Liver transplant: Treating end-stage liver disease

[Guest guest]

Liver transplant: Treating end-stage liver disease

Before making a decision about a liver transplant, learn about the organ

transplant process, including getting listed in the organ recipient

registry, the surgery itself, potential risks and follow-up care.

The liver has a remarkable ability to regenerate itself, but it sometimes

sustains severe damage that can't be reversed. In such cases, a liver

transplant may be an option for some people. Although a liver transplant may

be needed for sudden liver failure caused by toxins or severe infection,

it's more often a final treatment option for long-term, progressive liver

disease. Because many people must wait more than two years for a liver

transplant, your doctor may begin discussing transplantation with you long

before you actually need it.

What conditions lead to liver transplants?

Cirrhosis — irreversible damage to liver cells — is the most common reason

for liver transplants in adults. It occurs when scar tissue replaces healthy

cells and prevents normal liver function. Conditions that may cause

cirrhosis and the need for a liver transplant include:

Chronic hepatitis B and C

Diseases of the bile ducts

Alcoholic liver disease

Autoimmune liver diseases

Buildup of fat in the liver

In children, the conditions that most often cause liver damage that may lead

to a transplant are:

Defects in the liver or bile ducts present at birth

Metabolic disorders

Liver cancer

Sudden liver failure from drugs

The transplant journey: Taking the first steps

If your doctor recommends a liver transplant, you'll likely be referred to a

transplant center for an evaluation. Discuss with your health insurance

provider which transplant centers are covered under your insurance plan.

Most transplant programs offer the services of social workers and financial

coordinators, who can help you work through financial issues associated with

transplant surgery.

When selecting a transplant center, take into account the number of liver

transplants the center performs each year and the recipient survival rates.

You can compare transplant center statistics through a database maintained

by the Scientific Registry of Transplant Recipients.

In addition, consider support services provided by a transplant center. Many

centers coordinate support groups, assist you with travel arrangements, help

you find local housing for your recovery period or direct you to

organizations that can help with these concerns.

Once you select a liver transplant center, expect to undergo an evaluation

to determine whether you meet the transplant center's eligibility

requirements. The evaluation will assess whether you:

Have a medical condition that would benefit from a transplant

Aren't likely to benefit from other treatment options

Are healthy enough to undergo surgery and post-transplant treatments

Are willing and able to take medications as directed

Have sufficient emotional stamina to undergo the wait for a donor organ and

have a supportive network of family and friends to help you during this

stressful time

If liver failure is the result of alcohol or drug abuse, you'll be evaluated

to determine whether you currently abstain from use, have received adequate

chemical dependency treatment and are at risk of using alcohol or drugs

after the transplant.

Waiting for a donor organ

If it's determined that you're a good candidate for a transplant, you'll be

registered on a nationwide waiting list. When a donor organ becomes

available, the donor-recipient matching system, administered by United

Network for Organ Sharing (UNOS), makes an appropriate match.

Your medical team will assign you a score that represents how urgently you

need a transplant in order to survive. For adults 18 years of age and older,

the score is a number between 6 and 40 on a scale called the Model for

End-Stage Liver Disease, or MELD. The higher the number, the more urgent the

need for a transplant. Your MELD score may go up or down while you wait for

a transplant. Your medical team will evaluate your status frequently and

update your score as necessary.

The Pediatric End-Stage Liver Disease, or PELD, scale is a similar 6- to

40-point scale for transplant candidates under the age of 18.

An extremely urgent case, or status 1 liver failure, supersedes the MELD and

PELD scores. These individuals have sudden or nearly complete liver failure

and have a life expectancy of less than seven days.

Preparing for a liver transplant

A liver transplant from a deceased donor (cadaver) needs to occur within 12

to 24 hours after the liver is removed from the donor for the organ to

remain viable. The transplant center will most likely provide you with a

pager or cell phone to notify you when a potential donor organ is available.

When you arrive at the hospital, a team will prepare you for surgery. The

surgeon will also do a final assessment of the donor liver to ensure it's

healthy and a good match.

Split- and living-donor liver transplants

The need for livers far outpaces the number of donations. On any given day,

15,000 to 17,000 people are waiting to receive a liver transplant in the

United States, yet annually there are only enough available livers for about

a third of them.

One strategy to address the limited supply is to split a large and healthy

liver from a deceased donor into two parts. Usually, an adult receives the

right lobe (about 60 percent of the liver) and a child or adolescent

receives the left lobe (about 40 percent). An even smaller portion may be

used for an infant. Because of the liver's ability to regenerate itself,

these partial organs will increase in size after being transplanted.

Living-donor transplants are also becoming more common at some transplant

centers. Living donors can donate part of their liver to a recipient, the

right lobe to an adult or left lobe to a child or adolescent. The remaining

portion of the donor's healthy liver regenerates itself to full size within

a few weeks.

Donors are at risk of certain complications, including infections, bleeding

or abnormal liver function. Most of these problems eventually go away

without long-term effects. There is also a very slight risk of death to the

donor. To reduce the risk of complications, donors are carefully screened to

assess their general health, liver health and risk of liver disease.

The surgery

A liver transplant often takes three to five hours, but the time can vary

significantly. The diseased liver is removed through an incision in your

upper abdomen. The donor liver is then placed inside your abdomen, and blood

vessels from your body are attached to those of the new liver. The bile duct

of the donor liver is attached to your bile duct or to a segment of

intestine so that bile can drain into your small intestine.

After the surgery, you'll have some pain, which will be treated with

medications. Recovery often involves a five- to 10-day hospital stay,

depending on how well you and your new liver are doing. You'll also undergo

frequent assessments during the following two to four weeks and will be

expected to have living accommodations within a relatively short commute of

the transplant center.

After the surgery

Key to understanding post-transplant treatment is the concept that a

transplanted organ is foreign tissue to your body. Your immune system will

attack a new liver just as it would a viral infection.

Your new drug regimen after the transplant will include immunosuppressants —

medications that suppress the activity of your immune system — so that your

immune system won't attack your transplanted liver. Because your immune

system will most likely never get completely used to the new organ, you will

take some of these medications for the rest of your life.

Because immunosuppressants make your body more vulnerable to infection, your

doctor may also prescribe antibacterial, antiviral and antifungal

medications. Some immunosuppressants can also raise your risk of developing

certain conditions or complicating others you may already have, such as high

blood pressure, diabetes, high cholesterol and cancer.

Your post-transplant treatment, therefore, will be a delicate balancing act

focusing on preventing rejection, managing unwanted side effects and

maintaining enough disease-fighting power to ward off infection. Your doctor

will monitor your treatment closely and adjust it as necessary. Along with

taking medication, you'll be expected to follow a diet and exercise routine

designed to keep you and your new liver healthy.

What if your new liver fails?

Some transplanted livers lose their ability to function. Your new liver may

fail because of organ rejection, because the underlying causes of liver

disease damaged the new organ or because of other factors that couldn't be

controlled.

If this happens, you can be considered for a second transplant, or you may

choose to discontinue treatment. These decisions will depend on your current

health and ability to undergo surgery. Discussions with your transplant

team, doctor and family should address your expectations and preferences for

treatment.

http://www.mayoclinic.com/health/liver-transplant/DG00037

_________________________________________________________________

Dave vs. Carl: The Insignificant Championship Series.  Who will win?

http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?href=http://davevsc\

arl.spaces.live.com/?icid=T001MSN38C07001

[Guest guest]

Liver transplant: Treating end-stage liver disease

Before making a decision about a liver transplant, learn about the organ

transplant process, including getting listed in the organ recipient

registry, the surgery itself, potential risks and follow-up care.

The liver has a remarkable ability to regenerate itself, but it sometimes

sustains severe damage that can't be reversed. In such cases, a liver

transplant may be an option for some people. Although a liver transplant may

be needed for sudden liver failure caused by toxins or severe infection,

it's more often a final treatment option for long-term, progressive liver

disease. Because many people must wait more than two years for a liver

transplant, your doctor may begin discussing transplantation with you long

before you actually need it.

What conditions lead to liver transplants?

Cirrhosis — irreversible damage to liver cells — is the most common reason

for liver transplants in adults. It occurs when scar tissue replaces healthy

cells and prevents normal liver function. Conditions that may cause

cirrhosis and the need for a liver transplant include:

Chronic hepatitis B and C

Diseases of the bile ducts

Alcoholic liver disease

Autoimmune liver diseases

Buildup of fat in the liver

In children, the conditions that most often cause liver damage that may lead

to a transplant are:

Defects in the liver or bile ducts present at birth

Metabolic disorders

Liver cancer

Sudden liver failure from drugs

The transplant journey: Taking the first steps

If your doctor recommends a liver transplant, you'll likely be referred to a

transplant center for an evaluation. Discuss with your health insurance

provider which transplant centers are covered under your insurance plan.

Most transplant programs offer the services of social workers and financial

coordinators, who can help you work through financial issues associated with

transplant surgery.

When selecting a transplant center, take into account the number of liver

transplants the center performs each year and the recipient survival rates.

You can compare transplant center statistics through a database maintained

by the Scientific Registry of Transplant Recipients.

In addition, consider support services provided by a transplant center. Many

centers coordinate support groups, assist you with travel arrangements, help

you find local housing for your recovery period or direct you to

organizations that can help with these concerns.

Once you select a liver transplant center, expect to undergo an evaluation

to determine whether you meet the transplant center's eligibility

requirements. The evaluation will assess whether you:

Have a medical condition that would benefit from a transplant

Aren't likely to benefit from other treatment options

Are healthy enough to undergo surgery and post-transplant treatments

Are willing and able to take medications as directed

Have sufficient emotional stamina to undergo the wait for a donor organ and

have a supportive network of family and friends to help you during this

stressful time

If liver failure is the result of alcohol or drug abuse, you'll be evaluated

to determine whether you currently abstain from use, have received adequate

chemical dependency treatment and are at risk of using alcohol or drugs

after the transplant.

Waiting for a donor organ

If it's determined that you're a good candidate for a transplant, you'll be

registered on a nationwide waiting list. When a donor organ becomes

available, the donor-recipient matching system, administered by United

Network for Organ Sharing (UNOS), makes an appropriate match.

Your medical team will assign you a score that represents how urgently you

need a transplant in order to survive. For adults 18 years of age and older,

the score is a number between 6 and 40 on a scale called the Model for

End-Stage Liver Disease, or MELD. The higher the number, the more urgent the

need for a transplant. Your MELD score may go up or down while you wait for

a transplant. Your medical team will evaluate your status frequently and

update your score as necessary.

The Pediatric End-Stage Liver Disease, or PELD, scale is a similar 6- to

40-point scale for transplant candidates under the age of 18.

An extremely urgent case, or status 1 liver failure, supersedes the MELD and

PELD scores. These individuals have sudden or nearly complete liver failure

and have a life expectancy of less than seven days.

Preparing for a liver transplant

A liver transplant from a deceased donor (cadaver) needs to occur within 12

to 24 hours after the liver is removed from the donor for the organ to

remain viable. The transplant center will most likely provide you with a

pager or cell phone to notify you when a potential donor organ is available.

When you arrive at the hospital, a team will prepare you for surgery. The

surgeon will also do a final assessment of the donor liver to ensure it's

healthy and a good match.

Split- and living-donor liver transplants

The need for livers far outpaces the number of donations. On any given day,

15,000 to 17,000 people are waiting to receive a liver transplant in the

United States, yet annually there are only enough available livers for about

a third of them.

One strategy to address the limited supply is to split a large and healthy

liver from a deceased donor into two parts. Usually, an adult receives the

right lobe (about 60 percent of the liver) and a child or adolescent

receives the left lobe (about 40 percent). An even smaller portion may be

used for an infant. Because of the liver's ability to regenerate itself,

these partial organs will increase in size after being transplanted.

Living-donor transplants are also becoming more common at some transplant

centers. Living donors can donate part of their liver to a recipient, the

right lobe to an adult or left lobe to a child or adolescent. The remaining

portion of the donor's healthy liver regenerates itself to full size within

a few weeks.

Donors are at risk of certain complications, including infections, bleeding

or abnormal liver function. Most of these problems eventually go away

without long-term effects. There is also a very slight risk of death to the

donor. To reduce the risk of complications, donors are carefully screened to

assess their general health, liver health and risk of liver disease.

The surgery

A liver transplant often takes three to five hours, but the time can vary

significantly. The diseased liver is removed through an incision in your

upper abdomen. The donor liver is then placed inside your abdomen, and blood

vessels from your body are attached to those of the new liver. The bile duct

of the donor liver is attached to your bile duct or to a segment of

intestine so that bile can drain into your small intestine.

After the surgery, you'll have some pain, which will be treated with

medications. Recovery often involves a five- to 10-day hospital stay,

depending on how well you and your new liver are doing. You'll also undergo

frequent assessments during the following two to four weeks and will be

expected to have living accommodations within a relatively short commute of

the transplant center.

After the surgery

Key to understanding post-transplant treatment is the concept that a

transplanted organ is foreign tissue to your body. Your immune system will

attack a new liver just as it would a viral infection.

Your new drug regimen after the transplant will include immunosuppressants —

medications that suppress the activity of your immune system — so that your

immune system won't attack your transplanted liver. Because your immune

system will most likely never get completely used to the new organ, you will

take some of these medications for the rest of your life.

Because immunosuppressants make your body more vulnerable to infection, your

doctor may also prescribe antibacterial, antiviral and antifungal

medications. Some immunosuppressants can also raise your risk of developing

certain conditions or complicating others you may already have, such as high

blood pressure, diabetes, high cholesterol and cancer.

Your post-transplant treatment, therefore, will be a delicate balancing act

focusing on preventing rejection, managing unwanted side effects and

maintaining enough disease-fighting power to ward off infection. Your doctor

will monitor your treatment closely and adjust it as necessary. Along with

taking medication, you'll be expected to follow a diet and exercise routine

designed to keep you and your new liver healthy.

What if your new liver fails?

Some transplanted livers lose their ability to function. Your new liver may

fail because of organ rejection, because the underlying causes of liver

disease damaged the new organ or because of other factors that couldn't be

controlled.

If this happens, you can be considered for a second transplant, or you may

choose to discontinue treatment. These decisions will depend on your current

health and ability to undergo surgery. Discussions with your transplant

team, doctor and family should address your expectations and preferences for

treatment.

http://www.mayoclinic.com/health/liver-transplant/DG00037

_________________________________________________________________

Dave vs. Carl: The Insignificant Championship Series.  Who will win?

http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?href=http://davevsc\

arl.spaces.live.com/?icid=T001MSN38C07001

[Guest guest]

Liver transplant: Treating end-stage liver disease

Before making a decision about a liver transplant, learn about the organ

transplant process, including getting listed in the organ recipient

registry, the surgery itself, potential risks and follow-up care.

The liver has a remarkable ability to regenerate itself, but it sometimes

sustains severe damage that can't be reversed. In such cases, a liver

transplant may be an option for some people. Although a liver transplant may

be needed for sudden liver failure caused by toxins or severe infection,

it's more often a final treatment option for long-term, progressive liver

disease. Because many people must wait more than two years for a liver

transplant, your doctor may begin discussing transplantation with you long

before you actually need it.

What conditions lead to liver transplants?

Cirrhosis — irreversible damage to liver cells — is the most common reason

for liver transplants in adults. It occurs when scar tissue replaces healthy

cells and prevents normal liver function. Conditions that may cause

cirrhosis and the need for a liver transplant include:

Chronic hepatitis B and C

Diseases of the bile ducts

Alcoholic liver disease

Autoimmune liver diseases

Buildup of fat in the liver

In children, the conditions that most often cause liver damage that may lead

to a transplant are:

Defects in the liver or bile ducts present at birth

Metabolic disorders

Liver cancer

Sudden liver failure from drugs

The transplant journey: Taking the first steps

If your doctor recommends a liver transplant, you'll likely be referred to a

transplant center for an evaluation. Discuss with your health insurance

provider which transplant centers are covered under your insurance plan.

Most transplant programs offer the services of social workers and financial

coordinators, who can help you work through financial issues associated with

transplant surgery.

When selecting a transplant center, take into account the number of liver

transplants the center performs each year and the recipient survival rates.

You can compare transplant center statistics through a database maintained

by the Scientific Registry of Transplant Recipients.

In addition, consider support services provided by a transplant center. Many

centers coordinate support groups, assist you with travel arrangements, help

you find local housing for your recovery period or direct you to

organizations that can help with these concerns.

Once you select a liver transplant center, expect to undergo an evaluation

to determine whether you meet the transplant center's eligibility

requirements. The evaluation will assess whether you:

Have a medical condition that would benefit from a transplant

Aren't likely to benefit from other treatment options

Are healthy enough to undergo surgery and post-transplant treatments

Are willing and able to take medications as directed

Have sufficient emotional stamina to undergo the wait for a donor organ and

have a supportive network of family and friends to help you during this

stressful time

If liver failure is the result of alcohol or drug abuse, you'll be evaluated

to determine whether you currently abstain from use, have received adequate

chemical dependency treatment and are at risk of using alcohol or drugs

after the transplant.

Waiting for a donor organ

If it's determined that you're a good candidate for a transplant, you'll be

registered on a nationwide waiting list. When a donor organ becomes

available, the donor-recipient matching system, administered by United

Network for Organ Sharing (UNOS), makes an appropriate match.

Your medical team will assign you a score that represents how urgently you

need a transplant in order to survive. For adults 18 years of age and older,

the score is a number between 6 and 40 on a scale called the Model for

End-Stage Liver Disease, or MELD. The higher the number, the more urgent the

need for a transplant. Your MELD score may go up or down while you wait for

a transplant. Your medical team will evaluate your status frequently and

update your score as necessary.

The Pediatric End-Stage Liver Disease, or PELD, scale is a similar 6- to

40-point scale for transplant candidates under the age of 18.

An extremely urgent case, or status 1 liver failure, supersedes the MELD and

PELD scores. These individuals have sudden or nearly complete liver failure

and have a life expectancy of less than seven days.

Preparing for a liver transplant

A liver transplant from a deceased donor (cadaver) needs to occur within 12

to 24 hours after the liver is removed from the donor for the organ to

remain viable. The transplant center will most likely provide you with a

pager or cell phone to notify you when a potential donor organ is available.

When you arrive at the hospital, a team will prepare you for surgery. The

surgeon will also do a final assessment of the donor liver to ensure it's

healthy and a good match.

Split- and living-donor liver transplants

The need for livers far outpaces the number of donations. On any given day,

15,000 to 17,000 people are waiting to receive a liver transplant in the

United States, yet annually there are only enough available livers for about

a third of them.

One strategy to address the limited supply is to split a large and healthy

liver from a deceased donor into two parts. Usually, an adult receives the

right lobe (about 60 percent of the liver) and a child or adolescent

receives the left lobe (about 40 percent). An even smaller portion may be

used for an infant. Because of the liver's ability to regenerate itself,

these partial organs will increase in size after being transplanted.

Living-donor transplants are also becoming more common at some transplant

centers. Living donors can donate part of their liver to a recipient, the

right lobe to an adult or left lobe to a child or adolescent. The remaining

portion of the donor's healthy liver regenerates itself to full size within

a few weeks.

Donors are at risk of certain complications, including infections, bleeding

or abnormal liver function. Most of these problems eventually go away

without long-term effects. There is also a very slight risk of death to the

donor. To reduce the risk of complications, donors are carefully screened to

assess their general health, liver health and risk of liver disease.

The surgery

A liver transplant often takes three to five hours, but the time can vary

significantly. The diseased liver is removed through an incision in your

upper abdomen. The donor liver is then placed inside your abdomen, and blood

vessels from your body are attached to those of the new liver. The bile duct

of the donor liver is attached to your bile duct or to a segment of

intestine so that bile can drain into your small intestine.

After the surgery, you'll have some pain, which will be treated with

medications. Recovery often involves a five- to 10-day hospital stay,

depending on how well you and your new liver are doing. You'll also undergo

frequent assessments during the following two to four weeks and will be

expected to have living accommodations within a relatively short commute of

the transplant center.

After the surgery

Key to understanding post-transplant treatment is the concept that a

transplanted organ is foreign tissue to your body. Your immune system will

attack a new liver just as it would a viral infection.

Your new drug regimen after the transplant will include immunosuppressants —

medications that suppress the activity of your immune system — so that your

immune system won't attack your transplanted liver. Because your immune

system will most likely never get completely used to the new organ, you will

take some of these medications for the rest of your life.

Because immunosuppressants make your body more vulnerable to infection, your

doctor may also prescribe antibacterial, antiviral and antifungal

medications. Some immunosuppressants can also raise your risk of developing

certain conditions or complicating others you may already have, such as high

blood pressure, diabetes, high cholesterol and cancer.

Your post-transplant treatment, therefore, will be a delicate balancing act

focusing on preventing rejection, managing unwanted side effects and

maintaining enough disease-fighting power to ward off infection. Your doctor

will monitor your treatment closely and adjust it as necessary. Along with

taking medication, you'll be expected to follow a diet and exercise routine

designed to keep you and your new liver healthy.

What if your new liver fails?

Some transplanted livers lose their ability to function. Your new liver may

fail because of organ rejection, because the underlying causes of liver

disease damaged the new organ or because of other factors that couldn't be

controlled.

If this happens, you can be considered for a second transplant, or you may

choose to discontinue treatment. These decisions will depend on your current

health and ability to undergo surgery. Discussions with your transplant

team, doctor and family should address your expectations and preferences for

treatment.

http://www.mayoclinic.com/health/liver-transplant/DG00037

_________________________________________________________________

Dave vs. Carl: The Insignificant Championship Series.  Who will win?

http://clk.atdmt.com/MSN/go/msnnkwsp0070000001msn/direct/01/?href=http://davevsc\

arl.spaces.live.com/?icid=T001MSN38C07001

[Guest guest]

Liver transplant: Treating end-stage liver disease

Before making a decision about a liver transplant, learn about the organ

transplant process, including getting listed in the organ recipient

registry, the surgery itself, potential risks and follow-up care.

The liver has a remarkable ability to regenerate itself, but it sometimes

sustains severe damage that can't be reversed. In such cases, a liver

transplant may be an option for some people. Although a liver transplant may

be needed for sudden liver failure caused by toxins or severe infection,

it's more often a final treatment option for long-term, progressive liver

disease. Because many people must wait more than two years for a liver

transplant, your doctor may begin discussing transplantation with you long

before you actually need it.

What conditions lead to liver transplants?

Cirrhosis — irreversible damage to liver cells — is the most common reason

for liver transplants in adults. It occurs when scar tissue replaces healthy

cells and prevents normal liver function. Conditions that may cause

cirrhosis and the need for a liver transplant include:

Chronic hepatitis B and C

Diseases of the bile ducts

Alcoholic liver disease

Autoimmune liver diseases

Buildup of fat in the liver

In children, the conditions that most often cause liver damage that may lead

to a transplant are:

Defects in the liver or bile ducts present at birth

Metabolic disorders

Liver cancer

Sudden liver failure from drugs

The transplant journey: Taking the first steps

If your doctor recommends a liver transplant, you'll likely be referred to a

transplant center for an evaluation. Discuss with your health insurance

provider which transplant centers are covered under your insurance plan.

Most transplant programs offer the services of social workers and financial

coordinators, who can help you work through financial issues associated with

transplant surgery.

When selecting a transplant center, take into account the number of liver

transplants the center performs each year and the recipient survival rates.

You can compare transplant center statistics through a database maintained

by the Scientific Registry of Transplant Recipients.

In addition, consider support services provided by a transplant center. Many

centers coordinate support groups, assist you with travel arrangements, help

you find local housing for your recovery period or direct you to

organizations that can help with these concerns.

Once you select a liver transplant center, expect to undergo an evaluation

to determine whether you meet the transplant center's eligibility

requirements. The evaluation will assess whether you:

Have a medical condition that would benefit from a transplant

Aren't likely to benefit from other treatment options

Are healthy enough to undergo surgery and post-transplant treatments

Are willing and able to take medications as directed

Have sufficient emotional stamina to undergo the wait for a donor organ and

have a supportive network of family and friends to help you during this

stressful time

If liver failure is the result of alcohol or drug abuse, you'll be evaluated

to determine whether you currently abstain from use, have received adequate

chemical dependency treatment and are at risk of using alcohol or drugs

after the transplant.

Waiting for a donor organ

If it's determined that you're a good candidate for a transplant, you'll be

registered on a nationwide waiting list. When a donor organ becomes

available, the donor-recipient matching system, administered by United

Network for Organ Sharing (UNOS), makes an appropriate match.

Your medical team will assign you a score that represents how urgently you

need a transplant in order to survive. For adults 18 years of age and older,

the score is a number between 6 and 40 on a scale called the Model for

End-Stage Liver Disease, or MELD. The higher the number, the more urgent the

need for a transplant. Your MELD score may go up or down while you wait for

a transplant. Your medical team will evaluate your status frequently and

update your score as necessary.

The Pediatric End-Stage Liver Disease, or PELD, scale is a similar 6- to

40-point scale for transplant candidates under the age of 18.

An extremely urgent case, or status 1 liver failure, supersedes the MELD and

PELD scores. These individuals have sudden or nearly complete liver failure

and have a life expectancy of less than seven days.

Preparing for a liver transplant

A liver transplant from a deceased donor (cadaver) needs to occur within 12

to 24 hours after the liver is removed from the donor for the organ to

remain viable. The transplant center will most likely provide you with a

pager or cell phone to notify you when a potential donor organ is available.

When you arrive at the hospital, a team will prepare you for surgery. The

surgeon will also do a final assessment of the donor liver to ensure it's

healthy and a good match.

Split- and living-donor liver transplants

The need for livers far outpaces the number of donations. On any given day,

15,000 to 17,000 people are waiting to receive a liver transplant in the

United States, yet annually there are only enough available livers for about

a third of them.

One strategy to address the limited supply is to split a large and healthy

liver from a deceased donor into two parts. Usually, an adult receives the

right lobe (about 60 percent of the liver) and a child or adolescent

receives the left lobe (about 40 percent). An even smaller portion may be

used for an infant. Because of the liver's ability to regenerate itself,

these partial organs will increase in size after being transplanted.

Living-donor transplants are also becoming more common at some transplant

centers. Living donors can donate part of their liver to a recipient, the

right lobe to an adult or left lobe to a child or adolescent. The remaining

portion of the donor's healthy liver regenerates itself to full size within

a few weeks.

Donors are at risk of certain complications, including infections, bleeding

or abnormal liver function. Most of these problems eventually go away

without long-term effects. There is also a very slight risk of death to the

donor. To reduce the risk of complications, donors are carefully screened to

assess their general health, liver health and risk of liver disease.

The surgery

A liver transplant often takes three to five hours, but the time can vary

significantly. The diseased liver is removed through an incision in your

upper abdomen. The donor liver is then placed inside your abdomen, and blood

vessels from your body are attached to those of the new liver. The bile duct

of the donor liver is attached to your bile duct or to a segment of

intestine so that bile can drain into your small intestine.

After the surgery, you'll have some pain, which will be treated with

medications. Recovery often involves a five- to 10-day hospital stay,

depending on how well you and your new liver are doing. You'll also undergo

frequent assessments during the following two to four weeks and will be

expected to have living accommodations within a relatively short commute of

the transplant center.

After the surgery

Key to understanding post-transplant treatment is the concept that a

transplanted organ is foreign tissue to your body. Your immune system will

attack a new liver just as it would a viral infection.

Your new drug regimen after the transplant will include immunosuppressants —

medications that suppress the activity of your immune system — so that your

immune system won't attack your transplanted liver. Because your immune

system will most likely never get completely used to the new organ, you will

take some of these medications for the rest of your life.

Because immunosuppressants make your body more vulnerable to infection, your

doctor may also prescribe antibacterial, antiviral and antifungal

medications. Some immunosuppressants can also raise your risk of developing

certain conditions or complicating others you may already have, such as high

blood pressure, diabetes, high cholesterol and cancer.

Your post-transplant treatment, therefore, will be a delicate balancing act

focusing on preventing rejection, managing unwanted side effects and

maintaining enough disease-fighting power to ward off infection. Your doctor

will monitor your treatment closely and adjust it as necessary. Along with

taking medication, you'll be expected to follow a diet and exercise routine

designed to keep you and your new liver healthy.

What if your new liver fails?

Some transplanted livers lose their ability to function. Your new liver may

fail because of organ rejection, because the underlying causes of liver

disease damaged the new organ or because of other factors that couldn't be

controlled.

If this happens, you can be considered for a second transplant, or you may

choose to discontinue treatment. These decisions will depend on your current

health and ability to undergo surgery. Discussions with your transplant

team, doctor and family should address your expectations and preferences for

treatment.

http://www.mayoclinic.com/health/liver-transplant/DG00037

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