Written by David Bernstein, MD Friday, 01 January 2010 00:00
2010 promises to be a better year than 2009. With the onset of a new year and a new decade, we are filled with renewed hope and promise that things will get better. This New Year will bring lots of change. We will see new leaders, new policies and hopefully new peace and prosperity. With all this hope, my thoughts turn to liver transplantation and all of our neighbors out there who could benefit from this medical miracle.
Liver transplantation has rapidly advanced over the past two decades to become standard therapy for patients with end-stage liver disease. Children and adults with congenital and acquired disorders are candidates for transplantation. The most common indications for liver transplantation in the United States include viral hepatitis B and C, non-alcoholic fatty liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, alcoholic liver disease, in-born errors of metabolism, autoimmune disease, fulminant hepatic failure and liver tumors.
Liver transplantation involves removing the diseased liver from a patient with advanced liver disease and replacing it with a new, healthy liver from a donor. The surgery is performed in very specialized centers by surgeons dedicated to this operation. Unfortunately, the number of people waiting for a liver transplant far outnumbers the supply of donor livers. This leads to long waiting times and many patients do not survive their liver disease while on the list awaiting liver transplantation. We are getting better, however.
Liver transplantation is not indicated for all people with cirrhosis. It is indicated only for those people whose livers are not working properly. These end-stage complications include bleeding from distended veins in the esophagus and stomach, the filling of the abdomen with fluid called ascites, the onset of severe confusion termed encephalopathy or the development of liver cancer. Many people come to my office after being diagnosed with liver disease of any cause and are scared because they believe they will need a liver transplant in the near future. The good news is that only a very small percentage of people with liver disease will advance to end-stage disease and need a transplant.
Overall survival rates for liver transplantation in the United States are excellent. The in-hospital recovery period after surgery is highly variable with many transplant recipients being discharged within one week of surgery. After transplantation, the patients are placed on immunosuppressive therapy which is generally life-long. These medications are usually well tolerated but occasionally patients can have side-effects related to these medicines.
A shortage of donor livers is one of the major problems facing patients with liver disease in the United States. As a result, many children and adults die waiting for a liver transplant. Due to this shortage, the federal government and the non-profit United Network for Organ Sharing (UNOS) have been working together to establish strict guidelines for organ allotment. In an effort to increase donor numbers, transplant centers have begun to perform adult living-related liver transplantation. In this procedure, a relative or friend donates a portion of his/her liver to the person with end stage liver disease. Hopefully, through these tremendous acts of giving, more lives will be saved.
I would like to wish all the readers a happy, healthy and prosperous New Year. Please do not forget all those in need and in the spirit of giving, please remember to consider organ donation to aid the thousands of children and adults in our area in need of liver transplantation.
(Disclaimer: The views and opinions represented are those of the author and meant for informative purposes only. For your specific questions, consult your physician.)