Successful Liver Treatment
Modern surgical procedures and technology have also brought success to liver transplantation. The Intermountain Transplant Center consistently achieves patient and graft survival rates above the national average with two month shorter wait times than the national time.
Our Liver Transplant Process
Before You Arrive
A transplant hepatologist will review your case and decide if you are ready for a transplant evaluation. If the hepatologist decides it’s too early for a transplant, we will refer you to our hepatology/liver failure clinic where we will manage your case until you are ready for a transplant.
Life After Transplant
You should bring your medication list and surgery handbook to all follow-up visits. You will be given specific instructions for routine lab work or special tests that you might need.
Taking Care of your New Liver
The most important aspects of post-transplant care are to listen to your doctors’ advice and take your immuno-suppression medications, which you’ll need to take for the rest of your life. This will greatly decrease the chance of rejection episodes, in which your immune system attacks the new liver.Modern medical advances, including immunosuppressant drugs that prevent rejection of the new liver, make liver transplant complications less common. Patient and organ survival rates are high, and life expectancy rates are good. The Intermountain Transplant Center team’s experience coupled with your diligent care for your new liver, a normal life is once again possible.
Signs of Infection and Rejection
The primary concerns for your new liver are infection and rejection. Your local physician can handle many problems, such as colds or flu, adjustment of your medications, and minor infections. Learn to watch for signs of infection and rejection that necessitate notifying a local physician or transplant team immediately:
- A fever that continues for more than 2 days
- Shortness of breath
- Vomiting
- Diarrhea
- Yellow skin and yellowing of the whites of the eyes (jaundice)
- Pale stools
- Dark urine
- Pain in the liver area
Team Utah - Idaho
Once you're well enough, we invite you to join Team Utah Idaho in the Transplant Games of America. The team is made up of transplant recipients and living donors of all organs from throughout Utah and Idaho. Team members have ranged in age from 3 to 70. Grateful athletes with new hearts, kidneys, livers, lungs and pancreases participate in strenuous athletic events to celebrate a new life and prove that organ donation brings a full return to good health.
Schedule
Before you undergo a transplant, we perform an evaluation to see if you’re an appropriate candidate. Your first clinic visit will begin in the morning with a short orientation and proceed through the remainder of the day. In this first visit you will be seen by many of the professionals on our transplant team:
- A Transplant Hepatologist: A transplant hepatologist is a doctor who specializes in liver disease and treatment, including liver transplantation. This doctor will determine if you are medically suitable for a transplant, if you need further tests, or if a transplant is not right for you. The transplant hepatologist will also discuss the medications you would need and possible complications after a transplant.
- A Transplant Surgeon: Will discuss the transplant surgery, associated risks, and possible complications during and after your transplant.
- A Social Worker: Will meet with you to help you cope with the stress of transplantation and, if needed, follow a rigorous treatment plan after the transplant. The social worker will also help you identify a support network.
- A Financial Coordinator: Will discuss the costs of a liver transplant and the medications you will need after the transplant. The financial coordinator will help you understand your insurance coverage and any costs not covered by your insurance.
- A Transplant Pharmacist: Will provide information about transplant medications, including instructions and side effects.
- A Dietitian: May meet with you as requested by you or your doctor to assess your needs and suggest food choices to best support you before surgery, during your hospital stay, and recovery.
After your first clinic visit, our transplant team will have a clear picture of how to proceed with your transplant work-up.
A majority of our patients will need additional testing to determine their suitability for a transplant surgery. Some of those tests can be done during your initial visit; others can be done at your local hospital.
Test & Evaluation
Blood Tests
Blood tests are done to determine your blood type and markers that are important for organ matching. You will also be screened for immunity to specific viruses or the presence of viruses like HIV, syphilis, and hepatitis A, B, and C. Other blood tests will be done to evaluate your overall health, including routine chemistry, complete blood counts, and clotting factor tests. (Note: Utah state law requires healthcare providers to report cases of HIV and hepatitis to the state health department.)Urine Tests
Urine tests are used to screen for urinary tract diseases or abnormal cells in your urine, as well as for drugs or alcohol in your system.Heart Tests
Heart tests will help your doctors decide if your heart function is strong enough for transplant surgery:
- An electrocardiogram (EKG) combined with an echocardiogram and/or stress test, shows how well your heart is beating and the function of your heart valves.
- A coronary angiogram evaluates the pressures and anatomy of your heart.
Lung Tests
Lung tests helps your doctors evaluate your lungs, and are especially important if you have a history of smoking or lung disease:
- A chest x-ray helps your doctor identify any problems with your lungs.
- Pulmonary function tests and a hepatopulmonary screen are breathing tests used to analyze your lung function and capacity.
Liver Tests
Liver tests to evaluate your liver:
- An abdominal/pelvic CT scan or MRI determines the extent of your liver disease, identifies whether you have any tumors, and verifies the blood supply to your liver.
- A liver biopsy may be requested. During a liver biopsy, a needle will be used to remove a tiny sample of liver tissue. This is an outpatient procedure. Your doctors will do a microscopic examination of the tissue to get information about the cause and severity of your liver disease.
- An ultrasound of your liver and abdomen helps assess the size, shape, and circulation of your liver.
Other Tests
Other tests and procedures to evaluate specific conditions may include:
- A dexascan, which evaluates your bones to show whether you have osteoporosis. Many chronically ill people have low bone density, which creates a higher risk for fractures (broken bones).
- A TB skin test (a tuberculosis test placed on your forearm) that will need to be checked in 48 to 72 hours to see if your body has been exposed to tuberculosis.
- A dental exam.
- A prostate exam for males or pelvic exam and Pap smear for females.
- A mammogram for women over age 40.
- A colonoscopy for people over 50.
Transplant Surgery
The Telephone as a Lifeline
As soon as a donor liver becomes available, the coordinator will call you to get ready. Since this call could come at any time during the day or night, the transplant team should be able to reach you whether you are at home, at school, at work, or on vacation.Please provide our transplant team with the phone numbers of family members and close friends as well, and do everything you can to make sure that you can be contacted immediately.
When the Phone Call Comes
When that phone call comes, everything will seem like a blur. The coordinator will advise you when to be present at the transplant center. You must move quickly and get to the transplant center without delay. When a liver becomes available, there is a time limit!At the Hospital
After admission, you will have a thorough physical examination, including more blood work, a chest x-ray, an EKG, and other tests.
- You have an infection or have developed any other medical problem that would interfere with surgery or recovery
- The donor kidney shows signs of deterioration or poor function
If surgery is postponed, the transplant team can help you through the disappointment. This is only a temporary setback, and the search for a new liver will go on.
Transplant Surgery
Prior to entering the operating room, your anesthesiologist will review your medical history with you. Once he or she has completed this review, they will give you some medicine to help you relax. You will then be taken in to the operating room Once you’re asleep, special IVs will be placed to help monitor your status during the surgery. This process takes between 30-60 minutes.After everything has been properly prepared your surgeon will start your surgery. The surgery usually lasts from 6 to 8 hours. Your damaged liver will be clamped off and completely removed from your body, after which the surgeons will replace it with the donor liver. After blood flow is restored to your new liver and everything looks normal the surgeons will finish the surgery.
After surgery a typical hospital stay without complications spans from 8 to 10 days.
Waiting List
Donor Livers and the Waiting List
Once you’ve completed all testing, your case is presented in a multi-disciplinary selection meeting. At this meeting, surgeons, hepatologists, nurses, financial coordinators, social workers, and nutritionists discuss your options. Afterward, a majority of patients are placed on the waiting list for a cadaveric liver donation.Intermountain Medical Center offers living donor liver transplants. The liver is only organ that can regenerate itself, so a portion of a liver can be removed from a healthy donor and implanted in a recipient, and then both portions will grow into fully functional livers. There is a chance of complications or even death for the donor, but it can also save the life of patient who may otherwise die before a liver is available from a deceased donor.
Additional Patient Resources
Diseases that affect the liver are very serious medical conditions. Unlike those suffering from kidney failure, in which dialysis is an option, a person without a functioning liver will not survive. Chronic liver disease can eventually lead to end stage liver disease (ESLD), for which the only treatment is orthotropic liver transplantation. The Intermountain Transplant Center’s hepatologists aggressively treat many liver diseases to prevent their progression and eventual liver failure. Below is a short list of the most common liver diseases that cause ESLD, along with links to more information:
- Hepatitis C Virus (HCV): HCV can attack the liver and cause cirrhosis, liver failure, and even liver cancer, although not all people with HCV develop ESLD.
- Autoimmune Hepatitis: The body's immune system attacks liver cells, causing inflammation of the liver (hepatitis).
- Alcoholic Cirrhosis: Due to heavy alcohol abuse, the liver suffers chronic injury and scar tissue replaces healthy liver tissue causing the liver to malfunction.
- Primary Sclerosing Cholangitis (PSC): PSC causes damage to bile ducts inside the liver that can become blocked, and bile builds up in the liver and damages liver cells. PSC leads to cirrhosis.
- Primary Biliary Cirrhosis: Although not always caused by PSC, this is damage to the liver caused by blockage of bile ducts and a buildup of bile.
- Acute Hepatitis: A sudden onset of inflammation in the liver. There are many causes for acute hepatitis, one of which is overdose of acetaminophen.
- Hepatocellular Carcinoma (HCC/Liver Cancer): Cancerous hepatocytes (liver cells) form a tumor in the liver. These can cause liver failure, and can break away from the original tumor and cause cancer in other parts of the body.
Financial Resources
- National Transplant Assistance Fund: Provides emergency one-time grants for patients that have had a transplant.
- Social Security: Financial assistance for patients who will be disabled for at least a year and have enough “work credits.” SSI and SSDI.
- Cameron Siemers Foundation for Hope: Provides $5000 grant if you are between the ages of 18-28 and have been diagnosed with a life threatening illness, to be used in the fulfillment of a dream, goal, or project that you take on to make a difference.
Medication Assistance
- Rx Outreach: Provides deeply discounted mail order medications; 90 and 180 day supplies for many medications.
- Rx Assist: Quick and easy-to-use database of all medication patient assistance programs. If you have trouble paying for a medication, then you can do a quick search to find out if there might be an assistance program to help.
Frequently Asked Questions
How are donor livers allocated?
How does the waiting list work?
How does a “liver offer” work?
Are there risks from the donor liver itself?
Where do cadaveric donor livers come from?
The donor’s cause of death most often renders them brain dead, as determined by no blood flow to the brain. This is referred to as “brain death” and is the most common situation for organ donation. Livers may also be recovered from donors who have suffered severe brain damage, but die of heart failure once life-sustaining measures are withdrawn. This is referred to as Donation after Cardiac Death. Liver donors are screened and may be excluded for positive HIV, hepatitis B and C, liver abnormalities and/or damage, or high-risk activity. Any high-risk donor characteristic will be discussed with the potential recipient.