A liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. Most liver transplant operations use livers from deceased donors, however, in some cases, a part of a liver may be donated by a living donor. Currently, 14,000 people in the United States are on the national transplant waiting list for a donor liver.
How common are liver transplants?
In 2015, about 7,100 liver transplants were performed in the United States. Of these, almost 600 were performed in patients 17 years of age and younger.
When do people need a liver transplant?
People need a liver transplant when their liver fails due to disease or injury.
For adults in the United States, the most common reasons for needing a liver transplant in 2016 were:
- Alcoholic liver disease
- Cancers that start in the liver combined with cirrhosis
- Fatty liver disease (nonalcoholic steatohepatitis)
- Cirrhosis caused by chronic hepatitis C
Biliary atresia is the most common reason children need a liver transplant.
Doctors may consider a liver transplant to treat rare disorders such as urea cycle disorders and familial hypercholesterolemia.
People may also need a liver transplant due to acute liver failure. Acute liver failure is an uncommon condition most often caused by taking too much acetaminophen.
Other causes of acute liver failure include:
- Bad reactions to prescription medicines, illegal drugs, and herbal medicines
- Viral hepatitis
- Blockage of the blood vessels to the liver
- Autoimmune diseases
- Genetic disorders
What are the types of liver transplant?
Deceased donor transplants
Most livers for transplants come from people who have just died, called deceased donors. During a deceased donor transplant, surgeons remove a diseased or injured liver and replace it with the deceased donor’s liver. Adults typically receive the entire liver from a deceased donor. However, surgeons may split a deceased donor’s liver into two parts. The larger part may go to an adult, and the smaller part may go to a smaller adult or child.
Living donor transplants
Sometimes a healthy living person will donate part of his or her liver, most often to a family member who is recommended for a liver transplant. This type of donor is called a living donor. During a living donor transplant, surgeons remove a part of the living donor’s healthy liver. Surgeons remove the diseased or injured liver and replace it with the part from the living donor. The living donor’s liver grows back to normal size soon after the surgery. The part of the liver that is received also grows to normal size. Living donor transplants are less common than deceased donor transplants.
What are the survival rates after a liver transplant?
For patients receiving liver transplants from deceased donors, the survival rates are
- 86 percent at 1 year
- 78 percent at 3 years
- 72 percent at 5 years
The 20-year survival rate is about 53 percent.
The chances of a successful liver transplant and long-term survival depend on the individuals personal situation.
Facts on Living Liver Donation
Most donors know their recipient: Because of the size and scope of the operation — plus the speed a decision to donate might require — a living liver donor typically has close ties to the recipient. Still, both sides must undergo a range of compatibility tests.
Living donations save time: Living donation is intended to help a sick patient avoid the wait time for a deceased donor. That can mean an individual receives lifesaving intervention before his or her condition (typically end-stage liver failure, liver cancer or other rare and metabolic diseases) worsens.
Live liver donations remain rare: Living liver donation was first attempted in children in the late 1980s. Adult transplants initially took place a decade later. Today, they account for only about 5 percent of total liver transplants. That’s partially because the surgery can frighten or disqualify some donors — and there are limited surgeons and centers with robust expertise.
Risks affect both parties: Studies have shown that “long-term outcomes are as good or better” for living-donor recipients. But unique challenges remain. Because it’s only part of a liver, the implantation process for the recipient is more complicated. There also are risks to the donor, such as bleeding and the need for blood transfusion.
Recovery time: A living donor who gives a kidney might be hospitalized for a few days and spend four to six weeks healing. Those who offer part of their liver, however, can expect to double that length of time.
-Anant Nahata, Alexander’s Hope Intern