Although the first human liver transplant was done in
1963, the procedure did not gain widespread acceptance
in medical practice until the 1980's . With this
acceptance , questions from patients, relatives,
healthcare workers and the public have increased. This
pamphlet is designed to answer some of the most common
questions. 
The frequently
asked questions
What Are the
Symptoms and Signs of Liver Disease?
How
Can You Take Care Of Your Liver?
What
diseases are treated by liver transplantation?
Which liver diseases are the most
common?
What about
alcohol-related liver disease?
And
cancer of the liver?
Are there
alternative treatments for liver disease?
Is liver transplantation a treatment
of last resort, when everything else has failed?
How is the decision made to
transplant?
What are the
major risks?
What are the
overall chances of surviving a liver transplant?
How long does it take to recover?
What happens during this recovery
period?
If a
transplanted liver fails to function, or is rejected,
what can be done?
What
side-effects do patients commonly experience from the
drugs used to treat or prevent rejection?
Do recipients of liver transplant
have to take these medicines for the rest of their
lives?
How frequent is
medical follow-up?
Are patients
more susceptible to other infections?
What
about physical activity after a liver transplant?
What about sexual activity?
Is it safe for women to become
pregnant after transplantation?
What
about diet?
Can there be a
recurrence of the original disease in the transplanted
liver?
From the
description, patients with successful liver transplants
seem very healthy. How long can this good health last?
Where do the donor livers come from?
Do the donor and the recipient have
to be matched by tissue type, sex, age, etc.?
What happens if there are two
suitable recipients for a donated liver?
Will the hepatitis C be cured by a liver
transplant?
What can be done
for hepatitis C that comes back in a transplanted
liver?
I have hepatitis B and hepatitis C.
Can a transplant still be done?
How
can I donate my organs?
What are the symptoms
and signs of liver disease ?
Consult your
physician if you observe any of the following symptoms:
a yellow discoloration of the skin or eyes the
appearance of very dark urine or passage of pale, bloody
or tar-like stools abdominal swelling prolonged itching
of the skin chronic fatigue nausea or loss of appetite
vomiting of blood severe prolonged abdominal pain.
GO TOP
How can you take care
of your liver? Maintain a healthy,
well-balanced diet. Avoid taking medication
unnecessarily. Do not exceed the maximum daily dose and
do not mix alcohol and medication. If you drink alcohol,
have two or less drinks a day. Protect yourself from
viral hepatitis A and B by getting vaccinated. Avoid
exposure to industrial chemicals.
GO TOP
What diseases are
treated by liver transplantation?
A large
number of diseases are capable of interfering with the
liver's function sufficiently to threaten the life of
the patient and most are potentially treatable by liver
transplantation.
GO TOP
Which liver diseases
are the most common? In adults, cirrhosis, the
death of liver cells due to a variety of causes, is one
of the most common reasons for which liver
transplantation is done. In children, the disease most
often treated by liver transplantation is biliary
atresia, a failure of the bile ducts to develop normally
to drain bile form the liver.
GO TOP
What about
alcohol-related liver disease? Most people who
develop cirrhosis of the liver due to excessive use of
alcohol do not need a liver transplant. Abstinence from
alcohol and treatment of complications will usually
allow them to live for prolonged periods without a
transplant. For patients with advanced liver disease,
where prolonged abstinence and medical treatment fails
to restore health, transplantation is a
consideration,provided they abstain from alcohol
intake.
GO
TOP
And cancer of the
liver? Most cancers of the liver begin
somewhere else in the body and spread to the liver.
These are not curable with a liver transplant. Likewise
the tumors which start in the liver have usually spread
to other organs by the time they are detected and are
rarely cured by liver transplantation. Transplantation
at an early stage of liver cancer may result in
long-term survival for some patients especially if
cancer is associated with cirrhosis liver.
GO
TOP
Are there alternative
treatments for liver disease? There are
effective medicines for some liver diseases, while for
others only treatment for complications is available.
Treatment of complications may be all that is required
if the liver is not failing. Frequently medical
treatment delays, but does not eliminate, the need for
transplantation.
GO TOP
Is liver
transplantation a treatment of last resort, when
everything else has failed? Yes and no. If
medical treatment were likely to allow prolonged
survival with good quality of life, transplantation
would be reserved for the future. However, ideally the
surgery is undertaken before the terminal stage of the
disease when the person is too ill to withstand major
surgery and will not survive until a suitable donor is
available.
GO
TOP
How is the decision
made to transplant? This is a decision made in
consultation with all individuals involved in the
patient's care, including the patient and/or family. The
patient and family's input is vital and they must
clearly understand the risks involved with proceeding to
transplantation.
GO
TOP
What are the major
risks? Before surgery, the risks are mainly the
development of some acute complication of the disease,
which might render the patient unacceptable for surgery.
With transplantation there are risks common to all forms
of major surgery, as well as technical difficulties in
removing the diseased liver and implanting the donor
liver. One of the major risks for the patient is not
having any liver function for a brief period.
Immediately after surgery, bleeding, poor function of
the grafted liver, and infections are major risks. The
patient is carefully monitored for several weeks for
signs of rejection of the liver.
GO TOP
What are
the overall chances of surviving a liver transplant?
This depends on many factors but overall 60
-75% of adult patients and 80 - 90% of children survive
and are discharged from the hospital.
GO
TOP
How long does it take
to recover? In part this depends on how ill the
individual was prior to the surgery. Most patients
should count on spending a few days in an intensive care
unit and about four weeks in the hospital, as a
minimum.
GO TOP
What happens during
this recovery period? Initially in the
intensive care unit there is very careful monitoring of
all body functions including the liver. Once the patient
is transferred to the ward, the frequency of blood
testing, etc. is decreased, eating is allowed and
physiotherapy is used to regain muscle strength. The
drug or drugs to prevent rejection are initially given
by vein, but later by mouth. During the transplantation,
frequent tests are done to monitor liver function and
detect any evidence of rejection.
GO TOP 
If a transplanted
liver fails to function, or is rejected, what can be
done? There are varying degrees of failure of
the liver, however, and even with imperfect function,
the patient will remain quite well. Occasionally, when
circumstances and time permit, a failing transplanted
liver can be replaced by a second (or even third)
transplant. Unfortunately, there is no dialysis
treatment for livers as is possible with kidneys.
Researchers are experimenting with devices to keep
patients with failing livers alive while waiting for a
new liver.
GO TOP
What side-effects do
patients commonly experience from the drugs used to
treat or prevent rejection? All the drugs used
for rejection increase the person's susceptibility to
infections (and possibly to the development of tumors).
Various medicines are used, and each has its own
effects. Cortisone-like drugs produce some fluid
retention and puffiness of the face, risk of worsening
diabetes and osteoporosis (a loss of mineral from bone).
Cyclosporine produces some tendency to develop high
blood pressure and the growth of body hair. The dose of
this medication must be very carefully regulated. Kidney
damage can occur from cyclosporine but this can usually
be avoided by monitoring the drug levels in the blood.
Common side effects for FK-506 include headaches,
tremor, diarrhea, increased tension, nausea, increased
levels of potassium and glucose and kidney
dysfunction.
GO TOP
Do recipients of
liver transplant have to take these medicines for the
rest of their lives? Usually. However, as the
body adjusts to the transplanted liver, the amount of
medicine needed to control rejection is reduced. There
are patients who have been successfully taken off these
drugs. Researchers are attempting to determine why this
has been successful in these cases.
GO
TOP
How frequent is
medical follow-up? Routine follow-up consists
of monthly blood tests, measuring of blood pressure by a
local physician with annual or semi-annual checkups at
the transplant
center.
GO
TOP
Are patients more
susceptible to other infections? Recipients
should avoid exposure to infections as the immune system
is depressed. Illness should be reported to the doctor
immediately and medicines taken only under medical
supervision.
GO TOP
What about physical
activity after a liver transplant? Most
patients are able to return to a normal or near-normal
existence and can participate in fairly vigorous
physical exercise six to twelve months after a
successful liver transplant.
GO TOP
What about sexual
activity? As with other physical activities,
sexual activity may be resumed.
GO TOP
Is it safe for women
to become pregnant after transplantation?
Studies have shown that women who undergo liver
transplantation can conceive and give birth normally,
although they have to be monitored carefully because of
a higher incidence of premature births. Mothers are
advised against nursing babies because of the
possibility of immunosuppressive drugs being ingested by
the infants through breast milk.
GO TOP
What about
diet? Transplant patients have a tendency to
gain weight because of their retention of water. They
are advised to lower their intake of salt to reduce or
eliminate this water retention. Otherwise patients
should maintain a balanced diet.
GO TOP
Can there be a
recurrence of the original disease in the transplanted
liver? If the disease was caused by hepatitis B
or C viruses then recurrence is likely. Other types of
liver disease do not recur.
GO
TOP
From the description,
patients with successful liver transplants seem very
healthy. How long can this good health last?
The newness of this procedure makes this question
difficult to answer. There is every indication that
those who are well after one year remain so.
GO TOP
Where do the donor
livers come from? Livers are donated, with the
consent of the next of kin, from individuals who have
brain death, usually as a result of a head injury or
brain hemorrhage. When such a donor is identified,
transplant centers are contacted by a computer network
and arrangements are made to retrieve whatever organs
may be donated. Frequently this involves a team from a
transplant center flying to the donor hospital to remove
the organs, and returning with them for the transplant
operation.
GO TOP
Do the donor and the
recipient have to be matched by tissue type, sex, age,
etc.? No. For liver transplants, the only
requirements are that the donor and recipient need to be
approximately the same size, and of compatible blood
types. No other matching is necessary.
GO
TOP
What happens if there
are two suitable recipients for a donated
liver? This is unusual in practice but the
decision would be to transplant the patient with the
more urgent need.
GO TOP
Will a liver
transplant cure the hepatitis C? No. Hepatitis
C can live in cells other than in the liver. Once the
old liver is removed and the new one is connected the
hepatitis spreads back into the liver within the first
weeks to months after the transplant. This is the bad
news: at present we have no way to make the hepatitis C
go away completely. The good news is that overall
results with hepatitis C after liver transplantation are
good. Although the disease comes back it does not seem
to greatly damage the liver in the majority of cases. It
is possible for the hepatitis to return so severely that
the new liver fails, but this is uncommon. Long-term
results (ten years) are difficult to interpret since we
have only been able to diagnose hepatitis C since 1990.
Many people that were transplanted in the 1980's may
have gotten hepatitis C at the time of transplant, since
the blood supply was contaminated then. These people may
have different chances compared to those that had
transplant because of hepatitis C. Realistically it is
likely that hepatitis C will be a long term problem in
liver transplant recipients that harbor the virus. We do
not yet know how bad a problem this will be.
GO TOP
What can be done for
hepatitis C that comes back in a transplanted
liver? No treatment has been shown to change
the course of the disease. Interferon alpha is being
tried in experimental settings without much
success.
GO TOP
I have hepatitis B
and hepatitis C. Can a transplant still be done?
Yes, some transplant centers abroad are
currently doing liver transplants for this indication.
Excerpts from HEPV-L's HEPATITIS
C.
GO TOP
Any more Questions?
Everybody has
doubts about liver diseases, how to prevent / cure them,
treatment procedures, hot to become a donor, recipient
or an associate..If doubts persist click here
