Liver Transplant

Liver transplant is a surgical procedure to replace a diseased or injured liver with a healthy liver from a donor.

A liver transplantation is usually considered for patients whose livers are no longer functioning adequately due to conditions such as chronic cirrhosis, acute liver failure, liver cancer, or certain genetic liver diseases.

Our team of transplant surgeons at WashU Medicine has experience performing a high volume of liver transplants with excellent results at the Washington University and Barnes-Jewish Transplant Center.

Who needs a liver transplant?

Several medical conditions may lead to the necessity of a liver transplant. These include:

• Acute liver failure: Rapid deterioration of liver function due to viruses, infections, drug overdose, or other toxins, cancer or autoimmune disease
• Alpha-1-antitrypsin deficiency: Genetic disorder leading to abnormal amounts of A1AT protein in liver cells
• Cholangiocarcinoma: Bile duct cancer
• Cirrhosis: Chronic degenerative disease of the liver resulting from alcoholism, hepatitis B or hepatitis C
• Hepatocellular carcinoma: Cancer that starts in the liver cells
• Primary biliary cirrhosis: Slow deterioration of the liver’s bile ducts
• Primary sclerosing cholangitis: Disease leading to scarring of the liver’s bile ducts
• Wilson’s disease: An inherited disorder that causes too much copper to accumulate in the liver, brain and other organs

Liver transplant eligibility

The liver transplantation screening process starts with a detailed medical history and physical exam to identify any health conditions that might affect transplant success.

Our multidisciplinary team determines patient candidacy for transplant using the following criteria to optimize the chances of a successful outcome:

• Blood and urine tests: These assess organ functions and check for infections.
• Imaging studies (ultrasound, CT, MRI): These provide detailed views of the liver.
• Biopsy: In some cases, a biopsy may be performed to determine liver damage extent.
• Cardiopulmonary assessment: Tests such as an electrocardiogram (ECG) evaluate heart and lung health, to ensure no untreated malignancies exist.
• Psychosocial evaluations: A thorough mental health assessment is conducted to identify any psychological or social issues that might impact the patient’s ability to adhere to a postoperative plan.
• Nutritional assessment: Our professionals will assess the patient’s nutritional status and provide guidance on dietary changes needed before and after transplant.
• Infection screenings: These tests check for diseases like HIV and hepatitis.

The transplant team then reviews all results to determine the patient’s suitability for surgery, aiming to ensure a successful transplant and recovery by confirming the patient can handle the postoperative regimen.

Who is not eligible for liver transplant?

Not everyone is eligible for a liver transplant. Individuals may not qualify for liver transplant surgery if they:

• Have metastatic cancer (cancer that has spread from its primary location to other parts of the body)
• Have a history of chronic or ongoing drug and/or alcohol abuse
• Have chronic conditions or infections that cannot be treated
• Have disabling psychiatric conditions
• Have documented medical non-compliance (a history of not following medical advice to improve health)
• Lack adequate social support
• Lack adequate insurance coverage
• Have other serious diseases and conditions

Liver transplant procedure

Traditionally, the procedure itself is complex and can take between 5 and 10 hours.

During an open surgical procedure, the transplant team will make a curved incision in the upper part of the patient’s abdomen, remove the diseased liver and implant the donor liver. The team will suture the new liver to the blood vessels and bile ducts.

Surgeons at WashU Medicine also specialize in minimally invasive surgical approaches.

Liver transplant waiting list

The liver transplantation process begins after an evaluation with the transplant surgical team at the WashU Medicine and Barnes-Jewish Transplant Center.

After our team determines that liver transplantation is the best option, the patient will be added to the United Network for Organ Sharing (UNOS) waiting list. The donor organ can be a portion of the donor’s liver, due to the liver’s regenerative capability.

The liver transplant waiting list ranks patients based on their Model for End-Stage Liver Disease (MELD) Score, which is determined by lab tests. Factors, such as the severity of the condition, geographic location, blood type, and donor age, also influence a patient’s position on the waiting list.

Recovery

After liver transplant surgery, the patient might spend 24 hours or more in intensive care or an observation unit to monitor for complications. If stable, the patient will be moved to a transplant floor room, with an average hospital stay of a week or more as the body continues to heal.

Long-term, the transplant team will coordinate with your primary care physician to ensure optimal outcomes. Lifelong anti-rejection medications are necessary to help the body accept the new liver.