Hepatitis Hepatitis Treatment

The Challenges of Liver Transplantation

Summary & Participants

Liver transplants are the last source of hope for many patients with advanced liver disease. But not all patients are eligible for transplants, and those who are often have to suffer through an extended waiting period. Join us as we talk to an expert surgeon about the many risks and complications involved in this life-saving procedure.

Medically Reviewed On: June 23, 2008

Webcast Transcript

VAREN BLACK: I'm Varen Black. And welcome to our webcast. Today, we'll be talking about liver transplants, one of the last sources of hope for patients with advanced liver disease. Who is eligible for a transplant and how likely are they to get one?

Joining us is Dr. Michael Abecassis, Director of the liver transplantation program at Northwestern Memorial Hospital.

Dr. Abecassis, when is a liver transplant necessary?

MICHAEL ABECASSIS, MD: Well, there are a couple of situations that would mandate a liver transplant. First, patients with acute liver failure. Those are patients that have no history of any type of liver disease. Out of the blue, their liver would fail. There are multiple causes for that, including viruses or Tylenol overdoses. Those patients usually require transplantation very urgently.

The second group of patients are patients that have chronic liver disease. Chronic liver disease can be caused by a variety of etiologies, including viral hepatitis, hepatitis-B, hepatitis-C, alcohol, and cholestatic diseases, primary biliary cirrhosis, sclerosing cholangitis. There are pages and pages of possible causes for chronic liver disease.

In those patients, they progress to chronic liver disease and then develop complications of chronic liver disease. These might include bleeding varices, they might include ascites, fluid build-up in the abdomen. They might include liver cancer.

Once patients develop these complications of chronic liver disease, then they would need a liver transplant.

VAREN BLACK: When is a liver transplant not an option?

MICHAEL ABECASSIS, MD: A liver transplant is not considered an option when the patient is too far gone and has developed complications that are not reversible with liver transplantation, or when the patients have other medical conditions that would preempt them from getting a liver transplant. For example, advanced heart disease, advanced lung disease. If a patient has metastatic cancer, for example, they would not be a candidate for a liver transplant.

In evaluating when a liver transplant is no longer an option, we would look at the whole patient to try to decide if there are other medical conditions that would contraindicate a liver transplant.

Other potential contraindications would include psychosocial contraindications. If the patient, for example, is an active alcoholic or an active intravenous drug abuser or any type of recreational drug user, then those patients are typically not considered for a liver transplantation.

VAREN BLACK: Let's talk briefly now about the actual process of signing up for a liver transplant.

MICHAEL ABECASSIS, MD: When a patient is evaluated at a transplant center and deemed to be a potential recipient for liver transplantation, then that transplant center will list the patient with a national organization called UNOS, United Network for Organ Sharing. The patient will be listed with this national organization, but they will be listed at a local level. There are 60-odd organ procurement organizations in the country that divide up the country. There are 11 regions. So the 60-odd OPOs, as they are called, would be within these 11 regions.

VAREN BLACK: From the time a patient signs up until the actual time that he gets a liver transplant, how much time are we talking about here on average?

MICHAEL ABECASSIS, MD: The waiting time is a major problem. It depends on a lot of factors, which include the blood type, the severity of illness. To a certain extent, it includes the size of the recipient.

One of the biggest controversies today has to do with the federal government requiring that geography should not be a part of it, and that it should be entirely based on severity of illness. That has been a raging controversy between the transplant community and the federal government.

So to get back to your question about what happens when a patient gets listed. The patient gets listed with UNOS, and then depending on the level of severity, will get an organ allocated whenever their name comes up on this national, computerized list.

VAREN BLACK: We're talking years in some cases?

MICHAEL ABECASSIS, MD: Depending on the severity of illness. If the patient is moribund in the intensive care unit and has less than a week to live, then that patient may get a liver allocated within that week. Oftentimes, the patients will die before a liver becomes available. So in that status, for example, waiting times could be as long as a month.

If patients are stable and have no real need for an urgent liver transplant, the waiting time could be as long as two or three years.

VAREN BLACK: It can be discouraging for some patients, the waiting?

MICHAEL ABECASSIS, MD: It can be discouraging. About 20-30 percent of patients waiting for a liver transplant will die waiting for liver transplant.

VAREN BLACK: Thank you for being with us. I'm Varen Black.