Although liver transplantation was first performed
in 1960, it did not become standard form of therapy for advanced liver
disease until the 1990s.
There
are two main reasons why liver transplant has become so successful.
The first has been the major improvement in surgical techniques and
the second is the availability of new drugs which can help to prevent
rejection.
What are the reasons for Liver Transplantation?
Liver transplantation is usually performed only if a patient has end
stage liver disease.
Medical treatment is always the first choice of therapy but when this
medical treatment has been unsuccessful and the patient’s liver
can no longer support life, then liver transplantation is considered.
Liver transplantation can occur for a large number of different liver
disorders but there are several conditions which are more commonly treated
by liver transplantation. These conditions in general cause chronic
or continuing liver inflammation and cirrhosis.
In adults the most common reasons for liver transplantation in Australia
are:
1. Chronic viral Hepatitis B and C.
2. Alcohol related liver disease.
3. Primary biliary cirrhosis.
4. Advanced cirrhosis of any cause.
5. Drug induced liver disease.
6. Acute liver failure.
7. Primary liver cancer.
In children the most common cause of liver failure is biliary atresia
in which the bile ducts fail to develop.
Special considerations
1. Viral hepatitis.
In both Hepatitis B and Hepatitis C the transplanted liver will once
again become infected. The majority of patients with Hepatitis B and
C will never need a liver transplant.
2. Alcoholic Liver Disease.
Experience has shown that unless the patient has been completely abstinent
from alcohol for at least six month, the prospects of a good result
are compromised. It is very important then that patients with alcohol
related liver injury completely abstain from all alcohol.
3. Liver Cancer.
Only a small percentage of patients with primary liver cancer are
suitable for liver transplantation. Livers are a scarce resource and
if there is any spread of the cancer, then the liver transplantation
will not save the patient's life.
Transplant Centres
In Australia there are several transplant centres. The nearest transplant
centre to the Gold Coast is based at the Princess Alexandra Hospital.
This is a world class transplant centre with specialist surgeons, hepatologists,
psychiatrists and many ancillary staff. Currently this centre performs
around 50 transplants per year.
There is a close communication with other transplant units nationwide
and organs from one state may occasionally be used in another state.
Unfortunately, there are more patients who need a new liver than there
are donors. Choosing who gets a liver and when can be very difficult.
A fair system of allocation is necessary and the reality is that there
are patients who unfortunately will die from their liver disease while
still on the waiting list.
Donor livers usually come from individuals who have suffered fatal
brain damage due to trauma rather than disease. For various reasons
not all such patients who suffer severe brain trauma become organ donors.
There are factors other than the severity of the liver disease which
are considered by the transplant team in the decision regarding suitability
for liver transplantation. These include the patient’s psychological
make up, family situation and home support and in patients with alcoholic
liver disease, their ability to abstain from alcohol.
Other medical problems such as severe heart or respiratory disease,
may also preclude a person from liver transplantation.
After patients are assessed by the liver transplant team, they are
presented to a panel which has the ultimate decision as to whether the
patients are accepted on the active transplant list. If they are accepted,
the patient is then given a beeper to wear at all times so that they
can get to the transplant centre as soon as possible.
Surgery
Liver transplantation surgery is obviously complicated.
The first operation is the removal of the liver from the donor and
this operation is often performed at a different location e.g. if the
donor was in intensive care on the Gold Coast, the surgery to remove
the donor liver would be performed on the Gold Coast and then the liver
taken to Brisbane.
The transplant operation would then occur at the Princess Alexandra
Hospital and would take several hours at least. The new liver is attached
to the various blood vessels and bile ducts and when the surgery is
completed, the patient is transferred to Intensive Care.
The Post Operative Period
The patient often remains in hospital for several weeks after the operation.
There is continual monitoring for infection and rejection of the donor
liver by the body. 
Rejection occurs in all patients. Long-term treatment against rejection
is always necessary.
Medications used in liver rejection have significant side effects and
the patient will need close monitoring.
As recovery progresses, the patient is discharged home but continues
under the care of the Transplant Unit until stable.
Long-term care is usually managed by the patient’s personal physician
with occasional visits to the transplant team.
Once patients have recovered, they can resume normal physical and sexual
activities and even vigorous exercise is possible.
Liver donations
All healthy people are encouraged to make arrangements to become liver
donors. This would enable more livers to become available.
We encourage you to talk to your local doctor about becoming an organ
donor.
Interesting Web Sites on Liver Transplantation
www.cs.nsw.gov.au – Australian National Liver Transplant Unit
Referral Site
www.hepatitisc.asn.au – Hepatitis C Council of Queensland
