Liver Transplant Overview
Currently, more than 17,000 people in the United States are waiting for liver transplants. According to the United Network for Organ Sharing (UNOS), about5,300 liver transplantations were performed in the United States in 2002.
The liver is the second most commonly transplanted major organ, after the kidney, so it is clear that liver disease is a common and serious problem in this country. It is important for liver transplant candidates and their families to understand the basic process involved with liver transplants, to appreciate some of the challenges and complications that face liver transplant recipients (people who receive livers), and to recognize symptoms that should alert recipients to seek medical help.
Determining whose need is most critical: The United Network for Organ Sharing uses measurements of clinical and laboratory problems to divide patients into groups that determine who is in most critical need of a liver transplant. In early 2002, UNOS enacted a major modification to the way in which people were assigned the need for a liver transplant. Previously, patients awaiting livers were ranked as status 1, 2A, 2B, and 3, according to the severity of their current disease. Although the status 1 listing has remained, all other patients are now classified using the Model for End-Stage Liver Disease (MELD) scoring system if they are aged 18 years or older, or the Pediatric End-Stage Liver Disease (PELD) scoring system if they are younger than 18 years. These scoring methods were set up so that donor livers could be distributed to those who need them most urgently.
Who may not be given a liver: A person who needs a liver transplant may not qualify for one because of the following reasons:
Active alcohol or substance abuse: Persons with active alcohol or substance abuse problems may continue living the unhealthy lifestyle that contributed to their liver damage. Transplantation would only result in failure of the newly transplanted liver.
- Cancer: Cancers in locations other than just the liver weigh against a transplant.
- Advanced heart and lung disease: These conditions prevent a transplanted liver from surviving.
- Severe infection: Such infections are a threat to a successful procedure.
- Massive liver failure: This type of liver failure accompanied by associated brain injury from increased fluid in brain tissue rules against a liver transplant.
- HIV infection
Liver Transplant Causes
Liver disease severe enough to require a liver transplant can come from many causes. Doctors have developed various systems to determine the need for the surgery. Two commonly used methods are by specific disease process or a combination of laboratory abnormalities and clinical conditions that arise from the liver disease. Ultimately, the transplantation team takes into account the type of liver disease, the person's blood test results, and the person's health problems in order to determine who is a suitable candidate for transplantation.
In adults, chronic active hepatitis and cirrhosis (from alcoholism, unknown cause, or biliary) are the most common diseases requiring transplantation. In children, and in adolescents younger than 18 years, the most common reason for liver transplantation is biliary atresia, which is an incomplete development of the bile duct.
Liver Transplant Symptoms
People who have liver disease may have many of the following problems:
- Jaundice - Yellowing of the skin or eyes
- Itching
- Dark, tea-colored urine
- Gray- or clay-colored bowel movements
- Ascites - An abnormal buildup of fluid in the abdomen
- Vomiting of blood
- Tendency to bleed
- Mental confusion, forgetfulness
Read more about liver problems:
Liver disease Problems, Symptoms and Causes
Prevent liver Problems
Your liver is the largest organ inside your body. It is also one of the most important. The liver has many jobs, including changing food into energy and cleaning alcohol and poisons from the blood. Your liver also makes bile, a yellowish-green liquid that helps with digestion.
Definition
Liver problems include a wide range of diseases and conditions that can affect your liver. Your liver is an organ about the size of a football that sits just under your rib cage on the right side of your abdomen. Without your liver, you couldn't digest food and absorb nutrients, get rid of toxic substances from your body or stay alive.
Liver problems can be inherited, or liver problems can occur in response to viruses and chemicals. Some liver problems are temporary and go away on their own, while other liver problems can last for a long time and lead to serious complications.
Symptoms
Signs and symptoms of liver problems include:
- Discolored skin and eyes that appear yellowish
- Abdominal pain and swelling
- Itchy skin that doesn't seem to go away
- Dark urine color
- Pale stool color
- Bloody or tar-colored stool
- Chronic fatigue
- Nausea
- Loss of appetite
Causes
Problems that can occur in the liver include:
- Acute liver failure
- Alcoholic hepatitis
- Alpha-1-antitrypsin deficiency
- Autoimmune hepatitis
- Bile duct obstruction
- Chronic liver failure
- Cirrhosis
- Enlarged liver
- Gilbert's syndrome
- Hemochromatosis
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
- Liver adenoma
- Liver cancer
- Liver cyst
- Liver hemangioma
- Liver nodule (focal nodular hyperplasia)
- Nonalcoholic fatty liver disease
- Parasitic infection
- Portal vein thrombosis
- Primary biliary cirrhosis
- Toxic hepatitis
- Wilson's disease
This education video explains what hepatitis B is. It discusses
its causes, symptoms, diagnosis, treatment, and prevention.
Alcoholic liver causes or alcoholic liver disease is represented by a nonspecific total morphological lesion associated with clinical / paraclinical manifestation, among which some are induced by the abuse of alcohol.
Prevalence: alcoholic liver varies from country to country depending on the tradition, religion and especially on the cost of the alcoholic drinks in comparison with the income.
Alcoholic liver causes: excessive alcohol consumption has varied effect on organisms. Due to some unknown cause, 1/3 of chronic consumers of alcohol do not have hepatic consequences.
1. Duration and consumption of alcohol, it is considered that 60-80 ml of absolute alcohol/day for men and 40-50 ml of absolute alcohol women as a toxic dose. The duration of consumption is also important, a consumption of more than 5 years is considered as a risk. Continous consumption is more dangerous than intermittent consumtion. As well, hepatic injury does not depend on the type of drink but in this alcohol content.
2. Gender: females are more susceptible than men are, because at the same quantity of alcohol ingested reach a higher blood concentration. In women, gastric metabolism is reduced comparing to men and cytochrome P450 is less efficient.
3. Genetic factors: although no genetic markers has proved to have a clear association with susceptibility to alcoholism, seems to inherit certain behavior related to the alcohol consumpion.
4. Coinfection with hepatic viruses (B or C) accelerates the severity of the alcoholic liver disease.
5. Nutritional factors: protein caloric malnutrition precedes alcoholism in patients with socio-economic level leading to the appearance of alcoholic liver. It has been proved that healthy diet may protect those who consume alcohol, at least for a period.
The predisposing causes for the colon neoplasm are:
- colocrectal polyps
- familial colic polyposis
- inflammatory bowel disease
- familial predisposition
- Lynch syndrome
Colorectal polyps represent a frequent situation in the gastroenterological practice, almost 10% of people 50 years - old and up to 30% of people over 70 years present colonic polyps. These polyps may be adenomatous (adenoma) and hyperplastic.
Adenomatous polyps (real polyps) are of many histological types: tubular, tubulo - villous and villous. The villous polyps have the most increased potential of malignity. The hyperplasic (inflammatory) polyps have no malignant potential.
The evolution of polyps towards malignity seems to be linked to genetic factors (familial), metabolic factors (the co- carcinogen effect of billiary acids) and alimentary factors (the negative effect of lack of vegetables and fibers). The bigger the polyps are (generally over 2 cm diameters), the more numerous and the more severe dysplasia is found at biopsy, the highest is their malignant potential. Starting from these data concerning the relationship polyp - neoplasia, searching polyps by colonoscopy and the endoscopic polypectomia has become a necessity, because it is the best prophylaxis of rectocolic neoplasia.
Familial colic polyposis represents a pathological situation with a genetic character, defined by the presence of more than 100 polyps in the rectum and colon, appearing before the age of 30 years. The genetic transmission is autosomal - dominant and the evolution of polyps to cancer is the rule. Therefore, it becomes a necessoty to check - out actively the transmission is autosomal - dominant and the evolution of polyps to cancer is the rule. Therefore, it becomes a necessity to check - out actively the transmission in the affected families and the most precociously total colectomy, before the malignization.
Inflammatory bowel diseases with prolonged evolution increase the risc of colon neoplasm. This risk is of approx. 10% after 25 years of evolution in ulcero - hemorrhagic rectocolitis (becoming significant after more than 10 years of evolution). The risk is smaller in Chron's disease with prolonged evolution.
Familial predisposition represents an increased risk for the descendants of a family with colon cancer (the frequency of cancer is 2-3 times bigger in first - degree relatives).
The Lynch syndrome or the hereditary nonpolypoidal colorectal cancer (without the intermediate state of polyp and with important hereditary involvement) is characterized by presence in more members of a family, the apparition of cancer at young age and frequently associates other neoplasms (the most eften ovary and endometer).
The Amsterdam criteria for diagnosis of Lynch syndrome are at least 3 members of a family with diagnosis of colonic carcinoma, one of which must be a first-degree relative, in a generation; the transmission be done at two succesive generations and at least one of the casees to be diagnosed before 50 years.
