Liver transplants are sometimes the only treatment option for people with acute or chronic liver disease. Advances in liver transplantation have resulted in far higher life expectancy rates, with 58% of recipients surviving for 15 years.
Liver transplants were first performed in the late 1960s, although they remained largely experimental until the mid-1980s when there were better surgical techniques and better means of preventing organ graft rejections. Today, over 6,000 liver transplants are performed annually.
Motivating Reasons for a Liver Transplant
Because liver transplants are expensive and carry significant risk, doctors recommend them only as a last resort. This typically occurs when the liver is no longer functioning, and the complications from liver damage can no longer be controlled.
Among the most common reasons for a liver transplant:
- End-stage cirrhosis from any cause, including chronic hepatitis B or C, alcoholic cirrhosis, and non-alcoholic fatty liver disease. While cirrhosis itself isn’t an indication for a transplant, signs of decompensation, such as encephalopathy (where the liver is unable to remove toxin from the blood), bleeding varices, or recurrent ascites, can often serve as motivation.
- Certain liver cancers, including cholangiocarcinoma, hepatocellular carcinoma (HCC), primary hepatocellular malignancies and hepatic adenomas.
- Fulminant hepatic failure due to one of fulminant viral hepatitis (A, B, D, and rarely C), medication-associated liver failure, hepatic thrombosis, Wilson’s disease (a rare, inherited disorder that causes cooper to accumulate in your liver and other organs), or other causes
- Severe dysfunction of the bile ducts, resulting in biliary cirrhosis and sclerosing cholangitis
Qualifying for a Liver Transplant
Not surprisingly, more people need liver transplants than there are available to transplant. Because of this, health policy experts have developed the Model for End-Stage Liver Disease (MELD) score, an algorithm used to assess the severity of chronic liver disease and to help prioritize patients for transplantation.
Other methods for determination can be used, including the Milan Criteria, which qualifies a person based primarily on the size and/or a number of liver lesions (i.e., no bigger than 5 centimeters, or no more than three lesions equal to or less than 3 centimeters in size).
Although transplants can be considered applicable to any acute or chronic condition that causes irreversible and permanent liver dysfunction, there can often be a number of loopholes in the decision-making process.
The organization in the U.S. responsible for matching individuals with available livers is the United Network for Organ Sharing (UNOS). The non-profit organization works under contract for the Federal government to match and allocate organs.
Contraindications for liver transplantation are those that can either increase the likelihood of death for the recipient or will likely result in the failure or rejection of a transplant. Among some of the absolute contraindications for transplantation:
- Current alcohol or substance addiction
- Severe heart or lung disease
- Cancers (not including some liver cancers or non-melanoma skin cancer)
- Severe and multiple birth defects that will likely lead to premature death
- Certain uncontrolled infections or life-threatening diseases
There are also a number of relative contraindications, so-called because they may or may not contraindicate treatment based on an assessment of one or several factors, including:
- Advanced age (older than 65 years)
- Kidney failure
- Morbid obesity
- Severe malnutrition
- HIV (although less of an issue for patients with sustained viral control)
- Severe pulmonary hypertension
- Severe, uncontrolled (or untreated) psychiatric disorders