Liver transplantation may be indicated in the following patients:
- Those who have developed life-threatening cirrhosis and who have a life expectancy of more than 12 years.
- Patients with liver cancer that has not spread beyond the liver may also be candidates
Survival rates after transplantation are similar among those who have hepatitis B, hepatitis C, or alcoholic liver disease. Current five-year survival rates after liver transplantation are between 60% and 80%. Patients also report improved quality of life and mental functioning after liver transplantation. Patients should seek medical centers that perform more than 50 transplants per year and produce better-than-average results.
Liver transplantation in patients with hepatitis
One of the primary problems with many hepatitis patients is recurrence of the virus after transplantation.
- One study of patients with hepatitis C reported five-year risks of 80% for viral recurrence and 10% for cirrhosis
- Viral recurrence is also high in hepatitis B patients. Recurrence in hepatitis B has been significantly reduced with the use of monthly infusions of hepatitis B immune globulin (HBIg), with or without lamivudine. Life-long administratioin may be necessary. Lamivudine or other hepatitis B drugs may also be helpful in preventing recurrence of hepatitis B after liver transplantation in children as well as adults.
Liver transplantation in autoimmune liver diseases
Patients who require transplantation for primary biliary cirrhosis are those who develop major complications of portal hypertension and liver failure or who have poor quality of life and short survival without the procedure. Patients with primary biliary cirrhosis may be at higher risk for early rejection of the transplanted organ than patients with other forms of cirrhosis.
Rejection is also high after transplantation for autoimmune hepatitis. In one study three-quarters of the patients experienced organ rejection, and half required retransplantation within a year in one study. Autoimmune hepatitis recurred in 25% of patients studied.
Liver transplantation in alcoholism
There is considerable controversy over whether liver transplantation should be performed in alcoholics with cirrhosis who are unlikely to abstain. One French study reported no differences in survival, transplant rejection, and other indicators of success and failure after transplantation between alcoholics and non-alcoholics and between alcoholics who abstained and those who relapsed after the procedure.