Will You Need a Liver Transplant?

Liver transplantation is sometimes the only treatment for people with acute or chronic liver disease that is progressive, life-threatening and unable to be successfully treated with other therapies such as medications. Liver transplantation has about a 90% one-year survival rate and thousands of people are benefiting from this remarkable surgery in the United States and worldwide every year.

Because liver transplants are expensive, technically difficult, have significant risks and require a long recovery period, doctors recommend them only as a last resort. When you have a low chance of survival with your own damaged liver, it's worth the challenges of undergoing liver transplant. Here are some of the most common reasons for needing a liver transplant:

• End-stage cirrhosis from any cause including chronic hepatitis, alcoholic cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, primary biliary sclerosis, hemochromatosis or Wilson's disease. Cirrhosis itself isn't an indication for transplant, but transplant considerations are raised as cirrhosis progresses and there are signs of decompensation such as encephalopathy, bleeding varices or recurrent ascites.
• Certain liver cancers: cholangiocarcinoma, hepatocellular carcinoma, primary hepatocellular malignancies and hepatic adenomas. In cases of hepatocellular carcinoma, no single lesion can be bigger than 5 centimeters or no more than three lesions with the largest equal or less than 3 centimeters in size.
• Fulminant hepatic failure due to one of many potential causes such as fulminant viral hepatitis (A, B, D and rarely C), Tylenol or other drugs, hepatic thrombosis, Wilson's disease, or fatty liver of pregnancy.
• Severe problems with your bile ducts: biliary cirrhosis and sclerosing cholangitis.
• Liver birth defects: Occasionally children are born with genetic diseases that keep the liver from working properly.

More people need liver transplants than there are available livers to transplant. Because of this, experts have struggled to identify the best indications and time for someone to have a liver transplant. The presence of serious complications such as fulminant hepatic failure or end-stage liver disease as well as the MELD score play heavily into prioritization. The organization responsible for matching the list of people needing liver transplants with available livers is UNOS, United Network for Organ Sharing. Though transplant centers can vary on some of the indications that determine when and why a transplant is needed, most agree that the following are important contraindications (reasons that one cannot be referred for a liver transplant):

• Current (active) alcohol or drug abuse
• Severe heart disease
• Cancer: not including some liver cancers or nonmelanoma skin cancer
• Severe and multiple birth defects that will lead to very early death
• Uncontrolled infections
• Life-threatening diseases that affect the whole body: In these cases, doctors must first treat one disease before they can treat another

Finally, here are reasons that may prevent you from getting a liver transplant. These are called relative contraindications because they depend on many other factors and are decided on a case by case basis with your medical team. There are many more, but here are just a few:

• Older than 65 years of age
• Kidney failure
• Severe obesity
• Severe malnutrition
• HIV/AIDS
• Severe pulmonary hypertension
• Severe uncontrolled psychiatric problem

_Source:

Dienstag JL. Chung RT. Liver Transplantation. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008. 1983-1985.