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Frequently asked questions about liver transplantation

Whether you are a transplant recipient or someone who wants to learn more about transplantation, you can find answers to many of your questions by taking a look at the following Frequently Asked Questions (FAQs).

We encourage you to speak with your doctor for more information.

What is transplantation?

Transplantation is the surgical removal of a healthy organ from one person for placement into another person to replace a sick or injured organ.

Organs that can be transplanted include:

Liver
Kidney
Pancreas
Heart
Lung
Intestine

Why is transplantation necessary?

Transplantation is necessary when illness or injury leads to organ failure.

What diseases or conditions commonly lead to liver transplantation?

The most common causes of liver disease that lead to liver transplantation are cirrhosis and hepatitis—both of which occur in a variety of forms and are chronic conditions. For additional information, please refer to the American Liver Foundation.

Cirrhosis

Cirrhosis is an ongoing liver disease that may occur over a period of months to years. Cirrhosis destroys liver cells, which causes the liver to eventually shrink and harden. Ultimately, the liver will lose too many cells and lack proper blood flow. This process results in liver failure. There are different causes of cirrhosis.

Primary biliary cirrhosis

Primary biliary cirrhosis destroys the bile ducts in the liver. When bile ducts are destroyed, the liver can no longer secrete bile. Bile is required for the breakdown and digestion of fats. Alcoholic cirrhosis is the widespread death of liver cells caused by long-term alcohol drinking.

Hepatitis

Hepatitis is an inflammation of the liver often caused by hepatitis A, B, or C, or other viruses such as the Epstein-Barr virus (EBV) or cytomegalovirus (CMV). Inflammation of the liver can also be caused by alcohol abuse and drug use.

Hepatitis C, which is usually transmitted through blood, is the most common reason people need liver transplants. Other, less common causes of liver disease are:

Alagille syndrome
Alpha1-antitrypsin deficiency
Autoimmune hepatitis
Budd-Chiari syndrome
Cancer of the liver
Fulminant liver failure
Hemochromatosis
Primary sclerosing cholangitis
Wilson's disease

Symptoms of liver disease

The most common clinical symptoms associated with chronic liver disease are listed below. People with liver disease may experience one or more of these symptoms:

Nausea and vomiting
Loss of appetite
Weight loss
Fatigue
Yellow discoloration of the skin and whites of the eyes (jaundice)
Extreme itching sensation
Dark urine
Vomiting of blood
Dark gray-colored or clay-colored stools
Buildup of fluid in the abdomen
Shortness of breath
Lack of blood clotting, which may lead to nose bleeds, bruises, bleeding, etc.
Mental confusion

There are several other less common signs and symptoms of liver disease, some of which are only noticed after medical testing. These symptoms include damage of veins in the stomach and esophagus and the belching of stomach contents back into the esophagus. Kidney failure can sometimes occur as a result of liver complications (hepatorenal syndrome).

Abnormal levels of potassium, sodium, albumin, or glucose can also be signs of liver disease. These signs may only be detectable through medical testing.

If you are experiencing any of these effects, you should see your doctor immediately.

Effects of liver disease

Liver failure results in a decrease in the development of proteins that are necessary to keep fluid in the bloodstream. Liver disease can also cause serious internal problems, including increased risk of liver cancer, kidney failure, and internal bleeding. In addition to the physical problems, people with liver disease often suffer from some mental difficulties.

These problems can range from weak hand/eye coordination to memory loss and confusion. These effects on mental status result from the buildup of nitrogen waste products (ammonia) in the bloodstream.

How will transplant affect my condition?

While liver transplant is the only cure for cirrhosis and certain cancers, it will not provide a cure for all causes of liver failure. Even after surgery, you may still have the condition that caused your liver to fail. For example, if your liver failed because of a hepatitis virus, you will need to continue to take medications to control the infection. And, you will be instructed to take additional medications after transplant.

What is the United Network for Organ Sharing (UNOS)?

UNOS is a private, nonprofit organization that matches available organ donors with those awaiting transplant through the national Organ Procurement and Transplantation Network (OPTN). UNOS administers this program under contract with the US Department of Health and Human Services. Members of UNOS include all transplant programs, organizations that find organs, and tissue typing laboratories in the United States.

UNOS guarantees that all persons who need a transplant have an equal opportunity to receive their organs, regardless of age, sex, race, social status, etc. Who gets an available organ is determined by a number of factors, including the length of time a person has been on the waiting list, blood type (A/B/O typing), body size, and health status as determined by UNOS criteria. If you would like to learn more, contact UNOS at 1-888-894-6361.

How is waiting list status determined?

The status of a person awaiting a transplant organ is determined by such factors as severity of disease (as determined by your MELD score) and time on the waiting list. When a donor organ becomes available, the people for whom that organ is a perfect match are identified, and the organ is offered to the patient who has the most urgent need for the organ, based on his or her current health status. Therefore, the sickest people receive organs before those whose health status will allow them to wait longer for their transplants.

Why do waiting times vary around the country?

In addition to organ availability, geography and population both contribute to waiting times. For example, waiting times may be longer in large metropolitan cities with large populations because of an increased need for certain organs, while waiting times may be shorter in smaller communities. Your center will offer first the organ to someone within its own area. If no match is found, the organ will then be shared on a regional and national level.

What is the difference between living donor and deceased donor organ donation?

Deceased donor organ donation

Deceased donor organ donation is donation of an organ or organs after a person dies.

Living donor liver donation

Fortunately, waiting for an organ from a deceased donor isn’t the only option. For many people, living donation is an exciting possibility that enables a person who is still living to share an organ or portion of an organ with a family member, spouse, or a friend.

A healthy liver has the ability to regenerate. This means that through living donation, liver recipients can now receive a piece of a healthy liver from a living donor—a healthy liver can grow back to its normal size in the donor and the recipient.

The benefits of living donation include:

Long delays waiting on national lists may be avoided
The recipient may be in better health due to reduced time to transplant
The donated organ may be healthier than one received from a deceased donor
Surgery can be scheduled for a time when both the donor and the recipient are in the best condition possible

Living donation criteria

There are many criteria that must be considered for a person to donate a portion of his or her liver, including age, medical history, and current health status. The potential donor will undergo blood tests, a physical and psychological exam, X-ray tests to evaluate liver size, and a possible liver biopsy.

Before the operation, the surgeons will determine the amount of liver needed for the recipient to receive and the donor to keep. The donor will be in the hospital for approximately 1 week following surgery, with a continued 4 to 6 weeks of rest at home. It is important for the donor to follow up with the surgeon and a hepatologist for the first year post-surgery to make sure the liver is operating and growing normally.

If a living-donor transplant is not possible, the recipient will be placed on the waiting list for a deceased donor organ.

To learn more about living donation, download Sharing Life and speak with your transplant team.

Over the past few years, the number of living donations has increased. In fact, it even surpassed the number of deceased donations made during 2001 and 2003

What is TIPS?

TIPS is an acronym for transjugular intrahepatic portosystemic shunt. This shunt creates an artificial channel in the liver that connects the portal vein to a hepatic vein. TIPS is used to help treat portal hypertension (elevated pressure in the liver), a complication that occurs as a result of scarring, and to reduce the risk of hemorrhage (bleeding) and/or fluid accumulation in the abdomen. TIPS is commonly used as a "bridge to transplant" to help keep patients healthy while they wait for liver transplantation.

How is liver transplantation done?

The recipient is prepared for the transplant surgery in the operating room or holding area
The recipient will receive anesthesia to make him or her sleep
Once the recipient is asleep and the preparation is done, the surgeon will begin the operation to remove the diseased liver

During the removal of the recipient’s liver, one of the other surgeons will check and prepare the new liver for the transplant. Once prepared, the new liver will be put in place:

The blood vessels will be sewn together, and the bile duct of the donor liver will be sewn to the bile duct of the recipient
The abdomen will be closed using special stitches, some of which will dissolve over time
The recipient is taken directly to the intensive care unit, where the staff will monitor his or her vital signs very closely. It may be at least an hour before family members will be able to see the patient after surgery

Does the size of the liver matter?

Organ size (which can be affected by gender and weight of donor) is critical in matching a donor liver with a recipient. It is important that the surgeon ensure that your new liver will fit into the abdomen without pressing against or interfering with other organs and structures in the area.

What are the potential complications of liver transplantation?

It is important to remember that transplantation is a serious surgery and risks still remain. Talk to your transplant team about what you can expect and make sure your concerns are addressed. You should not be surprised if there are some complications after your procedure. Complications after any type of surgical procedure are common. However, most complications you experience will be minor. They usually occur within 6 months of transplantation and will be recognized by your doctors.

One of the more common complications of transplantation is rejection. However, thanks to anti-rejection medications, rejection episodes are less common and can be controlled.

Though such medications help prevent rejection, suppression of the immune system also makes transplant recipients more likely to get infections.

Talk to your transplant team immediately if you experience any of the following signs or symptoms of rejection or infection:

Fever over 100°F (38°C)
Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
Coughing up yellow or green mucus
A dry cough that lasts for more than 1 week
Severe diarrhea
A burning feeling when you urinate
Vaginal discharge or itching
A wound that oozes fluid, does not heal, or feels warm
Swelling, warmth, redness, pain, or tenderness of an arm or leg
Pain or tenderness over your transplant site
Change in pulse rate
Yellow color to the skin or eyes
Light-colored or blackened stools
Change in the color or smell of urine

What can I expect to experience during post-transplant recovery?

The period immediately after liver transplant surgery is a very critical time for you. Your transplant team will monitor you very closely. As your condition begins to stabilize, you and your family will be taught about medications, diet, and other important issues. Most people can go home 7 to 12 days after their transplant and can return to work and their normal, active lives within 3 months.

What can I expect to my physical activity level to be post-transplant?

In the days immediately following your transplant, you can expect to be tired and may be still feeling a little sick. Transplantation is major surgery. However, you will begin to feel better and stronger each day—and you may be encouraged to resume physical activity, including work. Exercise according to your transplant team’s instructions, generally at least 5 days a week. Start with something simple, like walking. Increase your time and pace slowly to reach a minimum of 30 minutes a day. Pace yourself so you don't feel rushed or overtired. Your transplant team will help you plan a proper exercise program.

Are there any concerns surrounding pregnancy?

If you are a woman of childbearing years, a liver transplant should not alter your ability to have a child. It is often recommended that people wait approximately 2 years before conceiving a child in order to allow the body to get stronger and healthier. However, you should always discuss your decision to get pregnant with your healthcare provider.

It is important to understand how the medications you are taking may affect pregnancy and breast feeding. Talk to your healthcare provider about your specific needs.

What medications will I have to take after transplantation?

To help ensure your transplant is a success, your doctor will prescribe several different medications to slow down your body's immune system and make your body less likely to reject your transplanted organ. This process is called immunosuppression.

Although your doctor will work to prevent rejection, it can still occur. If you experience a rejection episode, your doctor may decide to treat it with different or additional medications, or simply with a dose adjustment of the medication or medications that you are already taking.

Sometimes medications such as anti-infective medications (used to prevent or treat infections) or anti-ulcer medications (used to treat digestive problems) may be necessary. Many other medications may also be used but are not discussed here. Always ask your transplant team any questions you might have about the medications you are prescribed.

Your biggest responsibility post-transplant is keeping your organ, and yourself, healthy. Proper adherence to your regimen is critical to your long-term health.

Medications commonly used in transplantation include:

Because some medications may produce unwanted side effects, it is important that you ask questions and talk freely with your transplant team about how you are feeling.

Will I need to weigh myself, take my temperature, or take my blood pressure after surgery?

As part of your post-transplant care, you may be asked to weigh yourself daily. Your transplant team will also instruct you to take your temperature three times a day (morning, afternoon, and evening). A fever can be one of the first signs of infection. You may also be asked to measure your blood pressure. When preparing for your surgery, make certain that you have a scale, thermometer, and blood pressure cuff at home. These items may be given to you by your transplant coordinator.

What is Prograf^{^®} (tacrolimus)?

Prograf (tacrolimus capsules and injection) is an immunosuppressant approved for the prevention of rejection in people who have received a liver, kidney, or heart transplant. Anti-rejection medications like Prograf are essential to the success of transplantation. In fact, since approval for rejection prevention for liver transplantation in 1994, for kidney transplantation in 1997, and for heart transplantation in 2006, Prograf has helped more than 100,000 people. Read Prograf and You to learn more about what Prograf can do for you.

Important Safety Information About Prograf^®

Prograf® (tacrolimus capsules) is approved for the prevention of organ rejection in patients who have received a liver, kidney, or heart transplant. Only physicians and facilities specializing in transplantation should manage patients taking Prograf. Anti-rejection medications may increase the possibility of developing an infection or lymphoma, a type of cancer.

Before starting Prograf, tell your doctor if you are pregnant, planning to have a baby, or breastfeeding. Since some medicines can affect your body's ability to use Prograf, tell your doctor whenever you receive a new medicine, including any over-the-counter medicines or herbal supplements. Do not eat grapefruit or drink grapefruit juice in combination with Prograf.

In clinical studies, up to 22% of patients taking Prograf developed insulin dependent diabetes, but in some patients, after 2 years, insulin was no longer required. Black and Hispanic kidney transplant patients were at an increased risk. Early signs of diabetes include frequent thirst or urination, blurred vision, or confusion. You should tell your doctor if you experience any of these.

Prograf has been associated with toxicity to the kidneys and nervous system. Common side effects are tremor, headache, high blood pressure, diarrhea, nausea, constipation, stomach pain, changes in kidney function, diabetes, low white cell count, infection, and high cholesterol/lipid levels.

Prograf should not be used in patients allergic to tacrolimus. Take Prograf exactly as your doctor tells you to. Take it before or after you eat at the same time each day.

Only your healthcare professional can weigh the risks and benefits of a prescription medication and decide which medication is the right one for you.

Please see the full prescribing information.

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