The liver performs many essential functions. It makes the factors that the blood needs for clotting, aids in digestion and breaks down toxic substances (including drugs and alcohol) in the blood. If your liver fails, a liver transplant – surgery to replace your diseased liver with a healthy liver from another person – can save your life. The liver is the second most commonly transplanted organ in the U.S., after the kidney.
The multidisciplinary liver transplant team at the Transplant Center is led by nationally renowned transplant surgeon J. Steve Bynon, MD, FACS, Chief of Abdominal Transplantation and Director and Professor, Division of Immunology and Organ Transplantation at the McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). The liver transplant team is comprised of transplant hepatologists, transplant surgeons, transplant nurses, transplant anesthesiologists, transplant coordinators, financial counselors, social workers and dietitians.
Through our partnership with the Ertan Digestive Disease Center, we provide quality treatment for patients with liver disease. Our affiliation with McGovern Medical School allows us to offer clinical trials that further the scientific understanding of liver disease, as well as advanced treatment protocols that keep us at the cutting-edge of liver disease treatment.
Life-saving transplantation is made possible through the generous “gifts of life” by donors. While living, these individuals registered to become donors (upon their death), either when signing up for or renewing their driver’s licenses or through the DonateLifeTexas.org registry. If a deceased patient has not registered but is a candidate for donation, his or her next-of-kin can provide consent for donation on his or her behalf. Currently, about half of Texans are registered donors, and there are over 100,000 individuals awaiting organ transplants in the U.S.
Upon a donor’s death, the donor’s organs and/or tissues are recovered by an organ procurement organization (OPO). The OPO serving the Greater Houston area is LifeGift. To learn more about the organ donation process (for donation from deceased donors), please visit the LifeGift website.
Once the medical team and patient have chosen the path of transplantation for treatment, the patient will receive a thorough evaluation from the liver transplant team, which includes transplant hepatologists, transplant surgeons, transplant nurses, financial counselors, social workers and dietitians.
The overall evaluation takes approximately three days and includes:
Once the evaluation is complete and the results of the tests are received, the multidisciplinary transplant team will confirm that liver transplantation is the correct option for the patient. After being confirmed as a transplant candidate, the patient will be placed on the national waiting list for deceased-donor liver transplantation.
Livers from deceased donors are a scarce resource. In order to distribute this scarce resource most fairly, liver patients are ranked on the waiting list according to the severity of their illness.
The Model for End-Stage Liver Disease (MELD) score is based on three specific laboratory tests: bilirubin, INR and serum creatinine. The MELD score ranges from 4 to 40 and is used to rank patients on the waiting list.
Patients with higher MELD scores get first priority when a liver becomes available. In some cases, patients with certain diseases such as liver cancer may receive additional MELD points based on their disease.
Patients awaiting liver transplantation on our transplant list are seen by Transplant Center physicians on a regular basis to ensure that they will be ready for transplantation when a liver becomes available.
When a liver becomes available, the patient is notified and immediately admitted to the hospital, where the patient meets with a transplant hepatologist and a transplant surgeon, who will answer the patient’s questions. Prior to surgery, the patient will sign a consent form authorizing the procedure.
Liver transplantation is a major operation, performed under general anesthesia, that requires a specialized team of surgeons, specialized transplant anesthesiologists and operating room staff. The procedure, which involves removing the patient’s diseased liver and implanting the new one, usually takes 4-6 hours but may take longer in patients with prior abdominal surgery.
Following the procedure, patients are taken directly to a dedicated Transplant Surgical Intensive Care Unit (TSICU) to recover. All patients will have a urine catheter and a special IV for administering medications, both of which are typically removed within two days of transplant. In addition, the patient will have several abdominal drains in place for several days, and a small drain in the bile duct.
Most patients are in stable condition and are awake the same day as their liver transplant. The majority of patients are transferred out of the TSICU to the regular transplant surgery floor within two days of their transplant. Eating, drinking and walking are strongly encouraged as soon as possible after transplant. Most patients are discharged from the hospital within a week of their surgery.
Liver transplantation carries associated risks, including the risk of the body rejecting the implanted liver, the risk of infection and the increased risk of cancer or elevated blood sugar from the immunosuppression (anti-rejection) medication administered to reduce the risk of rejection.
It is important to know that rejection does not usually mean loss of the transplanted organ. Rather, rejection simply means that the balance of the immune system and the organ has changed and that immunosuppression needs to be increased. Your doctor will discuss all of the risks associated with transplantation with you prior to your procedure.
The goal of liver transplantation is to return patients to a full, satisfying quality of life after surgery, returning to school, work, sports and other activities they enjoyed prior to developing liver disease. This recovery to normal function may take months after liver transplantation, depending on the severity of liver disease before transplantation.
Although the hospitalization is relatively short post-transplantation, our physicians and staff continue to monitor recent liver recipients very closely in the clinic, where patients enjoy the comfort of home as they recover, while receiving the medical attention they need.
Clinic visits are scheduled weekly or twice-weekly during the early period post-transplant, and the time between visits will increase according to the patient's needs. Patients from outside the Greater Houston area should plan to stay in Houston for 4 to 6 weeks after transplant to ensure that this close follow-up is possible.
Transplantation can sometimes seem overwhelming for patients. The Transplant Center offers a transplant support group, run by our transplant social workers. The group meets monthly and includes patients who are waiting for a transplant as well as those who have already received a transplant. Adult family members, friends and caregivers are welcome and encouraged to come with the patient.
To learn more about our transplant support group, call (713) 704-5200.
To find out more about kidney transplantation or to schedule an appointment with an affiliated physician at the Transplant Center, please call (713) 704-5200.
If you are a physician, you can refer a patient to the Transplant Center. If you are from a dialysis center and would like to refer a patient, please download the Kidney/Pancreas Transplant Referral Form or Liver Transplant Referral Form.