When is a Liver Transplant an Option?
- An early liver cancer diagnoses might make you eligible for a liver transplant, potentially curing the condition.
- Transplants show high success, offering recipients normal life expectancies and quality of life.
- Your liver can come from a living donor, like a family member, or someone who has agreed to donate their liver after they have died.
- Post-transplant, patients undergo follow-up care to prevent organ rejection and monitor health, with a low chance of needing additional cancer treatments.
“Liver transplants are generally very successful,” Dr. Robert Brown, chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center in New York City, tells SurvivorNet.
Read MoreAm I a good transplant candidate?
“If your cancer is a primary cancer, meaning it started in the liver and hasn’t spread to other organs, and you are in generally good health and young enough, it’s very likely you will be a good candidate for a transplant,” Dr. Brown says. Doctors evaluate liver cancer on a scale called the Milan Criteria which takes into account the following factors:- A diagnosis of hepatocellular carcinoma (HCC), a cancer that originates in the liver and is the most common type of liver cancer
- Up to 3 tumors, none bigger than 3 cm or about the size of a ping pong ball
- Or just 1 tumor, but no larger than 5 cm — about the size of a tennis ball
- No cancer spread outside the liver.
- No major blood vessel involvement by cancer.
“We try to get tumors within the liver down to a size where we could do a transplant,” Dr. Brown says, adding that candidates also need to be in good physical health to withstand the surgery, ensuring only those likely to have successful outcomes proceed.
. “So we do cardiac testing and lung testing and a whole bunch of other tests to make sure that everything else is okay,” he says.
Related: What to Expect After Surgery for Liver Cancer
How long will I wait for a transplant?
Once you meet the transplant criteria, you will immediately join a waiting list for a compatible donor liver.
“Once someone meets the criteria, we give them added priority so that they can access a liver. The average patient with liver cancer waits six to nine months. Most are done within a year,” Dr. Brown says.
The matching process and the wait for a liver can be a very emotional and physically taxing experience for patients, Dr. Brown cautions. But they are a big part of the transplant experience.
Patients often describe this period as an exhausting rollercoaster of emotions, filled with hope, anxiety, and a sense of urgency, as they navigate through the pre-transplant evaluations, waiting for a donor organ to become available.
Factors for a match include:
- Your blood type is the same
- Size of the donor liver must fit in the space available for your body
- The donor liver must be healthy and disease-free
- Testing ensures the donor liver will work properly
Your donated liver will come from either a living donor or a dead donor:
- Living donor: A healthy person can volunteer to donate a portion of their liver. This is typically a family member or friend. Sometimes you can receive a portion of a liver from a living donor while you wait for a deceased-donor liver to become available.
This generous gift is possible because of the liver’s ability to regenerate itself. Surgeons can remove a portion of the donor’s liver—up to 60%—and transplant it into the recipient. Remarkably, both the donor’s and recipient’s liver segments can regenerate to near their original size within several weeks to months.
- Deceased donor: When someone has recently passed away, their family has agreed to donate their liver to save your life
Dr. Brown notes that there are usually more people waiting for a liver transplant than there are donors. A new technique called “liver splitting” is helping to address this shortage.
In this procedure, a single liver from a deceased donor is divided into two parts to transplant into two different recipients, typically an adult and a child. This innovative approach effectively doubles the liver’s life-saving potential from a single donor.
Who is on the transplant team?
When getting a transplant, there will be several professionals who will help you along the way — including doctors, specialists, and others who typically work in hospitals or cancer centers.
This team may include:
- A transplant surgeon: Who will discuss the risks and benefits of surgery with you and evaluate your health before performing the surgery
- A transplant hepatologist: A gastroenterologist with extensive training in liver disorders and liver transplantation will review your medical history and decide what testing needs to be done for evaluation. While you wait for your donor liver, this specialist will help keep you healthy and will provide most of your care after surgery.
- Nurse coordinator: Provides education and helps you move through the evaluation process
- Social worker: Evaluates how well you may handle the stress of a transplant and manages your care plan, before and after surgery
- Clinical psychologist or psychiatrist: Will evaluate your mental health and suggest rehabilitation programs for drug or alcohol abuse, if needed
- Nutritionist: Will assess your diet and provide education before and after transplant to improve your chances of a successful transplant.
- Pharmacist: Works with you and the transplant team to find the best medicines to prevent organ rejection and minimize side effects.
Related: The Difference Between Bile Duct Cancer and Liver Cancer
How is the surgery performed?
When a matching organ is found, your healthcare team gets you ready for surgery immediately.
Livers can travel a long way from donor to recipient. If the liver comes from a deceased donor, you need to head to the hospital quickly, day or night, because the liver can only last up to eight hours after being removed.
However, if the liver is from a living donor, your doctor can schedule the surgery and plan in advance, allowing both donor and recipient to have their procedures at the same time.
The surgery involves a significant incision under the ribs on the right side of your abdomen. The team then carefully detaches your diseased liver from its connections, including blood vessels and bile ducts.
To manage bleeding and prevent bile leaks, they use clamps before attaching the new liver, securing it to your blood vessels and bile ducts.
Liver transplant operations can take anywhere from four to eight hours, depending on the complexity of the case.
What’s recovery like?
After your liver transplant, you wake up in the intensive care unit. You usually move back to the regular part of the hospital within a couple of days.
Post-surgery, patients stay in the hospital and do some physical rehabilitation, for up to two weeks.
“Most of the complications are early on and, of course, surgical. But you do need to watch for infections related to immunosuppression,” Dr. Brown cautions.
The fact that the anti-rejection drugs weaken your immune system is something doctors really pay attention to post-transplant.
These medications are absolutely necessary to ensure you don’t reject your new liver but they increase the chance of getting a vial infection like Epstein-Barr. If the virus goes unchecked for too long, it can lead to cancer of the lymph nodes, a type of cancer known as lymphoma.
But because liver transplants are generally so successful, Dr. Brown says you will probably need relatively little medication to stay healthy after the fist few weeks. An impressive 90% of transplanted livers remain functional one year after the surgery.
“Our one year survival is over 90% and then 90% of them are alive at five years. Liver transplant patients have a life expectancy that’s the same as their age matched controls,” Dr. Brown says.
“Primary liver cancer, if detected early enough before it spreads, is curable,” he adds.
What sort of follow-up care should I expect?
As Dr. Brown points out, you are likely to need very little long term follow up care.
But you will need some, including:
- Regular check-ups to monitor liver function and overall health
- Medications to prevent organ rejection, along with adjustments to dosages based on response
- Lifestyle changes, including a healthy diet and avoiding alcohol and smoking
- Possible physical rehabilitation to regain strength and return to daily activities
- Long-term monitoring for any signs of rejection, infection, or liver function issues
Although the chances of the cancer returning is low, Dr. Brown says it does happen.
“When you treat the tumor and you find that they still have cirrhosis, they’re at risk for new ones and so they can develop new cancers even after that,” he says.
Recent advancements in liver transplant care may make patient’s lives even more manageable.
Some liver transplant recipients are able to reach “operational tolerance,” a unique condition where the immune system accepts the new liver without lifelong immunosuppression, avoiding its side effects. Currently about 20% of liver transplant patients achieve this status. Researchers are actively studying ways to increase this number.
However, if the cancer was more advanced at the time of transplant or if you have other health risks, you may need chemotherapy or immunotherapy (to boost your body’s immune system) to prevent your cancer from coming back.
Related: Understanding Liver Cancer — Signs, Symptoms & How it is Treated
Questions to ask your doctor
- Am I eligible for liver transplant?
- Should I expect to be cured?
- What side effects can I expect and how will we manage them?
- What follow-up care will I need?
- What part of my treatment is covered by insurance and how much can I expect to pay out of pocket?
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