LIVER TRANSPLANTATION

Although liver transplantation was first performed in 1960, it did not become standard form of therapy for advanced liver disease until the 1990s. 
 
Operating RoomThere are two main reasons why liver transplant has become so successful. The first has been the major improvement in surgical techniques and the second is the availability of new drugs which can help to prevent rejection.
 

What are the reasons for Liver Transplantation?

 
Liver transplantation is usually performed only if a patient has end stage liver disease.
 
Medical treatment is always the first choice of therapy but when this medical treatment has been unsuccessful and the patient’s liver can no longer support life, then liver transplantation is considered.
 
Liver transplantation can occur for a large number of different liver disorders but there are several conditions which are more commonly treated by liver transplantation. These conditions in general cause chronic or continuing liver inflammation and cirrhosis.
 
In adults the most common reasons for liver transplantation in Australia are:
 
1. Chronic viral Hepatitis B and C.

2. Alcohol related liver disease.

3. Primary biliary cirrhosis.

4. Advanced cirrhosis of any cause.

5. Drug induced liver disease.

6. Acute liver failure.

7. Primary liver cancer.
 
In children the most common cause of liver failure is biliary atresia in which the bile ducts fail to develop.
 

Special considerations

 
 
In both Hepatitis B and Hepatitis C the transplanted liver will once again become infected. The majority of patients with Hepatitis B and C will never need a liver transplant. 
 
 
Experience has shown that unless the patient has been completely abstinent from alcohol for at least six month, the prospects of a good result are compromised. It is very important then that patients with alcohol related liver injury completely abstain from all alcohol. 
 
 
Only a small percentage of patients with primary liver cancer are suitable for liver transplantation. Livers are a scarce resource and if there is any spread of the cancer, then the liver transplantation will not save the patient's life.
 

Transplant Centres

 
In Australia there are several transplant centres. The nearest transplant centre to the Gold Coast is based at the Princess Alexandra Hospital. This is a world class transplant centre with specialist surgeons, hepatologists, psychiatrists and many ancillary staff. Currently this centre performs around 50 transplants per year.
 
There is a close communication with other transplant units nationwide and organs from one state may occasionally be used in another state.
 
Unfortunately, there are more patients who need a new liver than there are donors. Choosing who gets a liver and when can be very difficult. A fair system of allocation is necessary and the reality is that there are patients who unfortunately will die from their liver disease while still on the waiting list.
 
Donor livers usually come from individuals who have suffered fatal brain damage due to trauma rather than disease. For various reasons not all such patients who suffer severe brain trauma become organ donors.
 
There are factors other than the severity of the liver disease which are considered by the transplant team in the decision regarding suitability for liver transplantation. These include the patient’s psychological make up, family situation and home support and in patients with alcoholic liver disease, their ability to abstain from alcohol.
 
Other medical problems such as severe heart or respiratory disease, may also preclude a person from liver transplantation.
 
After patients are assessed by the liver transplant team, they are presented to a panel which has the ultimate decision as to whether the patients are accepted on the active transplant list. If they are accepted, the patient is then given a beeper to wear at all times so that they can get to the transplant centre as soon as possible.

Surgery

 
Liver transplantation surgery is obviously complicated. 
 
The first operation is the removal of the liver from the donor and this operation is often performed at a different location e.g. if the donor was in intensive care on the Gold Coast, the surgery to remove the donor liver would be performed on the Gold Coast and then the liver taken to Brisbane. 
 
The transplant operation would then occur at the Princess Alexandra Hospital and would take several hours at least. The new liver is attached to the various blood vessels and bile ducts and when the surgery is completed, the patient is transferred to Intensive Care.
 

The Post Operative Period

 
The patient often remains in hospital for several weeks after the operation. There is continual monitoring for infection and rejection of the donor liver by the body.
 
Test Tube IIRejection occurs in all patients. Long-term treatment against rejection is always necessary.
 
Medications used in liver rejection have significant side effects and the patient will need close monitoring.
 
As recovery progresses, the patient is discharged home but continues under the care of the Transplant Unit until stable. 
 
Long-term care is usually managed by the patient’s personal physician with occasional visits to the transplant team.
 
Once patients have recovered, they can resume normal physical and sexual activities and even vigorous exercise is possible.
 

Liver donations

 
All healthy people are encouraged to make arrangements to become liver donors. This would enable more livers to become available.
 
We encourage you to talk to your local doctor about becoming an organ donor.
 

Interesting Web Sites on Liver Transplantation

 
www.cs.nsw.gov.au – Australian National Liver Transplant Unit Referral Site
www.hepatitisc.asn.au – Hepatitis C Council of Queensland