Liver Transplants
This fact sheet is based on information supplied by the Liver Transplant Unit of the Flinders Medical Centre. Flinders Medical Centre Tel: 08 8204 4720 Fax: 08 8204 4733 Flinders Drive BEDFORD PARK SA 5042 www.flinders.sa.gov.au
Hepatitis C is a disease which inflames the liver. It can also cause cirrhosis, which is scarring of the liver. In some cases this can eventually lead to liver failure. For many people with liver failure, a liver transplant offers the only hope of returning to a productive life. In Australia, and SA, the main reason for transplantation is hepatitis C. The first successful liver transplant was done in 1963, in Denver in the US, and then in 1968 in the UK, at Cambridge. In Australia the first successful liver transplant was in 1985, in Brisbane. Statebased liver transplant units started soon after that—Melbourne in 1988, Adelaide in 1992, and Perth in 1993. There’s now one in almost every State, with SA covering the NT, and Victoria covering Tasmania. In South Australia, all liver transplants are performed by the Liver Transplant Unit at the Flinders Medical Centre. This fact sheet discusses how the transplant program is run, and what people can expect if they need to have a liver transplant.
The Liver Transplant Unit The Flinders Medical Centre Liver Transplant Unit is the only liver transplant unit in SA, so patients from other hospitals (like the RAH and the Queen Elizabeth) go there. Doctors from each of the other hospitals also go there as part of the unit’s work. There are weekly meetings, and outside doctors also consult at the liver clinic. The unit follows patients all the way through the process. There are some who are referred to them for transplants, and some who they work up through the process for transplants. Then there’s the transplant operation itself, performed at the unit, and after that patients continue to see staff at the unit for monitoring for the rest of their lives. The unit usually has around 350 patients, pre- and post-transplant, at any one time.
The Waiting List The waiting list is slowly getting longer. As of 2019, the unit usually has 15 patients on the waiting list (this number fluctuates significantly depending on donor liver availability), and they perform 25 transplants or so a year, depending on donor liver availability. In 2018 there were 318 liver transplants performed in Australia. The average waiting time is usually a 6-12 months, but it depends on blood group. A transplant recipient has to have a liver from a donor of the same blood group. Unfortunately, some people do die on the waiting list before an appropriate liver is available. Currently, 80% of patients who are referred to The SA Liver Transplant Unit for liver transplants are suitable to proceed to liver transplant assessment. 93% of those who undergo a liver transplant assessment are then placed on the transplant waiting list.
Transplantation There’s a lot of variation in liver size—the liver actually adjusts to the size of the person it’s in, so a large man will have a larger liver than a small woman, for example. A smaller transplanted liver will grow to accommodate a larger body size. They can also shrink a little, as long as they fit into the recipient’s abdominal cavity in the first place. It is possible to transplant half a liver, which will then grow to the size of a whole liver in a couple of months. The liver is one of the few regenerative organs. For example, there aren’t enough child livers for transplants into child patients, but you can cut down an adult liver, as long as you leave enough to regrow and do the job.
After Transplant Surgery The stay in hospital after transplant can be from 10 days to 6 months, depending on complications. The average stay is 2 weeks. If all goes well, 1-2 days are usually spent in intensive care, and then the rest of the time is spent on the ward. Staff there teach transplant recipients about medications, and monitor them closely. Then, once the transplant recipient has gone home, they need to attend the liver transplant clinic once a week and have blood tests three times a week for the first month to check their medication levels. Later on, though, people may only need to come in for monitoring every three to six months. Liver transplantation restores quality of life, but can sometimes exchange one set of problems for another. Liver transplantation is a high-risk procedure, and the anti-rejection medications that transplant recipients must take for the rest of their lives can have side-effects. These medications suppress the immune system so that the body doesn’t reject the new liver, but this also means that the body can’t
fight bacteria and viruses the way it used to. This can make the transplant recipient more susceptible to infectious diseases and cancers. Transplantation doesn’t cure someone of hepatitis C, because the virus is still in their body (unless they’ve been successfully treated). This means that there’s a risk of the virus infecting the new liver, and that does occur in the majority of cases. However, the extent to which the virus damages the new liver can vary—for many people that new liver will last for many, many years. Receiving a transplant removes the problems associated with endstage liver disease: jaundice, fluid retention around the tummy, lethargy, encephalopathy, itching and bleeding. However, after a transplant a person may get infections because of the anti-rejection drugs. The Liver Transplant Unit try to keep the drug levels to a minimum, but it’s a balancing act. Dosages are varied very carefully for each patient on an ongoing basis. The chance of surviving a year after a liver transplant in South Australia is about 95%. This means there is a 5% chance of a patient not surviving surgery; perhaps the new liver just doesn’t work, or there’s too much bleeding, or they might have a heart attack. Remember, though, that there’s a risk associated with any surgery, even having an ingrown toenail removed. After surgery, there’s a 5-year survival rate of 80%, which means 4 out of 5 transplant recipients live for at least another 5 years. Furthermore, not every person in the 20% that dies loses their life because of anything to do with their liver. For example, they might have a heart attack several years after the operation.
Multiple Transplants Transplanted livers can sometimes fail too. When this happens, some people do have another liver transplant. Whether or not this happens depends upon the reason for their first transplanted liver failing. If it’s for a technical reason—perhaps an artery supplying blood to the liver has blocked off—then they will be able to receive a new transplant (when one is available), because that’s a technical problem beyond the patient’s control. If somebody has a failure of their transplanted liver because they started drinking alcohol again, they won’t be considered suitable for receiving another transplant. Fortunately, there hasn’t been much need to do re-transplantation in SA.
Rejection After receiving a liver transplant, there’s a risk of rejection for the rest of the recipient’s life. If they stop taking their medication 10 years down the track because they feel fine, they will still suffer rejection. Almost everybody gets a small degree of rejection, but because the medications are so effective, these days it’s rare to lose a transplant from rejection. It’s common to have some acute rejection in the first three months after transplant, which is why transplant recipients are monitored very closely for those first few months. Any rejection problems are usually easy to treat.
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