People facing a liver transplant often have questions about the process. The following is a list of some of the most common questions and their answers.
How successful is liver transplantation?
Liver transplantation at Penn Medicine is very successful. Of 100 people transplanted, more than 90 are doing well one year after their surgery, and nearly 70 percent survive five years. Most people are able to return to their daily routine within three months after the transplant, and many of them even earlier. Transplant success depends on a number of variables, including health status at the time of transplant, age, incidence of postoperative infection and recurrent disease.
How long is the wait for a liver?
The waiting time for an organ has increased dramatically as the demand for livers far outweighs the supply. Because of the high risk of death for patients with end-stage liver disease while waiting on the list, the United Network for Organ Sharing (UNOS) has developed a scoring system based on several factors, the most important is severity of illness. Other factors include blood type, the number of other patients listed within the local area and the region.
Can someone travel while on the transplant waiting list?
Many patients can travel safely. However, they are advised to ask their doctor and inform the transplant coordinator of their destination, contact address and phone numbers before they leave.
FAQs About Liver Cancer
What is liver cancer and who is at risk?
Primary liver cancer, or hepatocellular carcinoma (also called hepatoma or HCC), is a cancer originating from liver cells called hepatocytes. It is the most common form of liver cancer. HCC almost always occurs because of underlying chronic liver disease, often due to hepatitis C infection and less often due to hepatitis B infection. For this reason, it is possible to identify patients at risk and perform tests that allow early detection of HCC. Patients with cirrhosis due to any cause represent the main group of patients at risk of liver cancer and should undergo imaging tests of the liver twice a year to check for early liver cancer.
When and why is liver transplant needed for liver cancer?
Early detection of cancer in HCC is of utmost importance because only early cancer can be cured. The traditional treatment for early cancer is surgical removal (resection) of the tumor. The introduction of liver transplant as an acceptable treatment for HCC in the 1990s offered another option of curing liver cancer to a large group of patients in whom surgical resection was not possible. In fact, in the vast majority of patients with HCC the damage to the liver is not restricted to the tumor itself. Because HCC almost always occurs in a background of cirrhosis, the remaining liver may not function properly after the cancer is removed. This could result in a potentially life-threatening liver failure. As long as the tumor is detected early enough for transplant to be possible, the group of patients at risk of liver failure after resection of HCC is better served by liver transplantation since the entire liver is replaced by a healthy liver from a donor.
The other major advantage of transplantation is that it results in complete removal of the cirrhotic liver that could harbor additional HCC tumors or develop new tumors in the future. For this reason, the chance of cancer recurrence after treatment is lower in patients who receive a liver transplant compared to patients who receive surgical resection as the curative treatment for HCC.
What is involved in the process of liver transplant for HCC?
HCC is one of the major reasons for liver transplantation in the United States. Patients with HCC that is detected early enough for transplant are evaluated for liver transplantation similar to other patients, with additional careful evaluation of the extent of tumor. Transplant candidates with HCC are then placed on the liver transplant waiting list. In order to prevent the tumor from growing while patients are waiting for transplant, additional treatments, often requiring the expertise of an interventional radiologist, are frequently needed. Patients are expected to have the entire tumor as well as the entire diseased liver with cirrhosis removed at the time of transplant.
The approach to liver cancer at the Penn Transplant Institute
The process of early detection of HCC, determination of the extent of tumor, evaluation for transplant candidacy, treatment of the tumor while waiting for transplant, management of the complications of cirrhosis, as well as treatment of any underlying cause of liver disease such as hepatitis C, requires the expertise of many specialists. This includes hepatologists, transplant surgeons, radiologists, interventional radiologists, and oncologists, as well as nurse coordinators, social workers, and nutritionists. At Penn Medicine, the various specialists are part of one multidisciplinary liver tumor team that meets weekly and collaborates to provide outstanding care to every patient.