Cleveland Clinic Florida’s multidisciplinary team supports the Clinic’s vision, which is to provide exceptional clinical outcomes, best-in-class patient experiences, refined solutions for liver problems and excellence in research and education.
We have developed an extensive teaching program to help patients learn about the transplant process, liver transplant surgeries and caring for individual health needs before and after the transplant procedure. This information is necessary to assist patients in making informed decisions regarding transplantation.
We know that learning about the transplant process and how to care for yourself might be overwhelming at first. But remember, you can learn a little each day. We have also prepared reference materials that can provide you with all the information you need before, during and after transplantation.
Indications for Liver Transplantation
The criteria for Liver Transplant Surgery are based on a variety of ailments and irreversible liver failure or dysfunction as diagnosed by a patient’s doctors and healthcare providers. Conditions that can lead to liver transplantation can include the following:
1. Cirrhosis including:
- Alcohol cirrhosis (see Alcohol or Substance Dependence Addendum)
- Biliary cirrhosis (primary or secondary): Caroli, choledochal cyst, congenital cholestasis (PFIC), iatrongenic biliary tree injury/damage, trauma
- Chronic active hepatitis (A, B, C, non A, non B, autoimmune)
- Fatty liver disease
- Viral cirrhosis
- Congenital biliary cirrhosis
- Cryptogenic cirrhosis
- Alpha I Antitrypsin Deficiency
2. Extrahepatic biliary atresia or hypoplasia
3. Inborn errors of metabolism including:
- Alpha-I antitrypsin
- Hepatocellular Carcinoma (HCC), Stage I or II, or: single lesion
- Crigler-Najjar disease, Type I
- Byler's disease
- Glycogen storage disease, Type I
- Wilson's disease
- Wolman's disease
- Familial amyloidotic polyneuropathy
- Primary hyperoxaluria type 1
4. Sclerosing cholangitis
5. Hepatic vein thrombosis (Budd-Chiari)
- 6.5 cm, or multiple lesions with largest 4.5 cm or total maximum tumor diameter of less than 8 cm (UCSF criteria)
6. Acute hepatic fulminant failure
Liver Transplant Surgery
When a healthy liver has been found, a transplant coordinator will contact the patient by telephone. Remember, this could be any time of the day or night. Patients must be available to answer this call immediately. If they have a cold, sore throat, fever, or any type of infection, it is very important to tell the transplant coordinator. It is also very important to tell the staff about any other problems they may have.
As soon as the patient receives the call, they should go directly to Cleveland Clinic Florida and bring the suitcase they’ve packed ahead of time. Even though the donor liver receives special handling, there is a time limit. Upon arrival at the hospital, the patient must go directly to the Emergency Room and check in at the Registration Desk.
What Happens Before Liver Transplant Surgery
Patients will wait in a hospital room until the suitability of the organ is determined. They will then be prepared for surgery (generally within a few hours of their admission).
Just before surgery, the patient will be asked questions, and tests will be ordered to make sure they are in the best possible physical and emotional condition for the transplant. A complete physical, chest x-ray, blood tests, and an electrocardiogram (EKG) will be completed, and the doctor will review results.
While being prepared for surgery, surgeons will remove and prepare the donor liver. If the patient has had a significant medical problem, there are signs of infection, or if the donor liver is determined to be unacceptable, the surgery will be canceled. It is better to wait until another liver becomes available than to risk a transplant when the situation is not ideal.
What Happens After Surgery?
After surgery, patients will be taken to the Intensive Care Unit (ICU) where they are closely monitored. Patients will be very drowsy and will be sleeping most of the time.
Patients might have a dry, sore throat after surgery due to the breathing tube that was inserted during the transplant procedure. This will go away after a few days.
Special monitoring equipment will check the patient's pulse and blood pressure every 15 minutes. Occasionally, this monitoring equipment will beep or sound an alarm. This does not necessarily mean anything is wrong. Regularly, an electrocardiogram will be done to measure the patient heart rhythm and rate.
The nursing staff will help get the patient out of bed to move and walk around. Walking regularly in the hallway helps prevent lung and heart complications and helps the digestive system work properly again.
Once the transplant team has determined that the patient's condition is stable, they will be transferred from the ICU to a patient room in the transplant unit.
Liver Transplant Donation
There are more than 17,500 patients in the United States on the waiting list for a liver, with more added to the list each day. Nearly 5,000 patients receive liver transplants each year; however, more than 1,700 patients die each year while on the waiting list. New technology, has helped to advance the surgical procedure for living donation which has increased the number of patients receiving transplants.
Waiting and Preparing for Liver Transplant
Because of the shortage of donor organs, it is impossible to predict how long a patient will have to wait for an appropriate donor liver. The average waiting time can vary from days or weeks, to months or even years depending on several factors. Factors that might affect waiting time include blood type, severity of liver disease, presence of liver tumors and other conditions.
Living Donor Transplants
The living donor procedure, performed after the diseased liver has been removed, is possible because the liver regenerates, or grows. The liver’s ability to regenerate combined with advances in technology, enables more people to be liver donors.
When surgeons remove a piece of the donor’s liver, the part that remains grows back quickly to its original size, usually within a few weeks of surgery. The transplanted liver will also grow to an appropriate size for the recipient. If the right portion, or lobe, is being used for the transplant, the gallbladder is also removed.
Living donors reduce the waiting time for a transplant and also improve the chance of transplant success. Living donor transplants can be scheduled when the recipient is still healthy enough to undergo surgery. Knowing when the surgery is scheduled also helps recipients and donors prepare for the surgery. In addition, the living donor surgery allows the organ to be transplanted immediately. Because surgery on the donor and recipient are done at almost the same time, the liver can be transplanted within minutes of removal from the donor.
Liver Transplant Discharge, Planning and Recovery
Soon after surgery, health care providers will teach patients more about taking the new medicines to provide a smooth transition from hospital to home. We believe hands-on learning will help patients remember when to take their medicines, how to take them, learn about what happens if they miss a dose, and learn about potential side effects the medicines may cause.
Also, during the patient's hospital stay, they will learn how to take their pulse, blood pressure and check their gluclose levels. They will have a chance to practice the procedures and ask questions before they go home so they will feel comfortable with these skills.
When Will The Patient Be Able To Go Home?
The patient can expect to stay in the hospital for an estimated seven to ten days, but length of stay can vary. Length of stay depends on how quickly they recover from liver transplant surgery and whether they develop any complications.
Remember, each patient has a different rate of recovery. Patients will be discharged only after the transplant team has determined their health is stable and they know what to do to care for themselves at home. Our goal is to help patients feel comfortable and confident about taking care of themselves before they go home.
Frequently Asked Questions about Liver Transplant Procedure
How Will My Diet Change After The Liver Transplant?
Because of the new freedom to indulge in many different foods, and an increased feeling of hunger due to medicines such as prednisone (Deltasone), it is important for transplant patients to maintain a heart healthy diet.
How Is Liver Transplant Rejection Identified?
The transplant team will be able to determine whether the patient’s body is rejecting the liver by completing ongoing tests of liver function and conducting a potential biopsy during their hospital stay.
What Are The Signs or Symptoms of Liver Transplant Rejection?
The following are a list of the commons signs of liver transplant rejection
- Elevated Liver Tests
- Fever – If a patient’s temperature is over 100.4 F for more than 24 hours, they would need to consult the Transplant Center immediately at 954.659.5133
- New Abdominal Pain/Tenderness Over the Liver
- Fatigue, Malaise, Lethargy
- Flu-Like Symptoms
What is CMV?
CMV is short for cytomegalovirus and many people are CMV positive . It is a common virus within our population and often causes infection after transplantation. If left untreated, it might cause a more severe disease by infecting organs and parts of the body, such as the liver, colon, eyes, and others. Within the transplant population CMV is closely monitored and can be controlled with anti-viral medicines.
How Can I Prepare Myself While Waiting For A Liver Transplant?
Try to stay as healthy as possible by carefully following recommendations of the Liver Transplant Team. This can include:
- Taking prescribed medicine
- Having lab work completed
- Following dietary guidelines
- Continue exercise program as directed by doctor
- Quit smoking and or using tobacco products
- Keep all appointments with hepatologist
Liver Transplant Resources
Many organizations are available to provide information and support while patients wait for their liver transplant. Here are some organizations that patients may want to contact:
The Scientific Registry of Transplant Recipients includes information about transplants performed at Cleveland Clinic Florida and other relevant transplant data.
A Michigan-based free educational resource for transplant patients, including information about transplantation and donation
The Northern Brewery
1327 Jones Drive, Suite 201
Ann Arbor, MI 48105
The TIGER Fund
Helping Needy Organ Donor and Transplant Families
21218 St. Andrew Blvd #641
Boca Ratorn, FL 33433
Broward Palm Beach Transplant Support Group
Meets the third Thursday of the month
7:30 PM – 9:00 PM
The University of Miami Transplant Care Center
2201 West Sample Road, Bldg 9, Suite 3B
Pompano Beach, FL
954.956.5675 – John Venezia
Thoracic Transplant Education and Support Group
305.355.5135 – For information and times
Donor Family Services
University of Miami Organ Procurement Organization
After Care Program in Dade, Broward And Palmp Beach Counties
800.232.2892 – Josie Flores
Useful Web Addresses
US Department of Health and Human Services
A school program about organ donation for students
A service of the U.S. National Library of Medicine and the National Institutes of Health