Liver Transplant Program

UC San Diego Health System Liver Transplant Program provides comprehensive and innovative treatment for people with end-stage liver disease due to chronic liver disease and acute liver failure. Led by Alexander Kuo, our liver transplant team moves you through the transplant process and equips you with the know-how to live well following transplantation.

The Organ Procurement and Transplantation Network (OPTN) and United Network for Organ Sharing (UNOS) have designated UC San Diego Health System an approved living donor transplant program. Read more under Types of Liver Transplantation below.

Background

A liver transplant is a surgical procedure performed to replace a diseased liver with a healthy liver. The liver is the largest internal organ and has multiple functions necessary for sustaining life. It plays a crucial role in glucose metabolism, filtering blood, detoxifying drugs and alcohol, storing vitamins, and producing bile for fat digestion.

Recommendation for Liver Transplantation

Liver transplantation may be recommended for acute or chronic conditions resulting in irreversible liver failure or end-stage liver disease (ESLD). ESLD is a serious, life-threatening liver dysfunction that can result from cirrhosis, biliary atresia, metabolic disease, liver cancers,  nonalcoholic steatohepatitis (NASH), autoimmune hepatitis, hepatitis B and hepatitis C. ESLD can also be caused by acute hepatic necrosis. Read more about these diseases and conditions.

A liver transplantation may not be possible for individuals with metastatic cancer, recurring infection, active drug and alcohol use and severe cardiac or other medical problems.

The transplant process is a long and sometimes challenging path to health. It requires a partnership between you and the liver transplant team.

Types of Liver Transplantation

UC San Diego Health System experts have extensive skills in deceased donor, living donor, split and domino liver transplant procedures. We are heavily involved in research and clinical trials to refine and develop new surgical techniques for these delicate procedures.

Deceased Donor Liver Transplant

Most liver transplantations use a liver from a deceased donor. In this procedure, the liver comes from a donor who is diagnosed as “brain dead” but whose other organs are functioning. The diseased liver is removed and the donor liver is transplanted. There is a massive shortfall of donor livers, meaning that people are waiting increased lengths of time for a matched deceased donor liver.

Living Donor Transplant

The Liver Transplant Program at UC San Diego Health System operates an OPTN/ UNOS-approved living donor transplant program. A living transplant comes from a living donor, such as a family member or close friend, who donates a portion of his or her liver. Because the liver can regenerate, the liver portion remaining in the donor, and the new liver portion in the person receiving the transplant, can grow to normal capacity.

Split Transplant

A split transplant is a procedure in which a deceased donor’s liver is divided and used for two transplant recipients. For example, this procedure can provide liver function to two pediatric patients in need of liver transplantation.

Domino Transplant

A domino transplant involves transplanting a living or deceased donor liver into one recipient, and using that recipient’s original liver for transplantation into another recipient. The first patient’s liver is “dominoed” into the second patient. The first of the liver transplant patients in a domino procedure, who also donates his or her own liver, typically would have a genetic disorder. The disorder of the first patient would not impact the function of the liver in the second transplant recipient. Read news on domino liver transplant at UC San Diego Health System.

Overview of Liver Transplantation

Before Surgery

After a thorough evaluation by UC San Diego Health System transplant specialists, you are placed on the national liver transplant waiting list. Donors need to have a compatible blood type match with the recipient the organ needs to be approximately the same size. Gender or age does not need to match. Read more about organ donation and allocation and about the steps involved before surgery.

Risks

Before liver transplantation, risks include developing acute liver failure and its complications of bleeding, coma, kidney failure or progressive complications of chronic liver failure. These progressive complications include intestinal bleeding, severe abdominal fluid accumulation, confusion, as well as coma and severe infections, and could cause unacceptable risk for transplant surgery.

With surgery, the risks are those that are common to all forms of major surgery. There could be technical difficulties in removing the diseased liver and implanting the donor liver. Complications could arise from being without liver function briefly during surgery. Immediately after the operation, risks include bleeding, poor function of the grafted liver, bile leaks, and infections. We monitor transplant recipients carefully after surgery for signs the body is rejecting the new liver. Rejection long-term becomes less and less common.

Surgery

The average operating time for a liver transplantation procedure is four to eight hours. Simply state, the diseased liver is removed and the healthy liver is put in its place. Before the abdomen is closed, initial doses of medications are given to prevent the body from rejecting the new liver.

Recovery in the hospital may take several weeks, and resuming normal activities may take upwards of a year. Quality of life usually improves dramatically and most people lead healthy, normal lives. Read more on care after surgery for liver transplantation.

Research and Clinical Trials

Transplantation results improve continually as physicians and scientists develop new ways to combat organ rejection, develop improved procedures and minimally invasive surgical techniques. Advances in medicine have lead to the development of new liver support devices – technology that can postpone the need for transplantation or possibly improve the likelihood of a successful transplant. Read more about research and clinical trials taking place at the Center for Transplantation.