Advancing age, sarcopenia, acute on chronic liver failure, and non-liver-related medical co-morbidities are common conditions that arise while on the wait-list that can render a patient too sick for transplant.
You may not be able to have a transplant if you: Have a current or chronic infection that can't be treated. Have metastatic cancer. This is cancer that has spread from its main location to 1 or more other parts of the body.
You may be disqualified from having a liver transplant if you have: Current alcohol or drug abuse problems. Uncontrolled infection that will not go away with a transplant. Metastatic cancer or bile duct cancer.
"There is no standard age limit to be transplanted. Each transplant program sets its own practice. For example, one program may not accept anyone older than 80 years of age; another may have no age limit. A few medical conditions might rule out a transplant.
If rejection occurs, you may experience some mild symptoms, although some patients may continue to feel fine for a while. The most common early symptoms include a fever greater than 100° F or 38° C, increased liver function tests, yellowing of the eyes or skin, and fatigue.
Advice for patients while waiting
While waiting on the list patients are advised to stay as healthy as possible by eating a healthy balanced diet, taking regular exercise, completely avoiding alcohol, not smoking etc. An average waiting time for a liver transplant is 149 days for adults and 86 days for children.
This informal policy, often called "the 6-month rule," can be traced to the 1980s. The thinking was that six months of abstinence gave a patient's liver time to heal and, thus, avoid a transplant. If that didn't work, the patient would have proven they can stay sober and would not return to drinking after a transplant.
Since most patients with severe alcoholic liver disease will die before meeting the criteria of the 6-mo period of abstinence, liver transplantation has to be taken into account irrespective of the 6-mo abstinence period.
If the MELD score rises to greater than 15, there is no longer a significantly higher risk of death with the transplant and the patient would no longer be considered too well.
Rejection is when your body's immune system starts to 'attack' your transplanted liver. It happens when your immune system recognises the liver as coming from a different person and thinks it isn't supposed to be there. Rejection can still occur even if you're taking all of your medicines.
Throughout the United States, patients waiting for liver transplants are prioritized based on the severity of their illness, as measured by what's called the Model for End-Stage Liver Disease (MELD) score. The score uses blood tests to determine how urgently you need a liver transplant within the next three months.
Severe local or systemic infection. Severe neurologic deficits. Major psychiatric illness or active substance abuse that cannot be managed sufficiently to allow post-transplant care and safety.
Research suggests that some, but not all, devices may improve survival. A well-controlled multicenter trial showed that one system, called an extracorporeal liver support system, helped some people with acute liver failure survive without a transplant.
Expect six months or more of recovery time before you'll feel fully healed after your liver transplant surgery. You may be able to resume normal activities or go back to work a few months after surgery.
Most patients are hospitalized for seven to 10 days after liver transplant. Afterward, they generally recuperate at home and typically return to work or school after about three months.
If your recovery is going well, after 8 weeks, you will usually be encouraged to start moderate exercise. This could be walking, jogging, swimming or cycling. Most sports and activities are possible but you should avoid heavy contact sports (rugby, martial arts, boxing) as these risk damaging your liver transplant.
The duration of liver transplant surgery depends on how complex your case is. On average, the surgery can take between 6-12 hours.
Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT), but up to 20% of patients experience severe alcoholic relapse.
Most liver transplants take approximately six hours. Following the operation, the patient goes to surgical intensive care unit for recovery.
The average length of stay in the ICU is two days, after which you will be transferred to the medical floor/ transplant unit.
Most patients can return to work within 3 to 6 months after a transplant. Playing sports and getting healthy exercise, socializing, and traveling for business and pleasure are all possible. The Center's expectation is that people who undergo liver transplantation can and do go on to lead "normal" lives.
Medical Grounds
Alcoholics historically have been considered unsuitable for liver transplantation because of their presumed high risk of relapse to excessive drinking after transplantation.
Although vascular complications (VCs) following orthotopic liver transplantation (OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as they compromise the blood flow of the transplant (either inflow or outflow).