- Viral Hepatitis
- Portal Hypertension
- Liver Tumors
- Endocrine Tumors
- Liver Transplant
- Mediastinal Lesions/Masses
- Bile Duct Cancer
- Bile Duct Disorders (Noncancerous)
- Obstructive Jaundice
- Ampullary Lesions and Cancers
Liver transplantation is recommended for individuals who have serious liver dysfunction and will not be able to live without having the liver replaced. The most common liver disease for which transplants are done is cirrhosis. Other diseases may include:
- acute hepatic necrosis
- biliary atresia
- metabolic disease
- liver cancers
- autoimmune hepatitis
- liver damage from overdose of medications toxic to the liver
Liver transplantation is now a very safe and efficient treatment with a 90% success rate and long-term survival above 75% for patients who would not have survived one year without it. NewYork-Presbyterian has a distinguished track record for liver transplantation and features a team of world-renowned leaders in the field.
Our Center for Liver Disease and Transplantation offers seamless integration of medical, surgical, radiological, and support services. We are one of very few institutions to provide transplantation to patients who are co-infected with hepatitis C or HIV, and to patients with cancer of the bile ducts.
Evaluation for Liver Transplantation
Candidates for liver transplantation undergo thorough medical and psychiatric evaluations.
Medical tests may include:
- blood tests
- heart tests
- lung evaluations
- liver biopsy
- chest x-ray to determine the health of the lungs
- ultrasound to examine the liver, abdominal organs, and blood vessels
- CT scan of the liver
- MRI of the abdominal organs and blood vessels
- endoscopy to assess ulcers or inflammation in the esophagus and stomach
- ERCP (Endoscopic Retrograde Cholangiopancreatography) to view the bile ducts
- Liver angiogram
A psychosocial team evaluates potential transplant candidates and their families and assists with psychosocial needs and social support services to help them cope with the many issues that arise during the transplantation process. Because use of alcohol or illicit drugs will render patients ineligible for liver transplantation, substance abuse screenings may be conducted at random.
Waiting for a Liver Transplant
The length of the waiting period for a deceased donor liver varies depending on the patient's severity of illness, blood type and overall demand. Because the liver is able to regenerate, surgeons can divide a deceased donor organ and transplant each half into a different recipient (called "split-liver" transplantation), allowing more patients to receive transplants.
Staying Healthy Before Transplantation
The Center encourages patients to stay as healthy as possible by managing stress, eating well, and exercising regularly so that they are ready for transplant surgery as soon as a donor organ becomes available. Patients will come to the Center for regular checkups during this waiting period.
Education and support groups at the Center provide patients with tools and support to manage their stress and cope with the challenges associated with their condition. A nutritionist will provide dietary recommendations to help address any health problems associated with liver disease.
Staying in Touch
Patients on the deceased-donor waiting list must be reachable at all times. Pagers or mobile phones are not mandatory, but may be the best mechanism for immediately contacting patients when a donor liver becomes available. Transportation to the hospital and other details should be planned in advance.
Liver Transplant Surgery
Once a donor liver becomes available, the patient must come to the hospital immediately and undergo testing to ensure he or she is healthy enough to withstand transplantation. Deceased donor procedures must be done within 12 to 18 hours of the donor organ's procurement.
The transplant procedure typically takes between four and eight hours and is performed under general anesthesia.
Recovery After Liver Transplantation
Immediately following liver transplantation, patients are closely monitored in the Intensive Care Unit (ICU). Most are able to return home in a week to 12 days. About three months after surgery, most patients have recovered fully and have returned to their normal activities. Patients will return to the Center for frequent follow-up visits, blood work, and other testing.
Complications After Liver Transplantation
Liver transplant recipients must take medications to help the new liver function smoothly and to prevent organ rejection. Immunosuppressant medications have many side effects, including increased risk of infection. Other risks after liver transplantation include:
- bleeding at the anastomosis (the place where the blood vessels from donor and recipient liver were joined)
- hepatic artery thrombosis (a clot in the liver artery)
- bile duct leaks, which can cause infection
- organ rejection
Even with immunosuppression, the body's immune system can recognize the new liver as a foreign invader and develop immune cells, called lymphocytes, to attack it. Many patients experience some degree of organ rejection, especially within the first three to six months after transplantation. This is usually easily reversed with medications. Patients are closely monitored after transplant surgery so that warning signs of rejection can be detected early.
The immunosuppressant medications used to prevent organ rejection interfere with patients' natural immunity and render patients more susceptible to infections. Patients may need to take antibacterial, antiviral, and antifungal medications in order to prevent harmful infections from developing.
Patients who had hepatitis B or C before transplantation can experience recurrence of the virus after surgery. Regular blood tests and liver biopsies will be done in order to screen for recurrence, which is treatable by medications if it occurs.