Liver Disease May Lead to the Need
for a Transplant
Medical College of Wisconsin Hepatologist
Jose Franco, MD
Named one of the “Best Doctors in America®” 2006 by Best Doctors, Inc.
Liver failure can occur suddenly, or it can be the end result of chronic liver disease. A liver transplant may be considered for a patient whose liver function is declining. Jose Franco, MD, discusses the Froedtert & the Medical College of Wisconsin Liver Transplant Program, which performs about 40 liver transplants each year.
What important functions does the liver perform?The liver — the body’s largest solid internal organ — makes proteins that are necessary for many essential functions including blood clotting. It produces bile, which helps break down fats and other substances so that they along with essential vitamins can be absorbed. It aids in storing glucose as well as in removing toxins and bacteria from the bloodstream.
What types of liver disease can lead to the need for a transplant?There are two general types of liver disease: acute (sudden) liver failure and chronic liver failure. About 5 percent of liver failure is acute, in which the liver deteriorates rapidly. This is often caused by taking medications other than as prescribed and/or taking medications with alcohol. This is one reason why it’s so important to discuss all the medications you take — prescription and over-the-counter — with your physician.
Chronic liver disease, also called cirrhosis, is an irreversible scarring of the liver that occurs when liver cells die. In this country, one of the main causes of cirrhosis is viral hepatitis, especially hepatitis C. Other causes include alcohol abuse, conditions that damage the bile ducts, and fatty liver, caused by obesity and diabetes. Cancer can develop in a cirrhotic liver as well.
Can some forms of liver disease be prevented?The majority of liver disease can be prevented. In many cases, lifestyle changes can prevent serious liver disease. The liver has a remarkable ability to regenerate (grow back) after injury in an attempt to restore its functions. If a person abuses alcohol and stops drinking, the liver can regenerate. But once the cirrhosis occurs, the liver can no longer regenerate.
It’s important to diagnose liver disease early, before it progresses to cirrhosis and causes irreversible damage. Liver disease can be detected through a liver blood panel — a blood test to evaluate liver function — even before symptoms begin to appear.
What are the signs and symptoms of liver disease?Liver disease may not cause any symptoms in the early stages, or the symptoms may be vague. With chronic liver disease, most symptoms are slow to develop. They include:
- Fatigue, the most common symptom.
- Jaundice, a yellow discoloration of the skin and eye whites, resulting from high levels of bile pigment (bilirubin) in the blood.
- Fluid accumulation. When the liver is diseased, it doesn’t make proteins. Fluid leaks out of the blood vessels, causing the legs to swell and the belly to enlarge.
- Confusion. When the liver doesn’t function properly, toxic wastes build up in the blood, causing a person to become confused and disoriented. This is called liver encephalopathy.
- Bleeding in the esophagus. Liver disease can cause varicose (bulging) veins in the esophagus. These appear in response to increased pressure of blood that is unable to move through a diseased liver. The extra pressure causes these tiny veins in the food pipe to rupture and bleed.
Acute liver disease has many of the same symptoms, except that a person may go from being healthy to seriously ill in only a few days.
What treatment options exist for liver disease?For most forms of liver diseases, there are many effective therapies including surgery and medication. Many treatments can be performed using minimally invasive procedures. Lifestyle changes also play a key role in treatment for many people.
When would a person need a liver transplant?Patients who have one or more complications of cirrhosis — bleeding, cancer, confusion and fluid retention — are in liver failure and need a liver transplant. Hepatitis C is the No. 1 reason for liver transplants.
For people who need a kidney or heart transplant, artificial support such as dialysis and artificial hearts can sustain them until an organ becomes available. But there’s no such support for a person who needs a liver, and a person can’t live without a liver.
If a liver transplant is indicated, we need to determine if the patient will be an appropriate transplant candidate. We conduct blood tests to assess the level of liver function. The test results are entered into a formula to calculate the patient’s chance of survival over the next one, three and five years. We can then determine if the chance of survival is higher with the patient’s own liver or with a transplanted liver.
What are the options for liver transplantation?Today, a liver can be obtained from a deceased donor, or part of a liver can be surgically removed from a living donor for transplantation. Because the liver regenerates, a small piece of healthy liver removed from a living donor can grow to full size in a recipient in a few weeks. The donor’s reduced liver will also regenerate.
Living liver donor transplants have become more common in the last decade, and about 300 are done in the United States annually. Removing part of the liver is a complex and risky operation for the donor, however. While we can do transplants from living donors, all of the liver transplants we have done have used livers from deceased donors. Through the Wisconsin Donor Network, we have good access to livers.
What is the experience of Froedtert & the Medical College’s with liver transplant?When Froedtert & the Medical College launched the Liver Transplant Program in 1983, it was the first in the state. Today, we perform about 40 liver transplants each year. The program would not be possible without the many members of the transplant team, including transplant surgeons, transplant hepatologists, and staff dedicated solely to transplant patients — pharmacists, social workers, a psychologist and dietitians. Froedtert & the Medical College have dedicated transplant inpatient and outpatient units with nurses who specialize in caring for transplant patients. We care for the entire person — physically and emotionally. It’s a big team effort.
What are the short- and long-term outcomes for liver transplant?The Froedtert & the Medical College Liver Transplant Program exceeds national one- and three-year survival rates. The chance of living one year after a liver transplant is 93 percent; for three years, our survival rate is 85 percent. Survival rates depend on many factors, including a patient’s underlying liver disease and the patient’s adherence to a self-care plan after transplant.
Source: Every Day, Interview with Jose Franco, MD
Date: Jan - April 2007