Liver Transplant is surgery to replace a diseased liver with a healthy liver. The most common reason for a liver transplant in children is biliary atresia. The most common reason for a liver transplant in adults is cirrhosis. Cirrhosis, scarring of the liver that prevents function, can worsen over time and result in liver failure.
The most common causes of cirrhosis are:
- Long-term infection with hepatitis B or hepatitis C
- Long-term alcohol abuse
Other illnesses that may cause cirrhosis and liver failure include:
- Autoimmune hepatitis
- Hepatic vein blood clot (thrombosis)
- Liver damage from poisoning or medications
- Problems with the drainage system of the liver (the biliary tract) resulting in primary biliary cirrhosis or primary sclerosing cholangitis
- Metabolic disorders of copper or iron (Wilson’s disease and hemochromatosis)
- Cancer
The first human liver transplant was performed in 1963 by a surgical team led by Dr. Thomas Starzl in Denver, Colorado. Dr. Starzl performed several additional transplants over the next few years before the first short-term success was achieved in 1967 with the first one-year survival post transplantation. Liver transplantation remained experimental through the 1970s, with one year patient survival remaining in the vicinity of 25%. The introduction of cyclosporin (an anti-rejection drug) by Sir Roy Calne markedly improved patient outcomes, and by the 1980s, liver transplantation was recognized as a standard clinical treatment for both adult and pediatric patients with appropriate indications.
Like all transplant recipients, people receiving a transplanted liver must take immunosuppressive (anti-rejection) drugs to suppress the immune system and keep it from attacking the transplanted organ as an invader. Immunosuppressive medication must be taken for life to prevent rejection. Suppressing the immune system long term, however, makes the recipient vulnerable to infections and cancers that would not otherwise be a problem. In addition, the drugs themselves have side effects ranging from osteoporosis, appearance changes, cardiovascular disease and kidney damage. The cost of drugs and treatment generally run between $25,000 and $45,000 per year for the life of the patient.
The limited supply of diseased-donor livers has spurred the development of living-donor transplantation, in which a just portion of a healthy donor’s liver is used for transplantation. A major advance in pediatric liver transplantation was the development of reduced size liver transplantation, in which a portion of an adult liver is used for an infant or small child. Living donor liver transplantation for pediatric recipients involves removal of approximately 20% of the liver.
Further advance in liver transplant involves removing only the affected lobe of a patient with a liver tumor or cancer, leaving the tumor-free lobe intact.