At Mayo Clinic, doctors from many specialties work as a team to develop the most appropriate plan of care for you. They take the time to listen to your questions and concerns and provide comprehensive care, including nutritional, social, financial and spiritual issues. They follow you before, during and, most importantly, after your liver transplant, to ensure the best possible results and quality of care.

Before your transplant

A team of Mayo Clinic doctors trained in liver transplantation and other areas evaluate you to determine whether a liver transplant may be safe and beneficial for you. Your evaluation may last several days and may include:

• Physical examination
• Blood tests, including blood and tissue type analysis
• Imaging studies, including X-rays
• Consultations with specialists in liver conditions (hepatologists), transplant surgery, social services, nutrition and other areas
• Consultations with a financial coordinator to determine financial and insurance information for your transplant

Doctors, your transplant coordinator and others will discuss with you what to expect after a liver transplant, including taking medications, lifestyle changes and other changes. Your treatment team also will discuss with you the risks and benefits of transplant surgery.

If doctors determine you're a candidate for a liver transplant, your name will be placed on a waiting list for a deceased-donor liver. You may be on a waiting list from a few days to several months. Your time on the waiting list often is determined by your score on the Model for End-Stage Liver Disease (MELD), which prioritizes people waiting for a transplant based on the severity of their condition and how urgently they may need a transplant. You also may be considered for living-donor liver transplantation, based on your condition and likelihood of receiving a deceased-donor liver in a timely fashion.

While on the waiting list, remain in close contact with the transplant team, and notify your transplant coordinator of any significant changes in your medical or social situation. Be prepared to get to the hospital quickly, within eight hours, after you receive notice that a donor liver is available. Also, maintain your general health as much as possible. You may have a living-donor transplant, which reduces your waiting time and provides excellent long-term survival.

Transplant surgery

Before your transplant, you'll have blood tests, urine tests, an echocardiogram, an electrocardiogram and a chest X-ray.

During surgery, your surgeon removes your diseased liver and replaces it with the donor liver. Your surgeon needs to make four connections at the time of the transplant. First, your surgeon connects a large vein from the donor's liver (inferior vena cava) to your hepatic vein. Then, your surgeon connects your portal vein to the donor liver's portal vein, and connects your hepatic artery to the hepatic artery of the donor liver. Finally, your surgeon connects the donor's bile duct to your bile duct (or a replacement in case of bile duct disease). Surgery usually lasts four to five hours.

In a living-donor liver transplant, surgeons remove your entire liver and replace it with a portion of your living donor's liver, making all the same connections during surgery as in a deceased-donor transplant. Your donor's liver and the portion of the liver given to you grow back to its full size within a few weeks.

Doctors sometimes use a portion of a deceased donor's liver in a split-liver transplant. In this procedure, surgeons divide an entire deceased-donor liver into segments for transplantation for two recipients.

Some people who need a liver transplant may be eligible for a domino liver transplant, a surgery in which the recipient receives a liver from a donor with familial amyloidosis. In a domino liver transplant, two livers are involved. The person with familial amyloidosis receives a liver transplant to treat his or her condition, and then donates his or her original liver — which still functions well — to another person who needs a liver transplant. The recipient of the domino liver may eventually develop symptoms of familial amyloidosis, but not for many decades. Thus, doctors would consider this option only for a suitable recipient 60 years old or older.

In addition, surgeons at Mayo Clinic in Minnesota perform liver transplants in children, using a deceased-donor liver or a portion of an adult living-donor liver.

After your surgery, you'll usually spend one to two days in the intensive care unit and stay in the hospital for seven to nine days to recover, depending on your condition prior to transplant. During your hospital stay, your transplant team will monitor your recovery process. Your treatment team will provide you with instructions on post-transplant recovery, care, lifestyle changes and medications. You'll also be given contact information for your transplant doctor and transplant coordinator.

After your transplant

You'll need to stay near Mayo Clinic for about one month after your transplant so that your doctors can monitor your progress and recovery.

• Follow-up care. Your doctor will update your primary health care provider about your progress and give recommendations for your care at home. In addition, a certified transplant nurse coordinator will provide follow-up care for life, and answer your questions and communicate with you and your primary health care provider. You'll have follow-up appointments at Mayo Clinic after four months and then once a year, or more frequently if necessary.
• Medications. You'll need to take immunosuppressive medications daily for life to keep your body from rejecting your donor liver. Your transplant team will discuss your new medications in detail.
• Returning to wellness. The transplant team considers your return to wellness after your transplant a priority. You'll be given specific guidelines to return to wellness through an exercise plan and a nutrition plan. You also should wear sunscreen. Your transplant team will work with you to help you make healthy lifestyle choices to achieve an optimal transplant outcome.

Read more about liver transplant.

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July 11, 2013