Ask the Doctors Patient Care Transplant Surgery

Ask the Doctors: Adult Liver Transplant

The body’s largest internal organ, the liver performs many complex functions. The liver regulates most chemical levels in the blood and excretes a product called bile that helps carry away waste products. The liver processes all the blood leaving the stomach and intestine, breaks down nutrients to produce energy, stores vitamins and minerals, and helps your body fight infection by removing bacteria and other byproducts from your blood.

When your liver no longer functions adequately enough to keep you alive due to advanced or end-stage liver disease (known as chronic liver failure), a liver transplant may be recommended. A successful liver transplantation is a life-saving procedure for people with liver failure.

A member of the transplant surgery team at the Washington University and Barnes Jewish Transplant Center and professor in the Section of Transplant Surgery, Majella Doyle, MD, MBA, works with the multidisciplinary team to provide patients with the most effective, personalized care possible so they can get back to living and enjoying healthy and productive lives. An expert in the procedure, Doyle answers some frequently asked questions about adult liver transplants.

Adult Liver Transplant: Frequently Asked Questions

What diseases can lead to 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

How does a liver transplant work at WashU?

The liver transplantation process begins after an evaluation with the transplant surgical team at Washington University School of Medicine and the Barnes-Jewish Transplant Center. After your team determines that liver transplantation is the best option, you will be added to the United Network for Organ Sharing (UNOS) waiting list.

The waiting list ranks patients based on their Model for End-Stage Liver Disease (MELD) Score. This score is based on the results of several lab tests including your creatinine levels (related to how well your kidneys are working), bilirubin level (shows how well your liver clears bile), international normalized ratio (reflects how well the blood coagulates or clots), and serum sodium level (the concentration of sodium in the blood). Other factors such as the severity of your condition, your geographic location, blood type, donor age, and more determine your position on the UNOS waiting list.

Once you are placed on the waiting list, your transplant team will manage your liver disease, provide continuous support and maintain contact with you throughout the waiting process.

When an organ becomes available, timing is very important. The transplant team will call you and direct you to reach the Transplant Center within six hours of the initial call. Upon your arrival at the hospital, the team will conduct several tests and begin to prepare you for surgery. The procedure itself is complex and can take between 5 and 10 hours. During the procedure, the transplant team will make a curved incision in the upper part of your abdomen, remove the diseased liver and implant the donor liver. The team will suture (stitch) the new liver to your blood vessels and bile ducts.

After your surgery, you will be transferred to an intensive care unit or observation unit for at least 24 hours to monitor for bleeding or complications. If no complications occur, you will be transferred to a room on the transplant floor. The average hospital stay after an uncomplicated liver transplant is about seven to 10 days. You should remain in the area near the hospital for several weeks after discharge for follow-up care.

Over time, the transplant team may fully transition your care back to your primary care physician but remain in contact with you to ensure the best patient outcomes. After a successful liver transplant, you will need to take anti-rejection medicines to help the transplanted organ survive in your body for the rest of your life.

How much does a liver transplant cost? 

Every liver transplant case is unique and the exact cost can vary from patient to patient.

Costs associated with a liver transplant could include pre-transplant evaluations, numerous hospital visits for appointments, laboratory work and other testing procedures before and after your transplant, inpatient hospital stays, post-transplant office visits, long-term follow-up appointments and anti-rejection prescriptions.

Along with your team of medical professionals, you will be assisted by social workers and financial coordinators. Social work professionals will help you handle issues such as lodging and transportation, finances and legal issues while our financial experts will arrange and clarify the aspects of your care before, during and after the transplant, including details of your insurance coverage.

What qualifies you for a liver transplant?

The Liver Transplant Team works to ensure patients eligible for transplant evaluation are the most suitable candidates for the surgery.

There are many criteria that a patient should meet to be able to qualify for and undergo a liver transplant:

  • You must have a liver that is not functioning properly and is beyond the stage that it has responded to other medical or surgical treatments
  • You must qualify for and be able to tolerate major surgery
  • You and your family members and support system must understand the risks and benefits of transplantation, including the long-term need for close medical follow-up and lifelong need for anti-rejection therapy
  • You and your family must be able to accept the responsibility to be involved in the long-term care required after transplantation, including the financial responsibilities

The Washington University and Barnes-Jewish Transplant Center team has developed a method to shrink tumors in patients with liver cancer or bile duct cancer. If these types of tumors are identified, these treatments may be used to help ineligible patients become eligible for transplantation.

Who can’t get a liver transplant?

Since there are many requirements for liver transplant surgery, you may not be able to get a liver transplant if you:

  • Have metastatic cancer (cancer that has spread from its main location to one or more parts of the body)  
  • Have a history of chronic or ongoing drug and or alcohol abuse
  • Have any chronic conditions or infections that cannot be treated
  • Have disabling psychiatric conditions
  • Have documented medical non-compliance (a history of not following your doctor’s orders to improve your health)
  • Lack of adequate social support
  • Lack of adequate insurance
  • Other serious diseases and conditions.

How long can you live with a liver transplant?

Your chances of a successful liver transplant and long-term survival depend on your situation. According to the National Institute of Health, the rate of survival for patients receiving liver transplants are:

  • 86 percent at 1 year
  • 78 percent at 3 years
  • 72 percent at 5 years

The 20-year survival rate for patients receiving liver transplants is about 53 percent.

Who can I ask more about liver transplants?

Washington University Transplant Surgery draws upon a long, successful history as it offers the latest advancements in the transplant field. In the area of liver transplantation, the program offers living-related and living-unrelated donor transplantation, reduced-size liver transplantation, split liver transplantation and dual-organ (liver-kidney, heart-liver and liver-lung) transplantation.

At the Washington University and Barnes-Jewish Transplant Center, our surgeons have performed more than 1,700 liver transplants, helping restore patients’ liver function and health. Washington University transplant surgeons completed the first successful liver transplant surgery in Missouri.

The specialists within the Department of Surgery’s Section of Transplant Surgery perform liver transplant surgeries at the Washington University and Barnes-Jewish Transplant Center. The liver transplant surgical team includes:

For more information about the liver transplant program at the Washington University and Barnes-Jewish Transplant Center, call (888) 993-8511. For a patient appointment with a liver transplant surgeon, call (314) 362-7792.