Introduction

A liver transplant is an operation to remove a diseased or damaged liver and replace it with a healthy one.

It's usuallyrecommended when the liver has been damaged to the point that it cannot perform its normal functions.This is known as liver failure or end-stage liver disease.

The liver can become gradually damaged as a result of illness, infection or alcohol. This damage causes the liver to become scarred, which is known as Cirrhosis . Liver failure can also occur very rapidly as a result of inflammation and death of liver tissue (necrosis).

Some of the main causes of liver damage andcirrhosis in the UK are:

• alcohol-related liver disease (ARLD) where the liver becomes scarred because of years of persistent alcohol misuse
• hepatitis blood-borne viruses, including hepatitis B and hepatitis C ,that can sometimes cause extensive liver damage
• primary biliary cirrhosis (PBC) a poorly understood condition that causes progressive liver damage
• primary sclerosing cholangitis (PSC) a condition that causes long-lasting inflammation of the liver

A liver transplant may also sometimes be recommended as a treatment for liver cancer .

The only hope for the long-term survival of a person with liver failure is a liver transplant becauseunlike the kidney, heart or lungs there is no device (such as a dialysis machine)that can permanently replicate the functions of the liver.

Who can have a liver transplant?

There is a strict assessment process that decides who can have a liver transplant, as donated livers are scarce.

Under UK regulations, you are usually only considered a suitable candidate if you meet two conditions:

• without a liver transplant, it is highly likely that your expected lifespan would be shorter than normal, or your quality of life is so poor as to be intolerable
• it is expected that you have at least a 50% chance of surviving for at least five years after the transplant with an acceptable quality of life

Most people who meet these criteria will be eligible for a transplant, although there are a few situations where youmay beconsidered unsuitable. For example,you may not be able to have a transplant if you are unable to stop misusing alcohol, or you have liver cancer that has spread beyond the liver.

Aseries of tests will need to be carried out to determine whether you are suitable for a liver transplant.

The average waiting time for a liver transplant is 145 days for adults and 72 days for children.

While you're on the waiting list, you will need to keep yourself as healthy as possible and be prepared for the transplant centre to contact you at any moment, day or night.

You should also keep the transplant centre informed about any changes in your circumstances, such as changes in your health, address or contact details.

You'll need regular follow-up appointments tomonitor your progress and you'll be given immunosuppressantmedication thathelps to stop your body rejecting your new liver. These usually need to be taken for life.

More than nine out of every 10 people are still alive after one year, around eight in every 10 people live at least five years, and many people live for up to 20 years or more.

However,a liver transplant is a major operation that carries a risk of some potentially serious complications. These canoccur during, soon after, orseveral years after the procedure.

Some of the mainproblems associated with liver transplants include:

• your body rejecting the new liver
• bleeding (haemorrhage)
• the new liver not working within the first few hours (primary non-function), requiring a new transplant to be carried out as soon as possible
• an increased risk of picking up infections
• loss of kidney function
• problems with blood flowto and fromthe liver
• an increased risk of certain types of cancer particularly skin cancer

There is also a chance that the original condition affecting your old liver will eventually affect your new liver.

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