problems. Tell us if you think you may be having any psychological side effects.

  • Risks related to the donor. The success of your liver transplant can be affected by the donor's history and the condition of the organ when it is received in the operating room. There is also a risk that you may contract HIV and other infectious diseases if they cannot be detected in the donor.

Benefits of surgery

A transplant is a good option for many patients. Some of the possible benefits include:

  • Longer life. A liver transplant can be a life-saving therapy. However, this depends not only on the success of the surgery but also on how closely you stick to your treatment plan.

  • Better quality of life. A transplant can improve your quality of life. For most patients, this means freedom to do things they enjoy and the ability to return to work. This freedom comes with responsibility, though—to take medicines as directed, maintain a healthy lifestyle, go to all appointments and complete all blood work.

Is a transplant right for you?

A transplant may not be the right option for every patient. If we feel that it is too dangerous for you to have a transplant, we will let you know. If you do not want to take the risks of surgery and anti-rejection treatment, you can continue being treated as you are now. If you haven't decided yet whether a transplant is right for you, you can still go on the waiting list. Later, if you choose not to have the transplant, you can take your name off the list.

Right to refuse transplant

You have the choice not to have a transplant. If you choose not to have a transplant, treatment for your liver disease will continue.

Other treatments

There may be other ways to treat your condition. Please talk about this with your health care team. Some options are:

  • No treatment

  • Removing fluid through a needle in the belly (paracentesis)

  • Medicines

  • Controlling what you eat and drink

  • Treatment for pain and other symptoms (palliative care)

You may also qualify for an experimental treatment or research study. Ask your doctor to learn more.

National and transplant center-specific outcomes

We have given you data on our most recent outcomes for liver transplantation as released by the Scientific Registry of Transplant Recipients (SRTR). Our results meet or exceed SRTR standards and do not differ significantly from expected survival rates. For more information, go to www.ustransplant.org.

Notification of Medicare outcome requirements not being met

Transplant centers must meet certain outcomes. We have to notify you if we do not meet these requirements. Currently, the University of Minnesota Medical Center meets all requirements for transplant centers.

Transplantation by a transplant center not approved by Medicare

Having your transplant at a facility not approved by Medicare may affect whether Medicare Part B will pay for your anti-rejection drugs.

Insurance coverage after a transplant

After you have a liver transplant, health insurance companies may consider you to have a pre-existing condition and refuse payment for medical care, treatments or procedures. After the surgery, your health insurance and life insurance premiums may go up and stay up. Insurance companies may refuse to insure you.

For informational purposes only. Not to replace the advice of your health care provider. Copyright © 2010 Fairview Health Services. All rights reserved. SMARTworks 520660 – REV 01/18.

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