Liver Disease and Transplant

Absorption - the degree and pace at which a drug enters the bloodstream from the small intestine

Acute Tubular Necrosis (ATN) - reversible kidney damage resulting in delayed kidney function

Alkaline Phosphatase - an enzyme produced by liver cells; elevated blood levels of this substance may indicate abnormal function of the liver or other organs

Allograft - a graft between two individuals who are of the same species (ie. human) but have genetic differences

Antacid - a drug that aids in protecting the digestive system and relieves heartburn and digestive discomfort

Antibody - a protein produced by the body to eliminate foreign substances, such as bacteria

Anesthetic - medication that reduces pain by reducing sensation

Arteriogram - an x-ray of the arteries taken with the aid of a dye

Ascites - excess fluid in the abdomen

Atherosclerosis - a build up of fats in the lining of the arteries that may interfere with the flow of blood

B Cell - a specialized white blood cell responsible for the body's immunity

Bacteria - small germs that can cause disease

Biliary Stenosis - narrowing or constriction of a bile duct

Biliary Tree - all passageways inside and outside the liver that carry bile to the intestines

Bile - a fluid produced by the liver, stored in the gallbladder, and released into the small intestine to help absorb dietary fats

Bile Ducts - the tubes through which bile flows

Bile Leak - a hole in the bile-duct system that causes bile to spill into the abdominal cavity

Bilirubin - a substance in bile, orange in color, produced by the breakdown of red blood cells

Bio Availability - a measure of how much of an administered drug is absorbed into the bloodstream, actually reaching the intended site of action in the body

Biopsy - the removal and examination of tissue sampling for diagnosis

Bladder - the part of the urinary tract that receives urine from the kidneys and stores it until urination

Blood Urea Nitrogen (BUN) - a waste product normally excreted by the kidney. BUN values represent how well the kidneys function

Brain Death - when the brain has permanently stopped working, as determined by a neurological surgeon, artificial support systems may maintain functions such as heartbeat and respiration for a few days

Bun - see Blood Urea Nitrogen (BUN)

Cadaveric Donor - an individual who has recently died of causes that do not affect the function of an organ to be transplanted

Cellcept® - an immunosuppressive drug used with other immunosuppressants to prevent the rejection of the transplanted organ.

Cholesterol - a form of fat that performs necessary functions in the body but can also cause heart disease; cholesterol is found in animal foods such as meat, fish, poultry, eggs, and dairy products

Cirrhosis - a disease causing irreversible scarring of the liver

Cyclosporine - drug that helps keep the body from rejecting a transplanted organ. Brand names include Neoral® and Gengraf®

CMV (Cytomegalo Virus) - a virus infection that is very common in transplant recipients; it can affect the lungs and other organs as well; a member of the family of herpes viruses

Coagulation - blood clotting

Corticosteroids - a category of immunosuppressive medications that includes prednisone and prednislone

Creatinine - a substance found in blood and urine; it results from normal body chemical reactions; high blood creatinine levels are a sign of depressed kidney function

Detoxify - to change a harmful substance into a safer form

Diabetes - a disease in which patients have high levels of sugar in their blood

Dialysis - the process of cleansing and achieving chemical balance in the blood of patients whose kidneys have failed

Diastolic - the bottom of two blood pressure numbers which measures blood pressure when the heart is at rest

Diuretic - a drug that removes water from the body by promoting urine formation and the loss if salt

Edema - excess fluid in body tissues; Example: swelling of the ankles

Electrocardiogram - a recording of the electrical activity of the heart

Electrolyte - refers to the dissolved form of a mineral such as sodium, potassium, magnesium, chlorine, etc.

Encephalopathy - changes in mental function that develops when the liver cannot filter poisons from the bloodstream

Enzyme - a protein made in the body and capable of changing a substance from one form to another

Fibrosis - formation of excess fibrous connective tissue in an organ; fibrosis of the liver can lead to cirrhosis

Gallbladder - a muscular sac attached to the liver; it stores bile

Gastroenterologist - a physician who specializes in the care of the digestive tract

Glucose - a type of sugar found in the blood

Graft – a transplanted organ or tissue

Graft Survival - when a transplanted tissue or organ is accepted by the body and functions properly

Helper T Cell - the specialized white blood cell that tells other parts of the immune system to combat infection or foreign material

Hematocrit - a measure of the red-blood-cell content of blood

Hemochromatosis - a condition that develops when too much iron builds up in the body

Hemodialysis - a method of dialysis in which blood is purified by circulating through an apparatus outside the body

Hepatic - relating to the liver

Hepatitis - inflammation of the liver

Hepatocellular Carcinoma - liver cancer

Hepatologist - a physician who studies the liver and treats liver disease

Hepatomegaly - an enlarged liver

Hepatorenal Syndrome - Kidney failure that occurs in cases of advanced liver disease secondary to cirrhosis

Herpes - a family of viruses that infect humans; herpes simplex causes lip and genital sores; herpes zoster causes shingles

Histocompatibility - the examination of antigens in a patient, often referred to as "tissue typing" or "genetic matching". Tissue typing is routinely performed for all donors and recipients in kidney and pancreas transplantation to help match the donor with the most suitable recipients. This helps to decrease the likelihood of "rejecting" the transplanted organ

High Blood Pressure or Hypertension - Occurs when the force of the blood pushing against the walls of the blood vessels is higher than normal because the blood vessels have either become less elastic or have gotten smaller. Hypertension causes the heart to pump harder to move blood through the body. It can cause kidney failure and heart disease if not treated

Immune Response - any defensive reaction to foreign material by the immune system

Immune System - the body’s natural defense system against foreign substances, such as bacteria, viruses, some types of cancers, and transplanted organs or tissues

Immunosuppressive Agents - medications given to prevent rejection of a transplanted organ or tissue

Imuran® - an immunosuppressive drug used to help prevent the rejection of a transplanted organ. Also known by its chemical name, azathioprine

IV or Intravenous - refers to giving medicines or fluids directly through a vein

IV Catheter - a small needle with a hollow tube inserted into a vein and used to give medicines or fluids

Jaundice - yellowing of the skin and eyes caused by excess bile products in the blood

Kidney - one of the two kidney-bean-shaped organs located on both sides of the spine, just above the waist. They function is to remove the body’s waste materials and maintain fluid balance through the production of urine

Liver Enzymes - substances produced by the liver and released into the blood; enzymes are measured to assess liver function

Living-Related Donor (LRD) - a blood relative who donates an organ

Match - the compatibility between recipient and donor; the closer the match between donor and recipient, the greater potential for a successful transplant

Microemulsion - a suspension or mixture of tiny droplets of one liquid in a second liquid, such as the smooth mixture that is formed when Neoral® (cyclosporine capsules and oral solution for micro emulsion) combines with fluids in the digestive system

Nephrologist - a physician who studies the kidney and treats kidney disease

Neutrophil - a type of white blood cell

Non-Alcoholic Steatohepatitis (NASH) - inflammation of the liver caused by a build up of fat in liver cells

Non-Compliance - failure of patients to follow the instructions and recommendations of their medical team, such as not taking medicine as prescribed or not showing up for clinic visits

Orally - by mouth

Organ Preservation - methods used to preserve organs while they are out of a donor’s body to be transplanted to a recipient

Organ Procurement and Transplantation Network (OPTN) - The purpose of the OPTN is to improve the effectiveness of the nation's organ procurement, donation and transplantation system by increasing the availability of and access to donor organs for patients with end-stage organ failure. Administered by UNOS (United Network Organ Sharing), it provides a unique public-private partnership that links all of the professionals involved in the donation and transplantation system

Organ Procurement Organization (OPO) - An organization designated by the Centers for Medicare and Medicaid Services (CMS) that is responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation and transportation of organs for transplantation

Organ Rejection - an attempt by the immune system to reject or destroy what it recognizes to be a "foreign" presence (for example, a transplanted liver)

Paracentesis - a procedure in which a small needle is inserted through the abdominal wall to remove fluid that has built up in the abdominal cavity

PCP (Pneumocystis Carinii Pneumonia) - a type of pneumonia seen primarily in patients whose immune systems are suppressed

Platelet - a small blood cell needed for normal blood clotting

Portal Hypertension - high blood pressure in the veins that filter blood form the intestines to the liver

Potassium - a mineral essential for body function

Prednisone - a manufactured steroid hormone taken by most transplant recipients of a transplanted organ or tissue to help prevent rejections

Prograf® - See tacrolimus

Psychiatrist - physician who diagnoses and treats mental disorders

Rapamycin (Rapamune®) - medicine that belongs to a group of medicines known as immunosuppressive agents used to lower the body's natural immunity and prevent organ rejection in patients who receive kidney transplants

Rejection - an immune response against grafted tissue in which a recipient’s body rejects tissue or organ transferred from a donor

Renal - refers to the kidney

Sensitized - being immunized, or able to mount an immune response, against an antigen by previous exposure to that antigen

Shingles - a herpes virus infection that usually affects a nerve, causing pain in one area of the body

Sodium - a component of table salt (sodium chloride); an electrolyte that is the main salt in blood

Status - indicates the degree of medical urgency for patients awaiting heart or liver transplants

Survival Rates - indicate how many patients or grafts (transplanted organs) are alive or functioning at a set time post transplant

Systolic - the top of the two blood pressure numbers, which measures the maximum blood pressure reached as blood is pumped out of the heart chambers

Tacrolimus - a drug the helps keep the body from rejecting a transplanted organ. Brand name is Prograf®

Thrush - a fungus infection in the mouth

Triglycerides - a form of fat that the body makes from sugar, alcohol, and excess calories

T Cells - a white blood cell responsible for the body's immunity. T cells can destroy cells infected by viruses, graft cells, and other altered cells

T-tube - a tube placed in the bile duct that allows bile to drain into a bag outside the body

Tissue Typing - a blood test performed prior to transplantation to evaluate the closeness of tissue match between the donor and recipient

UNOS (United Network for Organ Sharing) - a national agency that maintains a national computerized transplant waiting list and helps locate donor organs

Urinary Tract Infection (UTI) - an infection of one or more parts of the urinary tract

Varices - enlarged veins in the digestive tract that could bleed

Ventilator - a machine that helps a patient breathe

Virus - a germ that causes infection

Waiting List - After a patient has concluded evaluation by the transplant physician, he/she is added by the transplant center to a national waiting list. Lists are specific to both geographic area and organ type. Each time a donor organ becomes available, UNOS generates a list of potential recipients based on factors that include genetic similarity, organ size, medical urgency, and time a patient has been on the waiting list

White Blood Cells - cells in the blood that fight infection; part of the immune system

Wilson’s Disease - rare inherited disorder that causes a build-up of copper in the liver and other organs of the body

Which are the most common liver diseases?

In adults, cirrhosis of the liver is one of the most common reasons for which liver transplantation is performed. In children, the disease most often treated by liver transplantation is biliary atresia.

What is the treatment for liver disease?

There are effective medicines used for the treatment and complications of liver diseases. If the liver is not failing, treatment for complications of the liver disease may be all that is required. Frequent medical treatment can delay, but not eliminate, the need for transplantation.

When is liver transplantation a recommendation for treatment?

If medical treatment allows prolonged survival with good quality of life transplantation would be reserved for the future. Ideally transplantation is performed before the terminal stage of the disease when the patient would be too ill to withstand major surgery and would not survive the wait for a suitable donor.

How is the decision for transplant made?

Once the transplant physician determines that transplantation is the most suitable treatment option, the patient undergoes a transplant evaluation by our transplant team in conjunction with the patient’s primary care physician. The patient and family's input is very important in this process and they must clearly understand the risks involved with proceeding to transplantation.

Are there any major risks involved?

With transplantation there are risks common to all forms of major surgery, as well as technical difficulties in removing the diseased liver and implanting the donor liver. One of the major risks for the patient is not having any liver function for a brief period. Immediately after surgery, bleeding, poor function of the grafted liver, and infections are major risks. The patient is carefully monitored for several weeks for signs of rejection of the liver.

What is the recovery time?

This depends on how ill the patient was prior to the surgery. Most patients should plan on spending a 4 to 5 days in the intensive care unit, and about 10 to 12 days in the hospital transplant unit.

What happens during the recovery period?

In the intensive care unit there is very careful monitoring of all body functions including the liver. Once the patient is transferred to the hospital transplant unit, the frequency of blood testing, etc. is decreased, eating is allowed and physical therapy is used to regain muscle strength. Medications to prevent rejection are initially given by vein, but later by mouth. Frequent tests will be done to monitor liver function and detect any evidence of rejection.

If a transplanted liver fails to function or is rejected, what can be done?

A failing transplanted liver can be replaced by a second (or even third) transplant.

Do recipients of liver transplants take medicines to prevent rejection for the rest of their lives?

Yes, however, as the body adjusts to the transplanted liver, the amount of medicine needed to control rejection is reduced.

What is the medical follow-up after transplantation?

Routine follow-up consists of regular blood tests to detect sign of rejection or other complications. You will be scheduled to see your transplant surgeon on a regular basis. You will also need to be followed by your own physician. It is very important to keep all your medical appointments.

Is there a chance of recurrence of the original disease in the new transplanted liver?

If the disease was caused by hepatitis B or C viruses then recurrence is likely. Other types of liver disease do not recur.

Do the donor and the recipient have to be matched by tissue type?

For liver transplants, the only requirements are that the donor and recipient need to be approximately the same size, and of compatible blood types. No other matching is necessary.

What lifestyle changes are necessary after a liver transplant?

Most patients can return to a normal or near-normal lifestyle 6 months to 1 year after a successful liver transplant. When practical, transplant recipients should avoid exposure to people with infections. Maintaining a balanced diet, getting regular exercise and staying on prescribed medications are all important ways to stay healthy.

Liver Disease and Transplant: Answers from the Experts

What Medication Will I Need to Take After a Liver Transplant?

Why Could My Body Reject a Transplanted Liver?

Is There More Than One Liver Transplant List?

Do Liver Tumors Factor Into the Liver Transplant Waiting Time?

How Long Is the Liver Transplant Waiting List?

How Long Can a Liver Survive Outside the Body Before Transplant?

How Long Does It Take to Receive a Liver Transplant?

What Would Exclude Me from Receiving a Liver Transplant?

Will I Need Blood Transfusions During a Liver Transplant?

How Is a New Liver Transplanted?

How Is a Liver Removed During a Liver Transplant?

How Is a Donor Liver Prepared for a Liver Transplant?

What Is Liver Transplant Surgery Like?

What Quality of Life Can I Expect After a Liver Transplant?

Is Follow-up Therapy for a Liver Transplant Difficult?

Why Does a Transplanted Liver Have Lower Rejection Rates?

What Is the Chance of My Body Rejecting a Transplanted Liver?