Liver Transplant

What you should know

• A liver transplant is surgery to replace your diseased or damaged liver with a donor (another person) liver. Your liver is an organ that lies in the upper right side of your abdomen (stomach). Your liver has many functions including removing waste products from your blood. It breaks down your blood so your body can better use the nutrients. Your liver also helps control your blood clotting. Donor livers may come from someone who has died, or from a living family member. You may receive a whole liver, or just a part of a liver. Partial liver transplants are done because the liver is the only organ that can renew itself, if it is healthy.
  
  
• You may need a liver transplant if you have liver failure. Liver failure may be caused by certain diseases that scar your liver and cause it to harden. Viral hepatitis infections may cause your liver to swell and fail. You may need a transplant because of liver cancer. Drinking too much alcohol, too often, also may lead to liver damage and failure. When you need a liver transplant, you will be placed on a transplant list. You may need to wait for a long period of time before a donor liver is found. When a donor liver is found and ready, you will be called to the hospital.
  
  
• During surgery, your caregiver will make incisions (cuts) in your abdomen down to your liver. Your failing liver will be removed, and the donor liver will be secured in place. When your new liver is in place and blood is flowing through it, your caregiver will close your abdomen. You may be watched closely in the hospital for a few weeks after your surgery. With a liver transplant, your symptoms such as abdominal pain, swelling, and yellowing skin may resolve. If you have cancer, it may prevent it from spreading. A liver transplant may even cure your cancer.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• When you have severe liver failure, you have an increased risk of dying before a donor liver is found. You may have an allergic response to the medicines used during, and after your surgery. The fluids used during your surgery may build up in your abdomen and lungs. Extra fluid may make it hard for you to breathe. During surgery, your blood vessels may be damaged, and you may lose large amounts of blood. Your blood pressure may decrease, or you may have abnormal heartbeats during surgery. Rarely, you may have a heart attack during surgery when the blood begins to flow through your new liver. Medicines used after surgery may increase your risk for infection or slow your healing. You also may have an increased risk for ulcers (open sores) and bleeding in your stomach. You may have a decreased level of electrolytes (body salts) which may damage your heart and be life-threatening.
  
  
• After surgery, bile (yellowish fluid from the liver) may leak from your bile ducts into your abdomen. You may get a wound, abdominal, lung, or blood infection. After surgery you are at an increased risk for blood clots that may travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening. Blood clots may form in the blood vessels of your liver. Your new liver may not function, and you may need a new liver right away. Other organs in your body may also fail, and you may die.
  
  
• After your transplant, you are at an increased risk for diabetes, kidney problems, and high blood cholesterol (fat). You also may be at risk of getting bone and heart disease, and cancer. Your body may reject (not accept) your new liver, and you may need another liver transplant. If you had liver cancer, your cancer may return, and you may need another transplant. If you have viral hepatitis, the virus may return and cause your new liver to fail. If you choose not to have a liver transplant, your symptoms may worsen, and you may die. Talk to your caregiver if you are worried or have questions about your surgery, medicine, or care.

Getting Ready

Before your surgery:

• While waiting for your donor liver:
  
  
  • You will need to stop drinking alcohol for at least six months before your transplant. Alcohol is found in beer, wine, whiskey, and other adult drinks. Ask your caregiver for help if you do not think you can stop on your own.
    
    
  • Your caregiver may order medicines for you to take while waiting for your transplant. If you have viral hepatitis, you may need immune globulin or antiviral medicines. These medicines may help decrease the amount of virus in your body before surgery. Ask your caregiver for information about medicines you may need before your transplant.
    
    
  • You may need liver support before your transplant to decrease the level of toxins (waste) in your blood. Liver support may include plasma exchange to remove your plasma and replace it with donor plasma. Plasma is a yellowish colored liquid that makes up your blood. You may also need hemodialysis before your transplant. Hemodialysis uses a filter to pull toxins out of your blood that your body cannot remove on its own.
    
    
  • If you have liver cancer, you may need treatment to slow tumor growth before your transplant. Treatment includes transarterial chemoembolization, percutaneous ethanol injection, and radiofrequency ablation. Ask your caregiver for more information about these treatments for liver cancer.
    
    
  • You may need to have a computed tomography (CT) scan or magnetic resonance imaging (MRI). You may also need an abdominal ultrasound, Doppler ultrasound, and a chest x-ray. These tests are done to check for cancer in your liver, or other body areas. The tests also may be done to check for any blockages in the blood flow to your liver. Blood tests will be done to check the function of your liver and other organs. You may also need an upper endoscopy to check for large varices and bleeding in your esophagus. Your esophagus is the tube that carries food and liquid to your stomach. Varices are veins that become large and may bleed. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• Getting ready for your surgery:
  
  
  • Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
    
    
  • Bring your medicine bottles, or a list of all your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine, or if you are taking herbs or food supplements. Ask your caregiver if you need to stop using aspirin, prescribed or other over-the-counter medicine before your surgery.
    
    
  • You may need a blood transfusion if you lose a large amount of blood during surgery. During a blood transfusion, you will get whole blood, or parts of blood through an IV. You may also need a blood transfusion after your surgery. You may ask a family member or friend with the same blood type to donate (give) blood for you. Ask your caregiver for more information about blood transfusions.
    
    
  • If you have diabetes (increased blood sugar), you may be at higher risk for problems after surgery. Ask your caregiver for instructions about what you should eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have instructions about using them before surgery.

The Day of Surgery:

• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Blood and urine tests: You may need blood and urine tests done the day of surgery to check your organ function. The tests may also be done to check for infection, or any recent alcohol or drug use.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• Medicines:
  
  
  • Antibiotics: You may be given antibiotics through your IV before your surgery. An IV is a tube that is placed in your vein for giving liquids and medicines. Antibiotics help prevent infection from germs called bacteria.
    
    
  • Immunosuppression medicine: These medicines are given to help your body accept your new organ. They also help prevent your body from rejecting it. You may be given this medicine before your surgery. You will also need this medicine after surgery, and for the rest of your life.
  
  
• Arterial line: This is a tube placed into an artery (blood vessel), usually in your wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line measures your blood pressure and may be used for taking blood.
  
  
• Central venous pressure line: A central venous pressure (CVP) line is a thin tube put in a vein near your collarbone, or in your neck or groin. The CVP line can monitor the fluid and pressure in your blood vessels. The CVP line may also be used to give medicines or fluids.

Treatment

What Will Happen:

• You will be taken to the room where your surgery will be done. You will lie on your back on the surgery table. Anesthesia medicine will be given to you to keep you asleep, and pain free during your surgery. Your caregiver will make cuts under each side of your rib cage. There will also be a cut made down the middle of your abdomen. Muscles and other tissues will be moved aside to help see your liver better. The blood vessels attached to your liver will be cut and closed to stop any bleeding. The blood flow to your liver will be stopped during surgery.
  
  
• Your liver will be removed, and the donor liver will replace it. Your caregiver will sew the blood vessels of the donor liver to your blood vessels. Blood will then be allowed to flow through your new liver. Your caregiver will then attach your bile duct to the donor livers bile duct. Your caregiver may use stitches, special glue, or a laser beam to stop any areas of bleeding. Drains will be placed around your liver to remove any extra blood and fluid after surgery. Your caregiver will then close the cuts with stitches, and cover them with a bandage. The bandages will help keep your wounds (surgery areas) clean and dry, and help prevent infection.

After Surgery:

You will be taken to a room where you will rest and be monitored. Caregivers will watch your heart rate, blood pressure, breathing, and temperature closely. You may still have an endotracheal (ET) tube in your mouth and throat. The ET tube is hooked to a machine called a ventilator that helps you breathe. The ET tube will not be removed until you can breathe well on your own. When you are fully awake you may still have many tubes in place. The tubes may make it hard for you to move, but are needed to watch your condition. Do not get out of bed until a caregiver says it is okay, and someone is there to help you. Caregivers will check your wound often for healing and any problems. Caregivers will also work with you to keep your pain controlled.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You get sick with a cold or the flu.
  
  
• You have a fever.
  
  
• You are diabetic and your blood sugar levels are not where your caregiver says they should be.
  
  
• You have new headaches or shakiness.
  
  
• You have new pain or tenderness in your upper abdomen.
  
  
• Your legs begin to swell.

Seek Care Immediately if

• You are urinating less than normal, or not at all.
  
  
• You feel very confused or have a seizure (convulsion).
  
  
• You feel very weak or get tired easily.
  
  
• You have a decreased appetite for food and are losing weight.
  
  
• You have black, tarry stools, or vomit (throw up) blood.
  
  
• You have new, or worsening yellowing of your skin or the whites of your eyes.
  
  
• You have severe (very bad) pain in your upper abdomen.
  
  
• Your abdomen becomes swollen.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.