You and your family members may find it confusing and frightening to learn you may be in need of a transplant. We understand that you will have questions. That is why we have a designated transplant team member who is available to talk with you about your disease, various treatment options and which options are best suited to treat your disease. In addition, our team of doctors, nurses, technicians, dietitians, social workers and others is available to provide you with care and support throughout the transplant process, during your hospital stay and even after you return home.
The following pages will help to explain the transplant process, along with the benefits, risks and various procedures involved with liver transplantation.
To be considered as a candidate for liver transplantation, you will first undergo a thorough transplant evaluation. The evaluation will help our transplant team learn more about you and your disease. This also will give you the opportunity to learn more about our liver transplant team and transplant program. The evaluation is an important part of the transplant process because it will:
- Confirm your diagnosis and determine the extent of the liver injury or disease
- Assess other medical or psychological problems affecting your health
- Provide information about the risks and benefits of transplantation
- Review your financial benefits and discuss the financial considerations associated with a transplant
- Answer any questions you and your family may have
The transplant evaluation usually takes place over three to four days and is done on an outpatient basis, unless an inpatient stay is necessary. The evaluation includes, but is not limited to, the following tests:
- Blood tests
- Heart tests
- Abdominal ultrasound
- Lung function tests for adults
- Complete physical examination
Consultations with the transplant team members including:
- Transplant physician
- Transplant surgeon
- Transplant nurse coordinator
- Social worker
- Financial Coordinator
- Child Life Specialist
- Other specialists as indicated (cardiology, pulmonary, endocrinology)
Upon completion of the evaluation, your results will be presented at the multidisciplinary transplant team meeting. Team members will carefully review all the information from the evaluation and give their recommendation of the best treatment option for you. A transplant coordinator contacts patients after the meeting to discuss their care plan.
Waiting for Transplantation
If liver transplantation is the best option for you and you agree, your name will be placed on a national waiting list based on your blood type, body size (height and weight) and medical urgency. This time of waiting can be a difficult time for you and your family because there is no way to know when a suitable donor organ will become available. Some patients may only wait days or weeks, while others may wait for months or years for a transplant.
The liver transplant operation usually takes between five to seven hours to complete. The surgical incision is made underneath the rib cage and the next several hours are spent removing the old liver. It then takes about 45 to 60 minutes to sew the four blood vessels to the new liver and restore blood flow. Once the blood flow is re-established, there may be some bleeding that may last for several minutes or hours. Once all the bleeding is controlled, the bile duct will be reconnected. Before the abdomen is closed, the gallbladder is removed from the donor liver. If the gallbladder was not removed, there is a possibility that gallstones may form and cause problems with the new liver. Few people notice any symptoms after removal of the gallbladder. The final step of the operation is to close the abdomen.
After the Operation
After surgery, you are taken directly to the intensive care unit (ICU). Generally, patients are in the ICU for one to two days before moving to the solid organ transplant unit. Once moved to the transplant unit, activity and diet are normalized as quickly as possible. Diet is advanced from clear liquids to a no-added-salt diet as soon as you are able to tolerate solid foods. You will be encouraged to be out of bed and active as much as possible, and physical therapy will be initiated to help with activity. The average stay in the hospital following liver transplantation is about two weeks.
At Nebraska Medicine, we have some of the most experienced physicians and nurses who take every step to prevent any of the potential complications that can occur following a liver transplant. However, like any major surgery, complications can arise. The most common complications after liver transplantation are:
- Hypertension (high blood pressure)
- Rejection of the new liver
- Kidney dysfunction
After your surgery, the transplant coordinator and doctors will instruct you on the following:
- How to take your medications
- What warning signs to look for
- When to call the Transplant Office
The extraordinary care that you received while hospitalized at Nebraska Medicine does not end at the time of discharge. The liver transplant team continues to follow and monitor your progress. To answer any questions after your transplant, our team is available to you, your family members and your local physician.
Prior to leaving the hospital, you will receive a detailed discharge instructional notebook that a transplant coordinator and transplant pharmacist will review with you and your family members. After a liver transplant, you may find your life has changed in several ways. Activities will not be restricted except for eliminating heavy lifting for the first month post transplant. Diet will depend on the patient and may include eliminating salt at the table. Some patients, mostly children, will require naso-gastric tube feedings for a period of time to support wound healing, strength and growth. A transplant dietician is available for assistance with any nutritional questions.
You will remain in the Omaha outpatient area for several weeks prior to returning home. Lab work will be monitored regularly, and you will be seen in our transplant clinic weekly or as needed. The time spent in Omaha allows you and your family to become familiar with the necessary care you will need to maintain. It also allows the team to make medication adjustments and address any other concerns prior to releasing you to return to your hometown.
Once at home, we return your care to your local doctor. However, the transplant team will continue to monitor lab work and adjust the anti-rejection medications. In addition, we will follow any health problems or concerns and may ask you to return to Omaha if we do not feel we can safely handle a medical issue over the phone. We do like to see patients at least once a year, or sooner if needed.