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February 9, 2012
The Cleveland Clinic

Digestive Diseases: Liver Transplantation

The liver is the body's largest internal organ, weighing about 3 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:

  • Produces most proteins needed by the body.
  • Metabolizes, or 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). Liver failure can occur suddenly (acute liver failure) as a result of infection or complications from certain medications or it can be the end result of a long-term problem. The following conditions may result in liver failure:

  • Chronic hepatitis with cirrhosis.
  • Primary biliary cirrhosis (a rare condition where 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 causing the backup of bile in the liver which can lead to liver failure).
  • Biliary atresia (malformation of the bile ducts).
  • Alcoholism
  • Wilson's disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail).
  • Hemochromatosis (a common inherited disease where the body is overwhelmed with iron).
  • Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).
  • Liver cancer

How Are Candidates for Liver Transplant Determined?

Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. Many healthcare facilities offer an interdisciplinary approach to evaluate and to select candidates for liver transplantation. This interdisciplinary healthcare team may include the following professionals:

  • 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 primary 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, which may accompany the liver transplantation.
  • Anesthesiologist to discuss potential anesthesia risks.
  • Chemical dependency specialist to aid those with history of alcohol or drug abuse.
  • Financial counselor to act as a liaison between a patient and his or her insurance companies.



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Suggested Reading on Liver Transplant by Our Doctors

  • Related Diseases & Conditions

    • Cirrhosis (Liver)
      • Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
    • Liver Disease
      • Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
    • Hepatitis C
      • Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by blood transfusion, hemodialysis, and needle sticks, especially with intravenous drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
    • Hepatitis B
      • The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
    • Ascites
      • Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
    • Tylenol Liver Damage
      • Tylenol liver damage (acetaminophen) can occur from accidentally ingesting too much acetaminophen, or intentionally. Acetaminophen is a drug contained in over 200 OTC and prescription medications from NyQuil to Vicodin. Avoiding unintentional overdoses include reading medication labels, write down the dosages of medications you are taking, do not drink excessive alcohol while taking acetaminophen. In severe cases, a liver transplant may be necessary.
    • Fatty Liver
      • Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
    • Vancomycin-Resistant Enterococci (VRE)
      • Vancomycin-resistant enterococci (VRE) infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters. Enterococci can survive for months in the digestive tract and female genital tract. Other risk factors for acquiring VRE include those how have been previously treated with vancomycin and combinations of other antibiotics. Treatment of VRE is generally with other antibiotics other than vancomycin. Prevention of VRE can be achieved by proper hand hygiene.
    • Primary Biliary Cirrhosis
      • Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile ducts transport bile from the liver to the intestine for the absorption of fat and elimination of waste products. The causes of Primary Biliary Cirrhosis may involve autoimmunity, infection, or genetic predisposition, acting alone or in combination. There are many medications and treatment options available for those with this and other associated diseases of Primary Biliary Cirrhosis.
    • Liver
      • The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
    • The Digestive System
      • Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
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Liver Transplant

What are the basic functions of the liver?

The liver, located in the right upper portion of the abdominal cavity just beneath the right side of the rib cage, has many vital functions. Briefly, some of these functions are:

  • Detoxification of blood
  • Production of important clotting factor and other important proteins
  • Metabolizing (processing) medications and nutrients
  • Processing of waste products of hemoglobin
  • Storing of vitamins, fat, cholesterol, and bile
  • Production of glucose

What are common liver blood tests?

Liver blood tests are some of the most commonly performed blood tests. These tests can assess liver functions or liver injury. An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes reside within the cells of the liv...

Read the Liver Blood Tests article »







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