Patients who have advanced liver disease or liver failure may be eligible for a liver transplant if they meet certain criteria. The initial stage in this process is often a thorough evaluation followed by placement on a waiting list. 1-5
In order to be put on the waiting list, evaluation and management are required.
A comprehensive examination is performed on the patient’s liver illness.
The overall health of the patient, as well as his or her capacity to endure a major operation, are assessed.
An experienced liver expert, also known as a hepatologist, as well as a transplant surgeon, as well as other specialists such as a heart specialist, infectious disease specialists, and thoracic surgeons, are often engaged in this evaluation. An additional service is provided by a social worker and a psychiatrist who visit with the patient and their family to provide motivation and support.
Routine blood and urine tests as well as electrocardiography are included in the general work-up process (ECG). These are used to evaluate overall fitness as well as fitness to resist general anesthesia and the main surgical procedure in question.
Other tests include those for viral hepatitis, HIV infection, liver function tests, blood coagulation testing, and tests for blood group and type, among others.
Patients who have drug or alcohol issues must be assisted in developing a plan before to transplantation in order to avoid relapsing once the surgery is completed.
Allocation of organs from dead donors is a complicated process.
Patients are put on the waiting list once they have been accepted for a liver transplant and have through the first assessment. When organs from dead donors are collected and distributed, they are usually coordinated by a national system such as the United Network for Organ Sharing (UNOS), in collaboration with organizations such as Organ Procurement Organizations. Everyone on the list is listed according to their height, weight, and blood group, with no exceptions.
End-Stage Liver Disease as a Simulation (MELD)
Finally, a method known as the Model for End-Stage Liver Disease is used to determine the final allocation (MELD). MELD consists of a few basic blood tests, including creatinine (to evaluate kidney health), bilirubin (to check liver function), and INR (to assess blood clotting time) (blood coagulation profile assessment). After that, the data are entered into a formula that produces the MELD Score.
This information is used to calculate the patient’s position on the waiting list. Extra points are awarded in the event of an emergency situation, such as hepatocellular cancer.
The MELD score of a person on the waiting list often rises as the severity of their liver disease worsens. MELD scores are calculated and vary from 6 to 40. In most individuals with chronic liver disease, a MELD score may be used to predict their mortality or risk of death between three months and one year.
In addition to the fact that it is based on short-term mortality risk, it may not be helpful for people who are not at immediate danger of death but who might benefit from a liver transplant, such as those with compensated or stable liver cirrhosis, among other things.
In instances of extreme urgency, such as drug overdose and acute liver failure, choices for transplantation must be made in a matter of days, and these decisions are often made in accordance with the King’s College criteria.
Diagnosis and Treatment of Pediatric End-Stage Liver Disease (PELD)
PELD (Pediatric End-Stage Liver Disease) is a formula that is identical to the one described above but is intended for children under the age of 12. It also takes into account other variables such as growth retardation in children and children who are less than one year old for short-term survival disparities. The PELD score is calculated based on serum albumin and bilirubin levels, as well as INR.
The system’s goal is to route organs to the sickest patients on the waiting list for liver transplantation in order to minimize the number of people who die while waiting. However, despite all attempts, there is a persistent scarcity of dead donor organs, making the situation challenging.
Over the past two decades, the need for donor livers has increased by 90 percent, but the quantity of fresh organs given has not increased in the same proportions and has stayed virtually unchanged since the early 1990s.
While patients are waiting, here is some advice:
While on the waiting list, patients are encouraged to maintain their health as much as possible by eating a healthy balanced diet, engaging in regular physical activity, abstaining from alcohol, not smoking, and so on.
For adults, the average waiting period for a liver transplant is 149 days, while for children, the average waiting time is 86 days.
Being on a waiting list may increase one’s risk of developing anxiety and despair. It has been shown that one in every four individuals who are waiting for a liver transplant suffers from signs of mild to severe depressive disorder. In these situations, professional counseling and assistance should be sought.
The vast majority of individuals who need a liver transplant are put on a waiting list until a suitable organ becomes available.
This is due to the fact that there are more individuals who need a liver transplant than there are available liver donors.
If you’re in good health, you may choose to remain at home while you’re on the waiting list. Prepare yourself to get a phone call at any moment informing you that a liver has become available and inviting you to come into the liver transplant facility.
Waiting periods are a factor.
The length of time you’ll have to wait for a liver may vary significantly. If you need an emergency transplant, you may only be required to wait a few days after being diagnosed.
In the United Kingdom, the typical waiting period for a liver transplant is as follows:
Adults have 65 days to complete the program.
77 days are allotted to youngsters.
If a family or acquaintance is willing and able to provide a living donor, it may be feasible to get a transplant sooner (where part of their liver is removed and given to you).
What to do while you’re waiting for your turn
It is critical that you do the following while you are on the waiting list:
Consume nutritious foods
If you are able to avoid smoking, you should engage in frequent physical activity.
check to be that all of your immunizations are up to date
maintain frequent dental check-ups
Use contraception to prevent getting pregnant and pack an overnight bag to go to the hospital if you need to go to the hospital at short notice.
Make plans with your friends, family, and job so that you can report to the transplant unit as soon as you get the call.
Your transplant team will advise you on whether or not you are allowed to consume any alcoholic beverages while on the waiting list. Inquire with your doctor about your ability to drive, since certain liver conditions may impair your capacity to do so.
Inform the transplant unit if any of the following occur:
If your mailing address or phone number changes, please notify us.
When you’re about to leave for a few days, your health may deteriorate – you may get an illness, for example.
Adapting to the fact that you’re on the list
It is tough enough to live with a severe liver disease, and the additional stress of waiting for a liver to become available may make the situation much more difficult.
Your physical and mental health may suffer as a result of this.
If you are having difficulty coping emotionally with the demands of waiting for a liver transplant, get help from your doctor or the transplant team.
It may also be beneficial to speak with others who are experiencing the same difficulties. On the British Liver Trust’s website, you may find a list of support groups. You may also join the Health Unlocked liver illness community if you have any questions.
What to do if you get a call
When you’re contacted, you’ll get the following information:
Take the quickest route possible to the transplant facility and do not eat or drink anything until you arrive.
It is possible that the call was a false alarm, and that further testing will reveal that the liver is not eligible for transplantation. If this is the case, you will be notified as soon as possible.
If your liver is eligible for transplantation, you will undergo a series of tests at the transplant center to ensure that you are healthy enough to undergo surgery. A general anesthetic will be administered before you are brought into the operation room.
The Liver Transplant Process
The liver transplantation procedure consists of many stages, including consultation with your doctor, visit to a transplant facility, and evaluation by a liver specialist.
Consult with your doctor about the possibility of a liver transplant.
You should consult with your doctor in order to determine if you are an appropriate candidate for a transplant. Doctors will only contemplate liver transplantation once they have exhausted all other therapeutic options on the table. A liver transplant, on the other hand, is not for everyone. You may be told by your doctor that you are not in good enough health to undergo surgery. It is possible that you have a medical condition that makes a transplant unlikely to be successful. If you and your doctor agree that a liver transplant is the best option for you, your doctor will send you to a liver transplant facility for further evaluation.
Visit a transplant clinic for more information.
Health experts will give you with information regarding transplantation on your initial visit to a transplant facility.
the evaluation and approval process being placed on the national waiting list the reasons for being removed from the national waiting list the evaluation and approval procedure
the length of time spent waiting
how individuals are chosen for liver transplant surgery and how long they will be in recovery
the long-term requirements of living with a liver transplant, such as the need to take medications for the rest of your life.
Make an appointment to be assessed for a liver transplant.
At the transplant center, you will undergo a series of assessments during which you will meet members of your transplant team for the first time. The transplant facility may need many visits over the period of a few weeks or perhaps months, depending on your situation.
Your transplantation group
Your transplant team consists of a large number of people. The following individuals will be a part of the team in some capacity:
Before and after your transplant, you will be in touch with a transplant coordinator—a highly trained nurse who will be your point of contact, will schedule appointments for you, and will offer you with information and instruction.
Transplant surgeons are highly qualified medical professionals who conduct the operation and offer follow-up treatment before and after the transplantation procedure.
The doctor who specializes in liver illness, known as a hepatologist, may be able to offer treatment both before and after your operation.
An insurance case manager is a professional who will assist you in navigating your insurance coverage.
A financial coordinator is someone who provides assistance with financial issues.
A social worker is someone who can assist you in resolving issues in your everyday life and coordinating your care requirements after your transplant.
A psychiatrist is a medical professional who evaluates whether or not you are psychologically and emotionally fit and capable of caring for a transplanted liver.
Dietitian is a professional that specializes in food and nutrition. Visiting a dietician may help you learn about the foods you should consume and how to prepare nutritious meals before and after your transplant.
Your team will ask you questions about your medical history and will administer medical tests to you.
These examinations may involve a physical examination,
Imaging tests, which include blood and urine tests that provide images of organs within your body, are also available.
a series of tests to determine how well your heart, lungs, and kidneys are functioning
The findings of these tests will be used by the team to inform them.
how probable it is that you will survive a transplant procedure
what other illnesses and disorders you have, what the origin and severity of your liver disease is, and how long you have had it.
Your medical team will determine whether or not you are in good enough health to have surgery.
Some medical problems or diseases may make it less likely that a liver transplant would be successful. If you have cancer, you may not be able to get a transplant.
an illness that is very serious
Problems with alcohol or drug abuse, severe heart or lung problems due to malignancy outside of the liver
Furthermore, the transplantation team will
Obtain an understanding of whether you or your carers will be able to comprehend and follow your doctor’s instructions for aftercare after your transplant. They want to make sure you’re psychologically prepared to take care of a new liver before proceeding.
Examine your support system to see if you have a strong network of family members or friends who can assist you with care both before and after the transplant.
Examine your medical insurance coverage as well as your other financial resources. There are many financial help programs. People who are undergoing a liver transplant and their families may apply for financial assistance to cover the costs of the operation, medications, and follow-up treatment.
Get your liver transplant application accepted.
The findings of your assessment will be reviewed by the selection committee for the transplant center. Each transplant facility has its own set of criteria for determining who is eligible for a liver transplant. Transplant centers often publish their policies and procedures on their websites. In addition, the centers adhere to national standards.
Keep in mind that even if you have been authorized for a transplant, you may decide not to proceed with the procedure.
Get your name added to the national waiting list.
The transplant center will submit your name to be put on the national waiting list for a liver from a dead donor if you are authorized for a transplant but do not have a living donor at the time of the transplant. You will not be placed on the national waiting list if you have a live donor, according to the transplant facility.
All regional organ-gathering groups, also known as organ procurement organizations, and transplant hospitals are linked together via the Organ Procurement and Transplantation Network External link (OPTN). The Organ Procurement and Transplantation Network (OPTN) is managed by the United Network for Organ Sharing (UNOS), a non-profit organization that has a contract with the Federal Government. When the UNOS formally adds you to the national waiting list, UNOS will inform you as well as your transplant facility of the decision.
Registration with more than one liver transplant facility is permitted under UNOS rules, increasing your chances of obtaining a liver. It is possible that each transplant facility may need a unique medical assessment.
Wait for a match to come along.
The waiting time for a dead donor transplant may be anywhere from less than 30 days to more than 5 years depending on the circumstances.
The length of time you will have to wait is determined on how severely you need a new liver. A variety of other variables, including your age, where you reside, your blood type and body size, your general health, and the availability of a matching liver, may influence how long you must wait for a liver transplant to take place. The UNOS computer matches the liver of a dead donor to your blood type and body size depending on your blood type and body size.
People who are in the most urgent need of a new liver in order to avoid mortality are prioritized at the top of the national waiting list, according to UNOS regulations.
The moment a matching liver from a dead donor is discovered, your transplant team coordinator will contact you immediately, explain the steps that you must take before coming to the hospital, and instruct you on how to go to the hospital as soon as possible.
If you select this kind of liver transplant, make sure you and your donor are a good match.
For those who want to donate their organs while still alive, the transplant team will examine if you and the individual in question have blood types that are compatible with one another and are of comparable body size. The transplant team will do the procedure.
Inquire about the medical history of the prospective donor.
carry out medical examinations to ensure that the individual is in excellent overall health and is not suffering from any significant medical or mental disorders
Applicants for liver transplantation must be able to comprehend and follow instructions before and after surgery.
They must also be between the ages of 18 and 60, and they must have an emotional connection to the person who will get the liver transplant.
The Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS) offer comprehensive information on the organ transplantation procedure.
What should I do to prepare for a liver transplant?
The kind of liver transplant surgery you have will determine how you prepare for surgery.
Transplant from a deceased donor. If you’re on a national waiting list for a dead donor liver, your transplant team coordinator will contact you as soon as a suitable liver becomes available. You must immediately go to the hospital. Before you go to the hospital, your transplant team coordinator will tell you what you need to do.
Transplantation from a living donor. You will plan your operation 4 to 6 weeks in advance if you are getting a liver from a living donor. Before you and the donor travel to the hospital for the procedures, your transplant team coordinator will tell you what you need to do.
What is the procedure for a liver transplant?
Doctors remove your damaged or wounded liver and replace it with the donor’s liver during liver transplant surgery. The procedure for a liver transplant may take up to 12 hours or more. The surgical team will monitor the patient throughout the procedure.
NIH external link offer you general anesthesia
intravenous (IV) and other kinds of lines are inserted into your body to provide medications and fluids.
Keep an eye on your heart rate and blood pressure.
Your operation will begin when the donor liver arrives at the transplant facility if you are receiving a liver from a dead donor. If you get a liver from a living donor, the surgical team will perform surgery on both you and the donor at the same time.
What are the potential drawbacks of a liver transplant?
Potential complications from a liver transplant should be addressed with your physician. Among the issues that may arise are:
NIH external link hemorrhage blood clots in your liver’s blood vessels damage to the bile ducts
infection of the donor liver’s failure
The liver that was donated was rejected.
After a liver transplant, what happens next?
You will be admitted to an intensive care unit after your operation (ICU). While you’re in the ICU, specially trained physicians and nurses will keep a careful eye on you. To avoid complications with your replacement liver, you’ll start taking immunosuppressants. The physicians and nurses will carry with their duties.
Blood tests should be done on a regular basis to ensure that your replacement liver is functioning correctly.
medical examinations to ensure that your heart, lungs, and kidneys are all in good functioning order
When your physicians believe you are ready, you will be transferred from the ICU to a normal hospital room.
Before you return home, your transplant team will educate you how to take care of yourself. Follow-up medical treatment, things to do to care for your new liver, and potential issues with your new liver will all be discussed by members of the transplant team.
A live donor will spend the first night in an ICU after surgery and will remain in a recovery room for a few hours. In the ICU, specially trained physicians and nurses will keep a careful eye on the donor. The donor is typically moved to a hospital room the day following surgery. The donor will be encouraged to get out of bed the day following surgery and sit in a chair, as well as walk small distances as soon as he or she is able.
When will I be able to return home following my liver transplant?
After your transplant operation, you should be able to return home in approximately two weeks. A live donor may usually return home following surgery in approximately a week.
When will I be able to resume my regular activities?
When you’re ready, your doctor will tell you when you may resume your regular activities. After a few months, you should be able to resume your regular activities. The majority of individuals are able to return to work, exercise, and have a regular sexual life. You’ll continue to undergo frequent medical exams to ensure that your liver is in good functioning order and that you don’t have any other health issues. Doctors typically advise women to wait at least a year following a transplant before trying to conceive.
Although recovery periods vary, most live donors may resume regular activities after one month following surgery and return to work within four to six weeks.
It is necessary to visit your doctor on a regular basis after a liver transplant to ensure that your new liver is functioning correctly. A series of blood tests will be performed on you on a regular basis to look for indications of organ rejection as well as other issues that may harm your new liver.
What is organ rejection and how does it happen?
It is possible to have organ rejection when your immune system recognizes your transplanted liver as “foreign” and attacks it. The first 3 to 6 months after your transplant are the most critical since you have the greatest risk of developing organ rejection. 5
Is it possible to tell whether someone is rejecting their organs by their body?
It is possible that abnormal liver blood test results from the National Institutes of Health external link are the first indication of organ rejection. When you are rejected, you may or may not experience any of the symptoms listed below. When rejection symptoms appear, they may include the following:
Feeling fatigued, with discomfort or soreness in your abdomen, fever, yellowing of the skin and whites of your eyes, dark-colored urine, light-colored stools
Symptoms of organ rejection should be discussed with your doctor as soon as they appear. If your doctor suspects that your body is rejecting the replacement liver, he or she will most likely conduct a liver biopsy.
Suggestions for avoiding organ rejection?
Immunosuppressants will be prescribed to you in order to assist prevent your body from rejecting the replacement liver after surgery. In order to prevent and cure organ rejection, these medications work by suppressing your immune system’s reaction to your new liver. Taking two or more immunosuppressive medications may be necessary. For the rest of your life, you’ll have to take these medications.
Rejection may occur if your immune system’s reaction to your new liver is not controlled by your immunosuppressive medications. Depending on the severity of your liver rejection, your transplant team will determine if another liver transplant is feasible.
In what ways can immunosuppressants have negative effects on the body?
Immunosuppressive medications may have a variety of potentially dangerous adverse effects, some of which are fatal. Because these medications impair your immune system, you are more susceptible to illness. The following are examples of potential negative effects:
Diabetes and high blood pressure are two conditions that may result in fragile bones.
Kidney damage is caused by elevated levels of cholesterol and triglycerides in the blood.
Skin cancer and other malignancies of the body are more likely to occur if you take these medications for an extended period of time.
Immunosuppressants may be affected by a variety of medications, including prescription and over-the-counter medications, vitamins, and dietary supplements. You should inform your doctor if you are given any new medications. Consult your doctor before using any over-the-counter medications, vitamins, dietary supplements NIH external link, or engaging in any complementary or alternative NIH external link medical practices or therapies.
What can I do to assist in the care of my newly transplanted kidney?
Follow these steps to ensure that your new liver is well taken care of:
It is important to take medications precisely as your doctor has prescribed.
Before using any additional medications, including prescription and over-the-counter medications, vitamins, and nutritional supplements, consult with your doctor first.
Make sure you attend all doctor visits and blood draws as planned.
Keep your distance from ill individuals.
In the event that you get ill, notify your doctor.
Learn how to identify the signs and symptoms of rejection in yourself and others.
You should go through the NIH external link cancer screening process as prescribed by your doctor.
Maintain current immunizations; however, “live” vaccines should not be administered.
Discuss with your doctor about the usage of contraceptives, as well as the dangers and consequences of pregnancy, both before and after your liver transplant.
Study the signs and symptoms of an illness to become more knowledgeable. It is possible to get the following symptoms of infection:
fever \chills
Coughing, diarrhea, and vomiting because of a congested nose
If you are experiencing signs of an infection, contact your doctor immediately away to get help.
Take care of yourself by making healthy choices.
Consume nutritious meals, engage in regular physical activity, and abstain from smoking.
If you have a history of alcohol use problem, you should avoid consuming alcoholic drinks and using alcohol in your cooking as much as possible.
Wearing shoes, socks, long-sleeved shirts, and long trousers may help protect you from dirt exposure.
Keep rats, reptiles, and birds away from the house.
Ticks and mosquitoes, for example, may spread illnesses, so protect yourself against them by wearing insect repellent, as well as shoes, socks, long-sleeved shirts, and trousers that are long enough to cover your legs.
refusing to go outside at times of day when organisms are most active, such as at dawn and dusk
You should consult with your transplant team at least 2 months before you intend to travel, particularly to poor countries, in order to identify the best strategies for minimizing travel-related hazards.
Following my liver transplant, what foods should I consume?
After having a liver transplant, you should follow a nutritious, well-balanced diet to aid in your recovery and to maintain your health. A dietitian or nutritionist may assist you in developing a healthy eating plan that fits your specific nutritional and dietary requirements and preferences..
I’m having a liver transplant, what foods should I avoid eating?
Some immunosuppressants may be affected by the consumption of grapefruit or grapefruit juice. Avoiding grapefruit and grapefruit juice may help to reduce the likelihood of interactions with certain of these medications.
It is not recommended that you consume alcoholic drinks or cook with alcohol when suffering from an alcohol use problem.
This list of foods should be avoided at all costs:
raw milk items that have not been pasteurized
fish and other seafood, especially if they are raw or undercooked; raw or undercooked eggs
According to your dietitian or nutritionist, it may be necessary to restrict your consumption of
salt \cholesterol \fat \sugar
