Liver transplantation (removing the damaged liver and putting in a new one) is a treatment for liver failure. This may be done for acute liver failure caused by severe damage to the liver by a drug (e.g. paracetamol overdose) or for chronic liver failure in cirrhosis. Not every person with liver failure is suitable for a liver transplant. There are eligibility criteria to be met and a complex vetting process to be gone through before a patient is deemed suitable for a transplant. The nature and severity of the liver disease, the age and overall fitness of the patient, and the availability of suitable organs are the major considerations in this process.
The new liver
The new liver that is put in may come from a dead person (cadaveric transplant) or from a living donor, usually a family member. In a cadaveric transplant the entire liver is usually put into the recipient (though in some instances, especially child recipients, one adult liver can be split into two, and used for two recipients). In the case of a living donor, only a part of the donor’s liver is removed.
The operation itself is a major undertaking, and there is a significant risk of immediate complications and even death.
In the aftermath of the operation, the patient’s own immune system will attack the new liver – a process called rejection. So the patient has to be put on immuno-suppressive drugs. If the immune system is not adequately suppressed, and the patient suffers a graft rejection, the new liver will not work properly. On the other hand, suppression of the immune system makes the patient vulnerable to infections. So a fine balance has to be achieved between rejection on the one hand and infections on the other.