Liver Transplant

The Swedish Liver Center and Liver Transplant Team work closely with patients to evaluate and assess patients with chronic liver disease to help determine if a liver transplant is the best option. Pre-transplant tests will be administered to help determine if a liver transplant is the best option and to increase the likelihood of success.

Evaluation of patients for transplantation is the result of a coordinated process which looks at the whole patient. A preliminary consultation can be obtained either at the center or in a regional liver clinic. Patients with decompensated liver disease may undergo a complete Swedish inpatient transplant evaluation while being managed for complications of liver disease.

Evaluation is conducted in stages and is customized to efficiently address key issues that might preclude transplantation in a particular patient. After the evaluation is completed, patients are discussed in the multidisciplinary selection committee A complete presentation is made and opinions welcomed from all participants in the program. Decisions about candidacy are made by consensus.

The comprehensive transplant evaluation seeks to determine the ability of the patient to benefit from transplantation and to enjoy a successful outcome with long-term good health.

• Progressive, potentially fatal liver disorder or suffers from a complication directly related to a liver disorder that substantially impairs the quality of life and daily function, and for which all alternative medical and surgical treatments short of liver transplantation have been exhausted or would be less effective.
• Liver disease is not expected to recur and cause disability within five years.
• Patient is not terminally ill and the liver transplant is likely to prolong life for at least five years restoring the patient to a range of physical and social function suitable for the activities of daily living.
• Patient does not have involvement of a major system (e.g., cardiovascular or neurologic) that would preclude surgery or indicate a poor potential for rehabilitation.
• Patient’s psychological assessment, social arrangement and family support indicate reasonable expectation that the patient will adhere strictly to the difficult long-term medical regimen that will be required post-transplant.
• Patient has no active alcohol or substance abuse problems and has signed a contract, has completed a period of documented sobriety from alcohol and unprescribed narcotics and illicit drugs, and has psychosocial clearance.
• Patient has a diagnosis meeting criteria for liver transplant, severity of illness meeting minimum listing criteria, and does not have any absolute contraindication.
• The patient undergoes a comprehensive assessment which is reviewed by the multidisciplinary transplantation committee.

Some patients may not be eligible for transplant if they are unlikely to survive the procedure or receive long term benefit.

Following are some medical conditions that would disqualify a candidate for a liver transplant:

• Non-Liver cancer (extrahepatic malignancy) where patients do not meet standard oncologic criteria for cure (e.g., stage 1 breast cancer greater than fiver years post treatment)
• Some primary liver cancers
• Sepsis unresponsive to treatment
• Current substance abuse
• Coma with evidence of irreversible brain injury
• Severe and non-treatable heart and /or lung disease limiting safety of the operation

Alcoholics in recovery and other prior substance abusers who have documented abstinence and have undergone a thorough multidisciplinary assessment (including social and psychiatric evaluation) may be considered for liver transplantation if they possess appropriate psychosocial support systems so that they can comply with life-long immunosuppressive therapy and be expected to maintain permanent abstinence from all addictive substances.

IV drug abusers must be drug free prior to listing. All substance abusers must sign a contract and submit to periodic, random drug screening.

Getting a liver transplant can be a long process. It can take months or even years before a compatible donor liver is found. Once you have been selected as a candidate for a liver transplant your name is added to a national waiting list. This list is ranked by how sick potential recipient’s are. Very sick patients are higher on the list than people who don’t need a transplant right away.

You will receive instructions on how to stay in contact with the Swedish Transplant Team. The Transplant team maintains your status on the waiting list. If your liver disease worsens or another health problem develops your status on the wait list could change.

The average hospital stay after your liver transplant is one to two weeks. Your hospital stay may be longer depending on complications that may arise from the transplant surgery and/or your condition prior to the transplant.

After the transplant surgery is complete you will be taken to the recovery room. When awake and stable you will be moved to the Intensive Care Unit for a short stay while your condition is monitored. Once stabilized and free of any complications, your hospital stay will continue in the Transplant Unit.

During your stay in the hospital, the transplant team will see you each day. The team includes the transplant hepatologist, surgeon, transplant coordinator, pharmacist, social worker, nutritionist and your primary nurse.

The transplant pharmacist will monitor the dosage and administration of your anti-rejection drugs. The pharmacist understands the many possible interactions between anti-rejection medicines and the other medicines you will be taking after your transplant.

The transplant social worker visits each transplant patient during his or her hospital stay. The social worker can assist with a wide variety of issues, including concerns about the need to be off work or helping you identify caregiving support after the transplant. The social worker is available to you when you are hospitalized and when you are an outpatient in the transplant clinic.

The nutritionist will discuss your dietary needs and requests.

Without specific types of medications, your body’s immune system would react to the transplanted organ as foreign and try to reject it. Anti-rejection drugs, or immunosuppressives, are medications that help prevent your body from rejecting the transplanted organ. The development of new, more effective medications has made transplants much more successful in recent years. However, immunosuppressives also decrease your body’s ability to fight some infections and some types of cancer. As a transplant patient, therefore, you need to actively participate in monitoring your health. The ongoing success of your transplant depends upon taking your medications exactly as prescribed by your transplant team.

You will have many changes when you receive a liver transplant transplant. These changes involve your medications, diet, fluids to drink, exercise, doctor appointments and lifestyle. Some will last a few months, and some will last as long as the new organ. It is very important for you to follow these new directions carefully so that you will stay healthy and your transplant will last a long time.

A notebook with information about how to take care of yourself and your new transplant is provided to help guide you, and those who will help you. In addition, the nurses in the hospital and the nurse transplant coordinators will begin teaching you on the day of your surgery. They will continue with your education until you are confident that you know how to take care of yourself and your new organ. Educational support will continue even as you return to daily life with your new transplant.

After discharge from the hospital, you will regularly visit the Organ Transplant Program outpatient clinic. At each clinic visit, you will have lab work (blood tests) to assess your liver function and the level of immunosuppression. The transplant surgeon will assess your healing from the surgery. Your fluid intake and output will be monitored, and medication changes will be made.

Common post-transplant tests may include:

• Abdominal ultrasound
• Abdominal MRI or CT Scan
• Blood tests
• Chest x-ray
• ERCP/MRCP
• Liver biopsy

During the first two weeks after you leave the hospital, you will come to the clinic two times a week. Clinic visits become less frequent in the following weeks and months. This schedule depends in part on your recovery.

Since you will be restricted from driving for four weeks after surgery, you will need to arrange transportation to the clinic.

Out-of-the-area patients are required to stay local to Swedish First Hill for six to eight weeks after discharge.

The total transplant recovery period varies with each person and depends on your new organ’s function, the possibility of rejection, the amount of medication needed and complications. Most patients return to work about eight weeks after being discharged from the hospital. Your physician will make recommendations regarding activity level, when to resume exercising and when it is appropriate to return to work. Our social worker will be available to help you with issues related to returning to work or specific home situations.

You are the new caretaker for your new liver. The Swedish Transplant Program will provide lifelong support to assist you in caring for your new liver. Regular visits to the Transplant clinic are an important part of your care after you leave the hospital.