Commonly asked questions for your liver transplant

Whether you are a transplant recipient or you are someone who wants to learn more about liver transplants, you can find answers to many of your questions by taking a look at the following frequently asked questions.

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

Before your liver transplant

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Why is a liver transplant necessary?

Liver transplants are necessary when illness or injury leads to organ failure.

What is transplantation?

Liver 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
  • Heart
What diseases or conditions commonly lead to liver transplants?

Common causes that may 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

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.

Common causes of liver disease
  • Chronic hepatitis
  • Primary biliary cirrhosis — a rare condition in which the immune system inappropriately attacks and destroys the bile ducts, causing liver failure
  • Sclerosing cholangitis — scarring and narrowing of the bile ducts
  • Biliary atresia — malformation of the bile ducts
  • Alcoholism
  • Wilson's disease — a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail
  • Hemochromatosis — an inherited disease in which the body is overwhelmed with iron
  • Amyloidosis — the liver has abnormal deposits of a protein called amyloid that disrupts normal liver function
  • Liver cancer
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 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 or bleeding from the veins in the esophagus.

Abnormal levels of albumin, liver function or complete blood count tests, or abnormalities found on abdominal CT or ultrasound 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, liver 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 a liver transplant affect my condition?

While liver transplant may be the only option to treat your failing liver, 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 liver donors with those awaiting a liver 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 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 factors such as severity of disease (as determined by your MELD score). When a donor organ becomes available, the people for whom that organ is the best match are identified, and the organ is offered to the recipient 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 liver donor 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 the first available liver 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 liver donors and deceased donor organ donation?
Deceased liver transplant donation

Deceased donor liver donation is donation of a liver after a person dies.

Living liver transplant donation

Fortunately, waiting for a liver transplant 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 be a liver donor by sharing a portion of their liver with a family member, spouse, or a friend.

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 portion of the liver 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. Length of surgery and recovery time may vary. It is important for the donor to follow up with the surgeon and a hepatologist 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.

What questions should I ask concerning finances?

Here are some important questions to ask before your surgery. Be sure to bring these with you to your meeting with your transplant financial coordinator.

  • What is the average cost for a transplant, including care required before and after the transplant?
  • Is treatment for my medical diagnosis covered?
  • Is there a pre-existing clause for my plan? If so, what are the terms?
  • Will my illness be considered a pre-existing condition?
  • Will I have to pay for a portion of the costs? If so, about how much?
  • Who will pay for my donor costs?
  • What financial coverage does the hospital accept (Medicare, Medicaid, private insurance, etc.)?
  • What can I do if my financial coverage runs out?
  • Are there deductible and co-payment amounts? If yes, what are they?
  • Does my plan cover expenses such as travel, food, and lodging while I am at the transplant center? Will it cover these expenses for my family?
  • If my plan covers travel, food, and lodging costs, how much will it pay? Will it cover the cost of a person to come with me?
  • Will my insurance require pre-approval for any of my treatment?

During your liver transplant

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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.
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 a liver transplant for the recipient?

It is important to remember that transplantation is a serious surgery with inherent risks. 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.

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

Medications that help prevent rejection suppress the immune system which makes patients more susceptible to infection.

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

  • 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

After your liver transplant

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What can I expect to experience post-liver transplant?

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 normal activity once their physician deems them healthy enough to do so.

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

As part of your post-liver transplant care, you will have to weigh yourself daily. Rapid weight gain may be a sign of fluid retention. If you notice any changes, call your transplant coordinator. Your transplant team will also instruct you to take your temperature.

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

In the days immediately following your liver transplant, you can expect to be tired. 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.

What medications will I have to take post-liver transplant?

To help ensure your liver 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 transplant liver. 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 (used to prevent or treat infections) or anti-ulcer (used to treat digestive problems) medications may be necessary. Many others may also be used but are not discussed here.

Always ask your transplant team any questions you might have about the medications your doctor has prescribed for you.

Your biggest responsibility after a liver transplant is keeping your organ, and yourself, healthy. Proper adherence to your regimen is critical to your health.

Medications commonly used in liver 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.