The liver transplantation program at Largo Medical Center has been built to serve patients with liver failure in our community and beyond with highly specialized services. By bringing in the only specialized hepatologist in the area, The Transplant Institute of Florida strives to be a leader in the care of liver patients.
The liver is one of the body's largest organs and has a large range of important biological functions. It supports nearly every organ in the body and plays a key role in regulating metabolism, detoxifying the body of harmful substances, and digestion. The liver has sizable reserves and a great capacity to regenerate itself. Often, symptoms aren't evident until significant damage has been done. At present, there is no known way to medically compensate for the loss of a liver.
Liver transplantation replaces a severely diseased or irreversibly damaged liver with a healthy one. Most often, the new liver will come from a deceased donor.
Liver transplants are reserved for the critically ill because the demand for available livers far outweighs the supply. Patients may spend many months waiting for a liver. Nationally, about 6,000 liver transplants are performed each year.
Biology & Causes
Liver transplantation is reserved for patients with end-stage irreversible liver failure, and for whom other treatments have proven ineffective. Occasionally, transplantation is also an option for some patients with liver cancer.
When a liver is damaged slowly over time, the condition is known as chronic liver disease. When it occurs rapidly, often in a matter of weeks, it's known as acute liver failure.
The causes of liver failure are many, and include among others:
- End stages of cirrhosis
Liver cells are replaced by scar tissue, causing a loss of liver function. Often caused by alcoholism and hepatitis B and C.
- Fulminant hepatic failure
Acute liver failure without any history of liver disease.
- Selected patients with Primary liver cancer (hepatocellular carcinoma)
Interferes with normal liver function.
- End stages of Hemochromatosis
Excess iron accumulation in the body.
- Alpha-1 antitrypsin deficiency affecting the liver
Incorrect production of A1AT.
- Metabolic disorders
Any metabolic disorder that leads to liver disease and additional complications.
Dedicated Transplant Unit
Along with our top notch service, The Transplant Institute of Florida also offers a dedicated transplant unit. This specialized unit helps patients post-surgery with staff that is fully committed to providing care to patients after surgery. Their goal is to help expedite and guide patients through the recovery process. Their training and expertise is designed specifically towards treating post-transplant patients.
Patient referral process
If you have chosen transplantation as a treatment option for your liver failure, there are several steps in beginning the process. The first thing you will need to do is be referred to the transplant program by either your gastroenterologist, primary care doctor, oncologist, emergency physicians, or hospitalists.
When you are referred to the Transplant Institute of Florida Program, you will undergo an evaluation to determine whether you are a good candidate according to medical and psychological criteria. Prior to the evaluation, you will be invited to attend our pre-transplant education class. This class will be your first opportunity to explore the option of liver transplantation and whether it is the right option for you.
Education Session- This is a mandatory session for all transplant candidates. It is designed to help familiarize patients with getting prepared for evaluation, to testing, being placed on the waiting list, and going home after the transplant surgery. We require all patients to bring a family member or friend with them to this session. All attendees will have the opportunity to ask questions throughout this class.
Liver Transplant Evaluation
Before setting out on the liver transplant journey, you'll undergo an evaluation that entails a detailed battery of tests and exams designed to confirm your diagnosis, assess your ability to undergo the transplantation procedure, and rule out any possible alternative treatments. The pre-transplant evaluation will cover physical, biological, psychological and emotional facets of your condition.
You'll first meet with a transplant hepatologist to determine if you are a likely transplant candidate. If so, your assigned transplant coordinator will see you through the entire evaluation process. They will handle scheduling and logistics, and can be counted on to provide any other resources you'll need.
Pre-transplant testing will likely include:
- Complete blood workup.
- Ultrasound exam of liver and other abdominal organs and blood vessels
- CT or MRI of Abdomen
- Cardiac stress test
- Echocardiogram (A heart exam done by ultrasound)
- Electrocardiogram (Measures your heart's electrical activity)
- Endoscopy (A small tube with a tiny video camera examines internal organs)
- Mammogram and various X-Rays
You'll meet with a transplant surgeon who will walk you through the entire process, including a complete discussion about possible risks and complications. The surgeon will describe the transplant procedure itself, how your donor organ will be found and obtained, the recovery/rehab stage and the logistics of your care in the weeks and months ahead. This is a discussion that requires the input and understanding of both you and your family. You need to be comfortable with the process and aware of the details.
You'll be seen and examined by a transplant anesthesiologist, who will talk with you about how sedation will be administered during your transplant. The anesthesiologist will evaluate the results of your previous heart and lung function tests, and discuss any possible concerns. You are encouraged to ask questions and become familiar with the sequence of events.
Social Services Consult
In the face of so many medical processes and details, it's easy to lose sight of the importance of a solid support network. A consultation with a social worker will help iron out many of the logistical kinks. A plan will be developed to help provide substance abuse counseling if required and an appointment with the financial coordinator will be arranged.
Diet remains a critical aspect of the transplant process, from start to finish. A complete nutritional assessment will guide the creation of a practical dietary plan that fits your lifestyle and enhances your chances of a successful outcome.
Activation for Transplantation
All the necessary tests, exams and diagnostics will have been performed at this point. Now it's time for the various specialists to meet to determine if your name should be entered on the national transplant waiting list. It's called the Medical Review Board.
Medical Review Board - When the evaluation appointments have been completed, the transplant coordinator will present each patient's case to the Medical Review board. The Committee is comprised of many members of the transplant team that will review each patient's records to make sure they are complete, then a collective decision will be made regarding suitability for transplant. If a patient is found suitable for transplant, his/her name will be placed on the national organ waiting list.
Things will happen very quickly once an appropriate donor liver is found. You'll be notified by phone that an organ is on its way to Largo Medical Center. You should plan in advance for transportation to the hospital. If you normally live more than a few hours from Largo Medical Center, you may need to temporarily live close by.
Once you've been admitted to Largo Medical Center for your transplant, an IV line will be placed so that medications can be administered as needed. You'll get your first dose of anti-rejection drugs and antibiotics as your body is prepared to accept the donor liver. Other lines will also be placed so the staff can monitor fluid volumes and provide additional medications.
Liver transplantation is performed under general sedation and a breathing tube will be inserted into your throat to help you breathe. It will be removed once surgery is complete and the surgeon feels you can breathe freely on your own. You can expect your throat to be a bit sore for a few days afterward.
The diseased or damaged liver is removed in its entirety, and replaced with a donor organ. Four main blood vessels and bile duct are connected and stabilized. Start to finish, this procedure typically takes four to eight hours. After surgery, you'll be taken to the ICU (intensive care unit), where your condition will be closely monitored until you are deemed stable enough to be moved to an in-patient room. You can expect to be in the Transplant Intensive Care Unit (TICU) several days.When you regain consciousness, you'll still be experiencing the effects of general anesthesia and may feel nauseous. You may still have a ventilation tube in your throat to help you breathe, and other IV lines will remain connected for the time being. As could be expected, the site of your incision is going to feel pretty sore, but will improve steadily as you recover.
You should start to feel better very quickly. Your appetite will return. Energy levels will rise. The nursing staff will work with you on various exercises and therapies designed to keep your lungs clear and get you back on your feet as quickly as possible.
You'll be monitored closely with bloodwork and various radiologic tests to ensure your liver is working properly and that infection is avoided. Expect daily exams and blood tests as you recover. It's also recommended that the number of visitors to your room be kept to a minimum during the one to three weeks you'll be hospitalized.
Your transplant team will develop a plan that will guide you through all aspects of your recovery, including medication schedules, exercise regimens, dietary restrictions and lifestyle modifications. Once you're cleared to leave the hospital, you'll need to live close by for up to three months. You'll continue to be closely monitored by the transplant team make sure all goes well. This will be a period of close follow up and you'll probably be seen two or more times in the week immediately following discharge from the hospital.
Your follow-up care is crucial to the success of your liver transplant. The Transplant Institute of Florida offers a post liver transplant clinic at varying times from Monday through Friday. The Transplant Institute will provide your physician with regular updates and reports on your progress.
- Clinic Visits - Initially, you will be required to attend clinic visits 3 times per week. Each visit lasts approximately 4 hours and includes lab work and visits with physicians/nurse practitioners and transplant coordinators. If after one month, everything is stable, the frequency of the visits will be decreased to two times per week, then eventually once per week. Gradually the number of clinic visits will decrease until you are seen on a yearly basis.
- Medications - All transplant recipients are required to take anti-rejection medication for as long as they have the transplant. Without these medications, the body recognizes the liver as something foreign, and works to reject it. You will receive personal instructions on how to take your medications before you are discharged from the hospital. The importance of taking medications properly after transplant will be reinforced continually by the transplant team.
- Financial Responsibilities - The anti-rejection medications needed after transplant can be very expensive-depending on what type of insurance coverage you may have. It is important to plan for these added expenses, as well as the expense of frequent trips to the transplant clinic and uncompensated time off work. Our financial coordinators and social workers will work with you to come up with a plan before the actual transplant takes place. If you need assistance after the transplant they are also available to help you follow through with your plan.