Liver transplant

When is a liver transplant necessary?

During a liver transplant, a donor liver is surgically implanted into a patient’s body. A liver transplant becomes necessary when the patient’s own liver is progressively failing or has already failed. There are two types of liver failure: acute and chronic.

Common causes of liver failure include liver cirrhosis (loss of functional liver tissue and fibrous remodeling), fatty liver disease (FLD), often caused by alcoholism, inflammatory conditions of the liver (e.g. viral hepatitis), or certain medications or toxins (e.g. paracetamol overdose or death cap mushroom poisoning).

Furthermore, congenital disorders with a genetic component can impair liver metabolism and may require a liver transplant. Examples of such conditions include haemochromatosis, alpha-1-antitrypsin deficiency and Wilson’s disease. There are also malformations of the liver, biliary tract, and hepatic vasculature of the liver that may necessitate a liver transplant. Moreover, certain autoimmune diseases, where the immune system mistakenly attacks its own organs or tissues, can progress to liver failure, requiring a liver transplant. Examples of such conditions include autoimmune hepatitis, primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).

In some cases, liver cancer can be cured by a liver transplant. However, this is only possible if the tumor (e.g. hepatocellular carcinoma or cholangiocarcinoma) is confined to the liver and has not metastasized to other organs or regional lymph nodes.

What are the requirements for a liver transplant?

The fundamental requirement for being placed on the waiting list for a liver transplant is an incurable, progressive liver disease that is life-threatening.

Moreover, it must be proven that there are no other treatment options available, such as certain medications or surgeries that can offer a cure. 

It is important to note that at the time of transplantation, no serious infection or sepsis (blood infection) or metastatic cancer (other than liver cancer) must be present. Other contraindications that limit a patient’s eligibility for a transplant include advanced cardiovascular disease, severe kidney damage, and severe levels of immunosuppression (e.g. current use of strong immunosuppressants, HIV etc.). Active alcohol abuse also rules out a liver transplant.

It is also important to ensure the patient’s cooperation following the transplant. This includes ruling out psychiatric disorders that could jeopardise the success of the transplantation. 

The MELD score (Model for End-Stage Liver Disease) is used to classify the severity of liver disease. It aids in assessing the urgency and priority of transplantation for each individual patient.

The MELD score is calculated using certain blood laboratory values (e.g. bilirubin, INR, creatinine, sodium), which are combined using a specific formula. The higher the value, the higher the risk of death from liver disease within the coming months, indicating a clear urgency for liver transplantation. 

The individual’s blood type also plays an important role when assessing the compatibility between the donor and recipient. Although this cannot be influenced, patients with certain blood types may have an advantage in terms of shorter waiting time for receiving a donor organ.

The allocation of a donor organ is handled centrally by Eurotransplant, an international organ donation allocation organization.

How long is the waiting time for a donor liver?

The waiting time for a donor liver depends on the above-mentioned individual assessments regarding disease severity and urgency.

Depending on the patient’s condition, a patient may have to wait between one to two years. However, in acute life-threatening cases, special urgent applications are available, and a transplant may become available within one to three days.

Generally, the higher the MELD score, the higher the patient will be prioritized and a suitable organ will be allocated sooner. The individual blood type often affects the waiting time. If the patient has a more commonly occurring blood type, the chances of finding a suitable donor organ are naturally higher than for patients with rare blood types.

How dangerous is a liver transplant?

The transplantation of an organ is a fundamentally serious, major surgical procedure that carries significant risks, requires careful and extensive follow-up care as well as long-term changes to the patient’s daily life (e.g., daily medication intake). The surgery is highly complex and extensive.

Nevertheless, the prognosis following a liver transplant is generally good and continuously evolves thanks to advances in modern medicine. Many patients regain their quality of life after suffering from serious liver diseases and are considered cured. Therefore, in most cases, the benefits outweigh the risks of the major surgery.

Alongside the general risks of surgery, such as bleeding or wound infections, there are some specific complications that can occur during a liver transplant.

These include non-function of the transplanted donor organ in the recipient’s body, requiring in the worst case an emergency re-transplantation. Liver diseases are generally associated with an increased risk of bleeding which becomes particularly relevant during surgery.

Furthermore, the surgically connected biliary ducts within and around the liver can become obstructed or leak, which could impair the function of the organ. Patients must take immunosuppressive medications after transplantation to prevent rejection of the new liver. However, these medications also significantly increase the patient’s risk of infection.

Despite the range of medical treatments available today, the risk of rejection remains. This means that the immune system attacks the foreign, transplanted organ. Symptoms indicating organ rejection include fever, weakness, abdominal pain, indigestion, loss of appetite, noticeably changed color of stool and urine, and jaundice (yellowing of the sclera and skin).

These symptoms must be investigated promptly (by checking certain blood parameters or via a liver biopsy) in order to prevent rejection of the new organ through appropriate treatment measures.

Procedure and duration of a liver transplant

Many different diagnostic tests have to be done prior to a liver transplant. Generally, there is regular contact between the doctor and patient through the transplantation center. 

Different transplant options are available regarding the origin of the donor liver. For example, it can come from a registered, deceased organ donor (the organ may also be divided between two patients; a process called split liver transplantation), or from a living donor who voluntarily donates part of their liver to a known recipient. This process is strictly controlled and subject to rigorous rules and conditions.

Once a suitable organ becomes available, the patient is notified promptly and is advised not to eat or drink any longer (as the surgery must be performed in a fasting state), and should make their way to the hospital immediately, if not already there (transport is often organized by the hospital). The patient is then prepared for surgery. The transplant is performed under general anesthesia, and the patient is ventilated via an endotracheal tube.

Following surgical disinfection, the abdomen is surgically opened, and the tissue layers are dissected accordingly. The diseased liver is separated from the vasculature and bile ducts and removed from the body. Afterwards, the new liver is inserted, and the conduits are reattached so that the blood and bile flow are restored, ensuring optimal function of the donor organ. This function is verified during surgery. Lastly, the abdomen is closed layer by layer.

The surgery generally takes about four to eight hours. Following the transplant, the patient will be transferred to the intensive care unit for several days for close monitoring. Afterwards, the patient can be transferred to the general ward, where they will spend several weeks.

The patient is regularly examined and closely monitored to detect and treat possible complications early. Patients are thoroughly informed and educated about their new liver and any changes to their daily lives. Another important aspect is the individual adjustment of the immunosuppressive therapy that is required to prevent rejection.

What is the life expectancy after a liver transplant?

The prognosis following a liver transplant is good and the survival rate is constantly improving thanks to advances in modern medicine and the available medications.

The one-year survival rate with a functioning transplant is currently above 80 %. The survival rate after 10 years shows that more than 70% of transplanted patients are still living with their new organ.

The prognosis heavily depends on the underlying disease, the overall condition of the patient and any additional medical conditions.

Which physicians and clinics specialise in liver transplants?

Patients who require a liver transplant will be closely connected with a transplantation center, which is usually found in larger hospitals.

The treatment starts from the moment the liver transplant is medically indicated to the follow-up care that continues for many years.

The physicians at transplantation centers are highly specialized and qualified in the field of organ transplantation.

Generally speaking, the treatment of liver disease is carried out by hepatologists (internal medicine specialists with a focus on liver diseases) while the surgery is performed by general and visceral surgeons.

Anyone seeking a physician naturally wants to find the best possible medical care. The patient therefore asks themselves: where do I find the best clinic? Since this question cannot be answered objectively as any reputable doctor would never claim to be the best, one can only rely on a physician’s experience.

We want to help you find an expert for your condition. All listed physicians and clinics have been carefully reviewed for their outstanding expertise in the field of liver transplantation and look forward to your inquiry.