Today, Liver Transplants Have an Outstanding Success Rate

One of the most significant advances in medicine over the past several decades has been the liver transplant, allowing recipients to lead much longer and healthier lives.

The liver plays a critical function in purifying the body of toxins, fighting infections and cleansing the blood. It also helps digest food and stores energy for later use. A malfunction of this vital organ means the gradual poisoning of the body. However, the growing success of liver transplants has meant revitalization for the lives of recipients. With careful, ongoing monitoring, liver transplant recipients can go on to lead lives that are greatly improved in both quality and longevity.

Wisconsin Successes
About 40 liver transplants are performed at the Medical College each year, with the main limiting factor being the shortage of organ donations. "Wisconsin has a generous tradition, with people willing to agree to donate," observes Jose Franco, MD, Associate Professor of Medicine and Medical Director of Liver Transplantation at the Medical College of Wisconsin.

Most transplanted livers are from deceased donors; a donation also requires the approval of surviving family members. In other cases, living family members may donate a part of a liver. However, live liver donors are fairly rare."

"Transplant recipients have done a lot of educating of the public, with booths at places like Summerfest and the State Fair," says Dr. Franco, who practices in the Froedtert & The Medical College of Wisconsin Gastroenterology and Hepatology Clinic.

Timing Is Essential
"The major factor used to match donor and recipient is the blood type," says Dr. Franco. "Other important factors which are considered include the age of the donor, size of the donor, and how ill the recipient is."

The chief challenge for the medical team is to act swiftly when a liver becomes available, with 12 hours the maximum time for a liver to survive after the donor death.

With the clock ticking, the Medical College transplant team has learned how to organize the team and facilities to respond rapidly for the complex procedure. "Most of the time, if a liver is available at 11 am, we can get the patient on the operating table at 3 pm to transplant the new liver," says Dr. Franco. "It's taken a lot of effort and time to get to this point of coordination."

The selection of recipients is based on local, regional, and national waiting lists, with the local list most typically being used. Patients are selected by the urgency of their need. "If the patient's blood tests are looking bad, they move up on the list," explains Dr. Franco.

In the wait for a transplant, it is valuable for potential liver transplant recipients to meet with those who have already received a new liver. In this way they can get a clearer sense of the long-term process of receiving a transplant, overcoming possible problems, and surviving with a new liver. "Education is definitely part of the process," Dr. Franco stresses.

Procedure and Follow-Up Both Crucial
A liver transplant typically takes five to six hours, Dr. Franco says. Transplantation is a complex process, requiring a team of three to four surgeons to carry out removal of the defective liver, inserting the new liver, and reattaching the veins, arteries, and bile ducts.

The surgical team must carefully monitor the patient's heart and lung function for stability during the operation. Following the surgery, the patient normally stays in the hospital several weeks, followed by three blood tests per week and weekly visits with their doctor.

But the transplant process does not end with the implanting of a new liver. The body's immune system might react against the new liver and seek to destroy it. Some signs of rejection of the new liver can be detected through the liver enzymes in the blood. Overt symptoms of rejection can include nausea, fever, jaundice, and pain.

To counter rejection, a variety of immunosuppressant medications might be required. These include steroids, sirolimus, cyclosporine, and tacromilus, among others. These medications have side effects and weaken the body's immune system.

An important safeguard for transplant recipients is to stay away from sick people as much as possible. Close monitoring is essential; health care providers will watch for increased blood pressure, higher cholesterol, and the potential for diabetes, weakened bones, and liver damage.

Causes
By far the leading cause of liver failure is cirrhosis, which deteriorates liver function, sometimes over the course of a two- to three-decade period. In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year. Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high. In the United States, chronic alcoholism and hepatitis C are the most common causes of cirrhosis.

Cirrhosis has many other causes as well. "Cirrhosis is the end result of multiple injuries to the liver, from hepatitis B or C, diabetes, obesity, and problems with the bile ducts," says Dr. Franco.

Rarely, liver failure can strike even the healthiest individuals, such as pro football great Walter Payton of the Chicago Bears, a non-smoker, non-drinker, and very well-conditioned athlete. Yet a congenital problem with his bile ducts, called "primary sclerosing cholangitis," cost Payton his life at age 45.

The most common symptoms of liver problems include a loss of appetite, tiredness, weight loss, nausea, bloating due to fluid buildup in the abdomen, suffering bruises or bleeding out of proportion to an injury, and a fogginess in mental functioning. Awareness of these symptoms is crucial to reversing a long-term downward spiral in health.

The growing success of liver transplants has given a great deal of hope to those with liver failure. With the increasing sophistication of doctors in overcoming the tendency for rejection, the success of liver transplants is now remarkably "over 95% at one year," says Dr. Franco.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.