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What is liver transplantion?
When is a liver transplant appropriate?
What happens after I go on the adult liver transplant waiting list?
What is a MELD (Model for End Stage Liver Disease) score?
How do I calculate my MELD Score?
How long is the wait for liver transplant?
What are my living donor options?
What are the advantages of living donor transplants?
What is the success rate for liver transplants?
What can I expect during a liver transplant?
How do you prevent organ rejection?
What causes liver failure?
The liver is a very important organ in your body. It performs three major tasks:
- It makes proteins from digested food. These proteins help fight infections and stop bleeding.
- It helps the body rid itself of waste products. It also helps to break down medicines and flush them from the body.
- It secretes bile, which helps the body absorb fat. Fat is needed for energy and for absorbing vitamins A, D, E and K.
Liver failure can be caused by a number of things, including inherited diseases, infections and toxins such as alcohol and some medicines. The most common cause of liver failure is cirrhosis, which is the scarring and death of liver cells. Cirrhosis that is caused by hepatitis C is the most common reason for liver transplants. Other conditions that may ultimately require a liver transplant include:
- Diseases of the bile ducts, including biliary atresia, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), which can cause liver failure if there is a backup of bile in the liver.
- Some inherited diseases, such as Wilson disease, in which dangerous levels of copper build up in the body, and hemochromatosis, where the liver is overwhelmed by iron.
- Primary liver cancer or cancer that affects only the liver.
- Alcoholism which can cause cirrhosis
Some of these diseases can come back in your new liver if you have a liver transplant. Your transplant doctors will tell you if you are at risk for this.
What is liver transplantation?
A liver transplant is surgery to replace a diseased liver with a healthy liver. When a patient receives a liver transplant, their entire liver is removed. It is then replaced by either a complete new liver or a portion of a healthy liver. Once a liver is transplanted, a piece of a healthy liver can often grow into a normal-size liver.
In many cases, the new liver or liver tissue comes from a deceased donor. At University of Minnesota Medical Center, it is becoming more common for patients to receive liver tissue from a living donor, who may be a family member. In this case, the transplant surgeon removes part of the donor's liver and uses it to replace the patient's liver.
When is a liver transplant appropriate?
A liver transplant is appropriate when a patient is likely to die because of liver failure. The goals of liver transplant are to extend your life and improve your quality of life.
The best time to have your transplant is when your health is stable but you are showing signs of liver failure. Signs include:
- Fluid retention (swelling or bloating)
- Feeling very tired
- Problems sleeping
- Confusion
- Unusual bleeding
- Yellow skin and eyes (jaundice)
If you vomit blood or pass blood in your stool (bowel movements), this is a medical emergency. Go to the nearest emergency room. Be sure to tell your doctor afterward.
The waiting time for a donor liver is 18-24 months. The actual waiting time depends on the number of people on the transplant list and the suitability of available organs. Patients can put their name on the liver transplant list, but for some, a living-donor liver is also an option.
What happens after I go on the adult liver transplant waiting list?
While waiting for a transplant, you will have regular appointments at the Transplant Center at University of Minnesota Medical Center -- at least every three to six months. The frequency of these visits will vary based on active medical issues and complications of liver failure. Blood work will also be obtained every one to three months to assess liver disease severity and to recalculate MELD scores (see more about MELD scores below). During these visits it is important to provide the liver transplant team with any changes in your contact information (including home address and telephone number), insurance or caregivers.
While on the transplant waiting list, patients will continue to be seen by their local doctors for ongoing treatment of general medical problems such as diabetes and high blood pressure. You should tell the transplant team about any major changes in your health status including new medical problems, medications, hospitalizations, or test results.
To remain active on the list, patients must keep up with the listing requirements. Listing requirements include submission of routine blood samples for antibody monitoring, scheduling visits to The Transplant Center, and follow up testing as requested. If these requirements are not met, the patient's status on the list will be changed to 'inactive'; which will cause a delay in getting a transplant. It is in the patient's best interest to actively participate with the transplant team to ensure their medical results remain current while they are on the wait list.
Other situations that may cause a patient to be placed on hold, include, but are not limited to, severe infections, stroke, heart attack, and operations. It is crucial for patients to keep the transplant team informed of any health changes or changes in their insurance.
What is a MELD (Model for End-Stage Liver Disease) score?
United Network for Organ Sharing
(UNOS), is a non-profit charitable organization. It operates the Organ Procurement and Transplantation Network(OPTN) under federal contract. On an ongoing basis, the OPTN/UNOS evaluates advances and research and adapts these into policies to serve patients waiting for transplants.
As part of this process, the OPTN/UNOS developed a system for prioritizing candidates waiting for liver transplants based on statistical formulas for predicting who needs a liver transplant most urgently. The MELD (Model for End Stage Liver Disease) is used for candidates age 12 and older and the PELD (Pediatric End Stage Liver Disease Model) is used for patients age 11 and younger. Your MELD score is based on your lab results. Adult scores range from 6 to 40. The patient with the highest score receives the next liver available for his or her blood type.
The higher your score, the more often you will need lab tests. Your doctor or transplant coordinator will tell you what your MELD score is at each clinic visit. Your lab results must be sent to the transplant office on time. (See below.) Make sure your clinic sends the results on time, or call your transplant coordinator after each lab test. If you do not, you may fall to a very low MELD score. This means your transplant could be delayed. If you have questions, please talk to your coordinator.
Your MELD score will change over time. A member of your transplant team will tell you how often you need lab tests.
- If your MELD score is 25 or greater: You will need new lab tests every week. Fax your results within 48 hours. If we receive tests that are more than seven days old, you must repeat the tests.
- If your MELD score is 19 to 24: You will need new lab tests every month. Fax your results within seven days. If we receive tests that are more than one month old, you must repeat the tests.
- If your MELD score is 11 to 18: You will need new lab tests every three months. Fax your results within 14 days. If we receive tests that are more than three months old, you must repeat the tests.
- If your MELD score is 10 or less: You will need new lab tests every year. Fax your results within 30 days. If we receive tests that are more than 12 months old, you must repeat the tests.
How do I calculate my MELD score?
You will ned to have your latest lab results to calculate your MELD score. If you have those, you can use the
MELD/PELD Calculator
on the
United Network for Organ Sharing
Web site to calculate your score.
How long is the wait for a liver transplant?
We cannot tell you how long you will wait for liver transplant. We do know that you are more likely to get called in for liver transplant if you MELD score is high. At the time a liver becomes available, the person with the highest MELD score will be offered the liver. If you are very sick and your lab values are very abnormal, you will have a high MELD score. Some patients only a few days for transplant. Others wait longer than a year.
What are my living-donor transplant options?
Living donor liver transplantation is another option for patients who need a liver transplant. In this kind of transplant, a healthy person (family member, friend or co-worker) donates a portion of their liver to the transplant patient. Doctors remove a single lobe of the donor’s liver, remove the recipient’s damaged liver and attach the healthy liver lobe in its place. Then it begins to regenerate healthy liver tissue. The donor’s liver quickly regenerates, too, and continues to function normally. Both procedures, for the donor and recipient, are performed at the same time in two different operating rooms. Click on the following link to learn more about our
Living Donor Liver Program
.
What are the advantages of living donor liver transplants?
This kind of surgery can be scheduled, and can be performed before the recipient becomes extremely ill. This leads to fewer complications, faster recovery and better long-term results. This is a very safe procedure for donors.
What is the success rate for liver transplants?
Nationwide, liver transplants are effective about 85% of the time, whether a donor organ or living donor is used.
What can I expect during a liver transplant?
During a iver transplant, the surgeon first removes the donor organ (or a portion of healthy liver for a living donor). Then the surgeon removes the recipient’s damaged liver and attaches the donor liver. Most liver recipients spend several weeks in the hospital. Living liver donors spend about one week in the hospital. Doctors monitor liver recipients closely for signs of organ rejection, infection or other complications.
How do you prevent organ rejection?
Fortunately, a number of very effective medications are available to prevent organ rejection. These medications suppress the immune system, which inhibits rejection of foreign tissue. The doctors will want to monitor your transplant medicines on an ongoing basis to make sure the levels are safe for you. It is very important to take your medicines as prescribed. This will impact the success of your liver transplant.
