What happens during the recovery period after liver transplantation in the intensive care unit and nursing unit in the hospital?

Initially when the patient is in the intensive care unit, we closely monitor the patient’s bodily functions, including the liver function, very carefully. Once the patient has been transferred to the floor nursing unit, we decrease the frequency of blood testing, allowing eating, and initiate physical therapy and activity to help regain muscle strength. Some of the medicines to prevent rejection are initially given intravenously or by vein, but others are given by mouth immediately and eventually all medications are given by mouth. During the first six weeks after liver transplantation, we will request that the patient have frequent blood tests and other exams to monitor liver function and detect any evidence of rejection or infection in the new liver.

How can individuals donate their organs?

If you wish to be an organ donor, carry an organ donor card and place an organ donor sticker on your medical identification card. It is important to discuss organ donation with family members since they will have to give consent for the donation.

Do individuals who have received a transplanted liver have to take medicines to treat or prevent rejection for the rest of their lives?

Yes, in general that is true, although every patient who has been involved with liver transplantation has often heard of that special case of someone who was able to stop the medication. Importantly, almost all patients who have to take these medicines long term can also undergo dose reduction as the body adjusts to the transplanted liver and the amount of medicine needed to control or prevent rejection is reduced.

Are patients who have received a transplanted liver more susceptible to other infections?

Individuals who have received a liver transplant need to avoid exposure to infections as their immune system is suppressed. Also, they need to report illnesses to their doctor immediately, especially fevers, and take over-the-counter medications or prescription medications only under their doctor’s direct supervision.

Can individuals have physical activity after receiving a new liver? Sexual activity?

We encourage you to get out of bed as soon as you can after your transplant and move and walk around your room in the first few days. Most patients can return to a normal or near-normal existence and participate in fairly vigorous physical exercise six to 12 months after successful liver transplant. Often we let patients drive as little as 2 to 3 months after liver transplantation. As with other physical activities, sexual activity may be resumed when desired.

Can a patient's original liver disease that caused the need for transplantation reoccur in the new, transplanted liver?

If a patient’s liver disease was caused by autoimmune hepatitis, hepatitis B or C viruses, then recurrence is possible. Hepatitis B right now only reoccurs in 5% or less of patients since we have mastered controlling this disease with an immune globulin medicine and an oral medication. Hepatitis C occurs in almost all patients and is progressive in maybe a quarter to half of patients in the first 5 to 10 years. For other types of liver disease, recurrence is less likely, but is still a possibility unless it was a genetic disease that was cured by the liver transplantation.

Where do the livers that are donated for liver transplantation surgery come from?

Livers are donated, with the consent of the next of kin, from individuals who have had brain death. Brain death is usually the result of a head injury or a brain hemorrhage. When such a donor is identified, a network of skilled professionals connected by computers contact the transplant centers and makes arrangements to retrieve whatever organs may be donated. Frequently, this involves a team of skilled professionals from transplant centers flying to the donor hospital to remove the organs and return with them for the transplant operation

Do the patient who is donating the liver/donor and the patient who will receive the liver/recipient have to be matched by tissue type/sex/age etc?

No. At this time for liver transplantation, the only requirements are that the donor and recipient need to be approximately the same size and have compatible blood types. No other matching is necessary such as gender or age.

What happens if two suitable recipients exist to receive a liver that has been donated?

This is unusual in practice. But, the decision would be made to transplant the patient who is more ill or with more urgent need using the MELD score. MELD stands for Model for End Stage Liver Disease and is a scoring system using renal function, Bilirubin and a coagulation test, called the INR, to determine how ill someone is and their chance of living or dying while awaiting a liver transplant or in general with liver failure.

How is the decision made to transplant a patient's liver?

The decision to transplant a patient’s liver is made in consultation with all individuals involved in the patient’s care, including the patient, referring physician, and the patient’s family. The patient and family’s input is vital in this decision-making process; they must clearly understand the risks involved in proceeding to transplantation and the post transplant care. In general, this means that a person has a poor chance of living in the next 1-2 years from their underlying liver disease.