Liver Transplant

Your doctor will likely do the following: Physical examBlood testChest x-rayElectrocardiogram (ECG, EKG) a test that records the heart's activity by measuring electrical currents through the heart muscle Possibly other tests The day before and the day of your procedure: Your stomach must be empty prior to surgery, so do not eat or drink anything after midnight, or once you learn a liver is available. You may be given an enema to clean out the intestines and prevent constipation following surgery. Your chest and abdomen will be shaved to prevent infection. During ProcedureIV fluids and medications, sedative, and anesthesia will be administeredA tube will be inserted to help you breathe AnesthesiaGeneral anesthesia is used for a liver transplant. Description of the ProcedureThe surgeon makes an incision shaped like a boomerang on the upper part of the abdomen. The old liver is removed, leaving portions of major blood vessels in place. The new liver is inserted and attached to the blood vessels and bile ducts. To help with bile drainage, a tube will also be inserted in the bile duct during surgery. The skin is closed with stitches. After Procedure You'll be closely monitored in the intensive care unit, and will have the following devices:

Breathing tube until you can breathe independentlyIV fluids and medicationBladder catheter to drain urine How Long Will It Take?The surgery will take several hours. Will It Hurt?Anesthesia prevents pain during surgery. You'll likely experience pain during recovery but you will receive drugs to relieve this discomfort. Possible ComplicationsRejection of transplanted liverExcessive bleedingInfectionBile-duct obstruction or leakinessAllergy to anesthesiaComplications from the antirejection drugs that must be taken for life after such a transplant (such complications can include severe infection, cancer)Blood clots in the major arteriesNeurological complications, such as seizures Average Hospital StayThis varies and can be several weeks. Postoperative CareAt first you will receive fluids and nutrition intravenously, but will eventually be transitioned to a normal diet.You will receive physical therapy to regain muscle strength.Once home, you may be directed by your doctor to monitor your temperature, blood pressure, pulse, and weight.You will have regular follow-up visits for check-ups and lab tests.You will be started on drugs to suppress your immune function and therefore decrease the risk that your body will reject your new liver.You may be prescribed a special diet to prevent water retention and to maintain a normal weight and blood pressure. OutcomeRecovery time varies and may depend, in part, on your overall health before the transplant. Most patients are able to return to normal or near-normal activities 6 to 12 months after transplantation.

To reduce the chance that your body will reject the donor liver, you will need to take immunosuppressive drugs for the rest of your life. These medications have potential side effects, so be sure to discuss special precautions with your doctor. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chills; you are more susceptible to infections while taking immunosuppressive medicationsRedness, swelling, increasing pain, excessive bleeding, or discharge from the insertion siteCough, shortness of breath, chest pain, or severe nausea or vomitingCough that produces a yellowish or greenish substanceDry cough that continues for more than one weekProlonged nausea, vomiting, or diarrheaInability to take prescribed medicationBruisingBlack stoolsRed or rusty-brown urineA rash or other skin changesPain, discharge, or swelling at the site of the drainage tubeVaginal discharge, in womenPain, burning, urgency, frequency of urination, or persistent bleeding in the urineExposure to mumps, measles, chickenpox, or shinglesUnusual weakness or light-headednessIllness that requires emergency room treatment or hospitalization RESOURCES: American Liver Foundationhttp://www.liverfoundation.org United Network for Organ Sharing

http://www.transplantliving.org CANADIAN RESOURCES: Canadian Liver Foundationhttp://www.liver.ca/Home.aspx Toronto General Hospitalhttp://www.torontotransplant.org/patients/liver.cfm References: American Liver Foundation website. Available at: http://www.liverfoundation.org. . Gee I, Alexander G. Liver transplantation for hepatitis C virus related liver disease. Postgrad Med J . 2005;81:765-771. Liu CL, Fan ST. Adult-to-adult live-donor liver transplantation: the current status. J Hepatobiliary Pancreat Surg . 2006;13: 110-6. Liver Transplant Program and Center for Liver Disease, University of Southern California website. Available at: http://www.surgery.usc.edu/divisions/hep/index.html . Luu L. Liver transplants (June 30, 2006). eMedicine website. Available at: http://www.emedicine.com . Neuberger J. Developments in liver transplantation. Gut . 2004;53:759-68. OGrady JG. Liver tansplantation alcohol related liver disease: (deliberately) stirring a hornets nest! Gut . 2006;55: 1529-31

Last reviewed November 2007 by Daus Mahnke, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.