A liver transplant operation may be recommended to replace a damaged or diseased liver with a healthy one from an organ donor.
Around 726 liver transplants are carried out each year in the UK, but the number of people needing a liver transplant is higher than the number of available donor organs.
A liver transplant is considered when the liver no longer functions adequately, called liver failure. This can happen suddenly, called acute liver failure, as a result of infection or complications from certain medications. It can also be the end result of a long-term problem.
The following conditions may result in liver failure:
- Chronic hepatitis with cirrhosis
- Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts, causing liver failure).
- Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside the liver, causing a back-up of bile in the liver which can lead to liver failure).
- Biliary atresia (malformation of the bile ducts).
- Wilson's disease (a rare inherited disease that involves abnormal deposition of copper throughout the body, including the liver).
- Haemochromatosis (a common inherited disease where the body is overwhelmed with iron).
- Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).
- Liver cancer.
How are candidates for liver transplant determined?
Evaluations by specialists from a range of fields are needed to determine if a liver transplant is appropriate. These include a review of your medical history and a variety of tests. Hospitals take a multidisciplinary approach when assessing and selecting candidates for liver transplantation. This multidisciplinary healthcare team may include the following professionals:
- A liver specialist (hepatologist).
- Transplant surgeons.
- A transplant co-ordinator - usually a registered nurse who specialises in the care of liver-transplant patients (this person will be your main point of contact with the transplant team).
- A social worker to discuss your support network of family and friends, employment history and financial needs.
- A psychiatrist or psychiatric nurse to help you deal with issues that may arise with liver transplantation, such as anxiety and depression.
- An anaesthetist to discuss potential anaesthesia risks.
- A physiotherapist to educate patients about pre-operative exercises and post-operative rehabilitation.
- A dietitian to ensure adequate nutrition before and after the transplant.
- A dependency specialist to help people with a history of alcohol or drug misuse.
- A financial counsellor to advise on issues such as lost work time after a transplant.
Which tests are required before getting a liver transplant?
The transplant team will assess your medical records, X-rays, liver biopsy slides and a record of any medicines you are taking as part of the process of evaluating you for a liver transplant. To complement and update previous tests, some or all of the following diagnostic procedures are generally performed during your evaluation:
- A CT scan, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape.
- A Doppler ultrasound scan to determine whether the blood vessels to and from your liver are open.
- An echocardiogram test to help evaluate how well your heart is functioning.
- Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide.
- Blood tests to determine your blood type, clotting ability and the biochemical status of your blood, and to gauge your liver function. HIV testing and hepatitis screening are also included.
If specific problems are identified, additional tests may be arranged.