End-stage Liver Disease Without Transplant

What Happens During A Liver Transplant

Liver transplant surgery requires a hospital stay. Procedures may varydepending on your condition and your providers practices.

Generally, a liver transplant follows this process:

How Is Decompensated Cirrhosis Treated

There are limited treatment options for decompensated cirrhosis. At this later stage of liver disease, its usually not possible to reverse the condition. But this also means that people with decompensated cirrhosis are often good candidates for a liver transplant.

If you have at least one symptom of decompensated cirrhosis and a MELD score of 15 or higher, a liver transplant is strongly recommended.

Liver transplants are done with either a partial or whole liver from a donor. Liver tissue can regenerate, so someone can receive a portion of a liver from a live donor. Both the transplanted liver and the donors liver will regenerate within a few months .

While a liver transplant is a promising option, its a major procedure with a lot of aspects to consider. In most cases, a doctor will refer a prospective patient to a transplant center, where a team of medical professionals will evaluate how well the patient would do with a transplant.

Theyll look at:

Are There Stages Of Cirrhosis

If you have been diagnosed with cirrhosis of the liver, you are already beyond the early stages of liver disease. Having cirrhosis means your liver has scar tissue in it because it has been damaged.

Liver specialists and researchers have developed many different scoring systems to predict outcome and to guide treatment for chronic liver disease. Some specific liver diseases also have their own scoring systems. However, not every liver disease has a scoring system and theres no scoring system if you happen to have more than one liver disease at the same time.

For these reasons, perhaps its easier to talk about cirrhosis according to a classification system you are more likely to hear from your healthcare provider. He or she may refer to you having either compensated cirrhosis or decompensated cirrhosis.

Compensated cirrhosis means you have cirrhosis but you dont yet have noticeable symptoms . Your lab work and imaging findings may not be abnormal. A liver biopsy may be the only way to confirm a diagnosis of cirrhosis. Median survival in patients with compensated cirrhosis is approximately nine to 12 years.

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How Common Is Cirrhosis

Scientists estimate that cirrhosis of the liver affects about one in 400 adults in the U.S. It affects about 1 in 200 adults age 45 to 54, the age group most commonly affected by cirrhosis. Cirrhosis causes about 26,000 deaths each year in the U.S. and is the seventh leading cause of death in the U.S. among adults 25 to 64 years of age.

Liver Failure Life Expectancy

Liver failure usually occurs when your liver has become seriously damaged due to cirrhosis . Liver scarring can be caused by illnesses such as hepatitis C, liver cancer, genetic conditions, autoimmune disorders, or conditions caused by poor diet and obesity or excessive alcohol use.

Cirrhosis can be present in one of two forms:

• Compensated: Your liver has enough healthy tissue remaining to compensate for the loss of liver function from the scarring. You have no signs or symptoms related to cirrhosis, though you may have conditions affecting your stomach, esophagus or other organs. Life expectancy with this type of cirrhosis is about 9 to 12 years.

• : Your liver is too scarred to compensate, so liver failure symptoms and complications are present. You may experience jaundice , fluid in your abdomen, or a type of mental confusion thats caused by liver failure, called hepatic encephalopathy. Life expectancy with this more severe form of cirrhosis is significantly lower than with compensated cirrhosis. Studies show one-year survival of 61%, two-year of 54%, and 45.4% at five years.

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Acute Liver Failure Life Expectancy

Sometimes liver failure occurs suddenly, rather than after years of chronic illness, and is more often seen in younger people. The most common cause in the U.S. for acute liver failure is acetaminophen overdose. Survival rates for acute liver failure have improved since 1998, according to a study that compared rates between 1998 and 2013. In 1998, 21-day patient survival was 59%, but jumped to 75% by 2013. Survival without a transplant nearly doubled, from 33% in 1998 to 61% in 2013.

What Are The Treatment Options For Liver Failure

Since damage to the liver leads to liver failure, treatment involves addressing whats causing liver damage to occur.

For example, antiviral medications can be used to treat a viral hepatitis infection, or immune suppressing medication can be given to treat autoimmune hepatitis.

Lifestyle changes may also be recommended as a part of your treatment. These can include things like abstaining from alcohol, losing weight, or avoiding the use of certain medications.

According to the American Liver Foundation, damage from the inflammation and fibrosis stages of liver failure may be reversed and healed over time . The liver damage caused by cirrhosis is often not reversible, although it can be slowed or stopped.

In people with severe cirrhosis or ESLD, a liver transplant may be necessary. This involves removing the diseased liver and replacing it with a liver from a healthy donor.

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A Comprehensive Transplantation Evaluation Process

The Liver Center will evaluate any patient referred for an opinion regarding liver transplant candidacy. Not every patient requires a full evaluation patients who may be too well for transplantation may continue to be followed by their primary doctors, with a full evaluation initiated only when appropriate.

A full transplant evaluation is a comprehensive process that includes extensive patient and family education, multiple physician assessments by our multidisciplinary team and aggressive medical and psychosocial intervention to prepare the patient for liver transplantation. Once a patient is listed for transplantation, our team becomes intimately and directly involved in all aspects of the patient’s care in order to prevent complications that could interfere with his or her active status on the waiting list.

Liver Transplantation For Liver Malignancies

Another possible indication for liver transplantation is hepatocellular carcinoma , the most common primary liver cancer.

Patients who receive a liver transplant for early HCC enjoy excellent survival in the short and long term. The care of patients with HCC is complex and involves several steps to treat and keep the tumor within the liver transplant criteria. Our multidisciplinary program offers all the expertise necessary to achieve this goal.

We also perform liver transplants for other less common liver cancers that meet certain criteria. Our multidisciplinary team carefully reviews the details of each patients cancer diagnosis, such as cholangiocarcinoma or metastatic neuroendocrine tumors, to determine if liver transplantation is the best option for the patient.

Our surgeons and caregivers have extensive experience and expertise in liver and bile duct surgery procedures for liver cancer treatment, liver tumors, end-stage liver disease and liver transplant. From open surgery to minimally invasive laparoscopic liver surgery, program surgeons provide the full range of procedures, from the most common to the latest surgical advancements. Surgery team members participate in cutting-edge research and train future surgeons in best practice treatment approaches.

To learn more, see our liver cancer FAQ videos which include several liver surgery topics.

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What Is A Liver Transplant

A liver transplant is surgery to replace a diseased liver with a healthyliver from another person. A whole liver may be transplanted, or just partof one.

In most cases the healthy liver will come from an organ donor who has justdied.

Sometimes a healthy living person will donate part of their liver. A livingdonor may be a family member. Or it may be someone who is not related toyou but whose blood type is a good match.

People who donate part of their liver can have healthy lives with the liverthat is left.

The liver is the only organ in the body that can replace lost or injuredtissue . The donors liver will soon grow back to normal sizeafter surgery. The part that you receive as a new liver will also grow tonormal size in a few weeks.

What Is Palliative Care

The goal of palliative care is to improve the quality of life for individuals suffering from an advanced illness, to provide comfort and dignity, and to relieve suffering. Palliative care addresses medical, emotional, and spiritual needs. Early access to palliative care for those living with a chronic disease is associated with an improved quality of life. Instead of prolonging life with medical treatment, palliative care focuses on quality of life. Symptom management is an important aspect of palliative care.

The course of ESLD is not easily predictable due to its periods of recovery and worsening symptoms therefore, early palliative care referrals should be sought.

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Liver Regeneration After Tylenol Overdose

We then decided to test whether a new drug could help recover liver zonation and regeneration. This drug, an antibody called FL6.13, shares similar functions with Wnt proteins, including activating liver regeneration.

Over the course of two days, we gave this drug to mice that were genetically engineered to lack Wnt2 and Wnt9b in their liver endothelial cells. We found that the drug was able to nearly completely recover liver cell division and repair functions.

Lastly, we wanted to test how well this drug worked to repair the liver after Tylenol overdose. Tylenol, or acetaminophen, is an over-the-counter medication commonly used to treat fever and pain. However, an overdose of Tylenol can cause severe liver damage. Without immediate medical attention, it can lead to liver failure and death. Tylenol poisoning is one of the most common causes of severe liver injury requiring liver transplantation in the U.S. Despite this, there is currently only one medication available to treat it, and it is only able to prevent liver damage if taken shortly after overdose.

We tested our new drug on mice with liver damage from toxic doses of Tylenol. We found that one dose was able to decrease liver injury biomarkers proteins the liver releases when injured in the blood and reduce liver tissue death. These findings indicate that liver cell repair and tissue regeneration are occurring.

What Causes Decompensated Cirrhosis

Anything that damages the liver can result in scarring, which could eventually turn into decompensated cirrhosis. The most common causes of cirrhosis are:

• long-term, heavy alcohol consumption
• chronic hepatitis B or hepatitis C
• buildup of fat in the liver

Other possible causes of cirrhosis include:

• autoimmune diseases of the liver
• bile duct injuries

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Reducing The Wait For A Donor Liver

The waiting time for a donor liver is based on severity of illness and blood type. Patients may be waitlisted in multiple centers in different regions to improve their chances of receiving a donor liver that is the best match.

Possible alternatives to transplantation are discussed with each patient during transplant education. One option is the identification of a healthy donor to provide a portion of his or her liver. Another option is to receive a deceased donor liver that may be at increased risk of poor graft function or disease transmission. In some cases, this type of “expanded criteria” organ may be acceptable and potentially preferable to long wait times.

What Are Some Complications Associated With Esld

Specific complications of ESLD are related to portal hypertension .

• Spontaneous bacterial peritonitis The symptoms may include fever, abdominal pain, and low blood pressure, but this can also be present without any symptoms at all
• Esophageal and gastric varices
• Hepatic encephalopathy which may be experienced as:

Trouble sleeping at night Poor concentration or shortened attention span Mild to severe confusion Worsening of handwriting or other fine motor movements Unusual movements, such as shaking of hands or arms Slurred speech

Bleeding inside the stomach or intestine Bloating

• Hepatorenal syndrome

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Whats The Life Expectancy For People With Cirrhosis

Life expectancy depends on several factors including the cause and severity of your cirrhosis, your response to treatments, presence of cirrhosis complications, your age and any other existing general health problems. Ask your liver specialist about your life expectancy since every person is unique, with unique overall health issues and specific liver health issues.

If your cirrhosis is advanced, liver transplantation may be an option. You and your doctors will discuss if this is an option for you.

When Should I Call 911 Or Go To The Emergency Room

If you have cirrhosis and experience the following, call 911:

• Your poop are black and tarry or contain blood .
• You are vomiting blood.
• You have muscle tremors or shakiness.
• You are confused, irritable, disoriented, sleepy, forgetful or foggy.
• You have a change in your level of consciousness or alertness you pass out.

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Symptom Experience And Qol

There are few studies examining the perspective of patients living with ESLD and those undergoing liver transplantation. A Korean questionnaire-based study of 129 cirrhotic patients identified fatigue, abdominal distention, peripheral edema, and muscle cramps as the symptoms most often needing management.6 One hundred eighty-eight Australian patients with chronic hepatitis C were surveyed and 83% reported 6 or more symptoms in the past 3 months, with physical and mental fatigue, irritability, depression, and abdominal pain being the most frequently reported.7 The SUPPORT Study reported that 60% of ESLD patients identified experienced pain.8 This was rated at least moderately severe most of the time in 1 of 3 patients.9 There is often a discrepancy between patient-reported symptom burden and physician awareness of such symptoms, for example, muscle cramps, which occurred in 52% of 92 cirrhotic patients in a 1996 survey, are not often identified as an issue by physicians.10

The Transplant Evaluation Process

If your provider thinks you may be a good candidate for a liver transplant,he or she will refer you to a transplant center for evaluation. Transplantcenters are located in certain hospitals throughout the U.S.

You will have a variety of tests done by the transplant center team. Theywill decide whether to place your name on a national transplant waitinglist. The transplant center team will include:

• A transplant surgeon

• Other team members such as a dietitian, a chaplain, or an anesthesiologist

The transplant evaluation process includes:

• Psychological and social evaluation . Many different issues are assessed. They include stress, financial concerns, and whether you will have support from family or friends after your surgery.

• Blood tests . These tests are done to help find a good donor match and assess your priority on the waiting list. They can also help improve the chances that your body wont reject the donor liver.

• Diagnostic tests . Tests may be done to check your liver and your general health. These tests may include X-rays, ultrasounds, a liver biopsy, heart and lung tests, colonoscopy, and dental exams. Women may also have a Pap test, gynecology exam, and a mammogram.

The transplant center team will review all of your information. Eachtransplant center has rules about who can have a liver transplant.

You may not be able to have a transplant if you:

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What About Acute Liver Failure

Acute liver failure is often treated in the intensive care unit of a hospital. Supportive care is given to help stabilize the condition and control any complications during treatment and recovery.

If a medication overdose or reaction is suspected, drugs may be given to reverse the effects. A liver transplant may also be recommended for some people with acute liver failure.

You can help to prevent liver failure by making lifestyle changes that keep your liver happy and healthy. Here are some tips for improving liver health:

• Drink alcohol in moderation, and never mix medications with alcohol.
• Take medications only when needed, and carefully follow any dosing instructions.
• Dont mix medications without first consulting your doctor.
• Maintain a healthy weight theres a connection between obesity and fatty liver disease.
• Get vaccinated against hepatitis A and B.
• Be sure to have regular physicals with your doctor during which they perform liver blood tests.