What does the liver do and why would a transplant be needed?

The liver is the body's largest internal organ (approximately three pounds in adults). It is located below the diaphragm on the right side of the abdomen.

The liver performs many complex functions in the body, including the following:

  • Produces most proteins needed by the body.
  • Metabolizes (breaks down) nutrients from food to produce energy, when needed.
  • Prevents shortages of nutrients by storing certain vitamins, minerals, and sugar.
  • Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K.
  • Produces most of the substances that regulate blood clotting.
  • Helps your body fight infection by removing bacteria from the blood.
  • Removes potentially toxic byproducts of certain medications.

When is a liver transplant needed?

Liver transplantation is considered when the liver no longer functions adequately (liver failure). Two possible causes of liver failure are an acute (sudden) failure from infection or complications from certain medications.

Long-term liver failure is more common and can be a result of the following conditions:

  • Chronic (long-term) hepatitis
  • Primary biliary cirrhosis (a rare condition in which the immune system inappropriately attacks and destroys the bile ducts, causing liver failure)
  • Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver). This causes backup of bile in the liver and liver failure.
  • Biliary atresia (malformation of the bile ducts). This is a common reason for liver transplant in children.
  • Alcoholism
  • Wilson's disease (a rare inherited disease in which copper is deposited abnormally throughout the body, including the liver)
  • Hemochromatosis (iron overload disease, a common inherited disease in which the body is overwhelmed with iron)
  • Amyloidosis (abnormal deposits in the liver of an abnormal protein called amyloid that disrupts normal liver function)
  • Liver cancer

In advanced liver disease, some or all of the following signs might begin to appear:

  • Jaundice (yellow coloring of the skin and eyes).
  • Itching.
  • Nausea, vomiting, and/or loss of appetite.
  • Poor weight gain.
  • Tendency to bruise and bleed easily.
  • Ascites (fluid in the abdomen).
  • Swelling in the legs and feet due to fluid accumulation.
  • Fatigue and decreased energy.
  • Clay-colored stools.
  • Dark, tea-colored urine.
  • Mental confusion, possibly progressing to coma.
  • Vomiting blood or passing blood in the stool.

The type of liver disease determines which liver functions are impaired. Your child’s symptoms might be different from other patients undergoing evaluation for liver transplants.

How are candidates for liver transplant determined?

Candidates for liver transplant are evaluated by specialists from several fields to determine if transplantation is appropriate. The evaluation includes a review of the patient’s medical, surgical, and psycho-social history, and a variety of tests.

Many healthcare facilities offer an interdisciplinary approach to evaluate and select candidates for liver transplantation. This interdisciplinary healthcare team may include the following:

  • Liver specialist (hepatologist)
  • Transplant surgeons
  • Transplant coordinator, usually a registered nurse who specializes in the care of liver transplant patients. This person will be your main contact with the transplant team
  • Social worker, to discuss your support network of family and friends, employment history, and financial needs
  • Psychiatrist, to help you deal with issues, such as anxiety and depression, that may go along with the liver transplantation
  • Anesthesiologist, to discuss potential anesthesia risks
  • Chemical dependency specialist, to aid those with history of alcohol or drug abuse
  • Patient Financial Advocate, to act as a liaison between you and your insurance companies
  • Nutritionist, to help evaluate your current nutritional status
  • Pharmacist, to review your medications for potential drug interactions

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