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>> Liver transplant is considered when a patient
has end stage liver disease or cirrhosis.
Cirrhosis in the United States is most commonly caused
by hepatitis C virus infection or alcohol use,
but there are other conditions
that could also cause cirrhosis;
auto-immune conditions like primary sclerosing cholangitis
or primary biliary cirrhosis.
There are even conditions that effect little kids
like biliary atresia that can cause
the need for a liver transplant.
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Unfortunately when a patient becomes sick with a bad liver
there aren't great medical options,
there aren't great medicines,
and there certainly is no dialysis for the liver
so a liver transplant becomes the only and best option.
In terms of liver transplant,
there are basically two options.
The first is to get a liver transplant from a person
who has passed away and decided to donate their organs.
That's a whole liver from a deceased owner.
The other option is to get half of a liver,
a partial liver transplant, from a living donor.
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We know that a living donor partial transplant
has excellent results equal to that for a whole graft.
The advantage would be that you don't have to wait
for your liver transplant if you have a living donor.
There are 7,000 Americans
on the liver transplant wait list now
and the wait can be years
and that can be very difficult for sick patients.
If you're lucky enough to have an appropriate living donor,
you don't have to wait on the list.
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The most exciting development over the last couple of years
in liver transplant is the arrival
of powerful new anti-hep C meds.
Hepatitis C used to be a very difficult disease to treat.
The medicines weren't very good and they were pretty toxic.
Maybe two years ago we have discovered new anti-virals.
They are pills that are taken once a day for 12 weeks.
They cure hepatitis C 98% of the time
and they are very well tolerated.
This has entirely changed the game
for liver transplantation for hepatitis C.
Now many patients have had hepatitis C
often for 20 years without knowing it,
so clearing the virus, while it's wonderful, good news,
may not prevent their need for a liver transplant,
but if they get a liver transplant and take these meds,
hepatitis C will not come back after a liver transplant
and that's a huge improvement in terms of how the liver
will work and how long it will last.
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The biggest risk is not getting your liver transplant.
We know that it is incredibly difficult
for patients on the wait list.
We know with mathematical certainty that
if they need a liver transplant
and they don't get one they will die waiting.
Liver transplant itself certainly has it's own risks,
but for example, the one year survival
after liver transplant is over 90%,
so if you get a liver transplant the odds are very much
in your favor that a year later
and far beyond you'll be alive and well.
Specifically we always worry about infection
after a liver transplant because you have to take meds
so that you don't reject your new liver,
those cause immunosuppression.
We worry about bleeding during a liver transplant,
but for the most part, complications are very well handled
and long term success is the rule after a liver transplant.
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Patients with liver disease are very complex
and they benefit from a team approach.
They don't need just a surgeon,
they need an entire team,
a team with a hepatologist, a dietician,
a pharmacist, a social worker, a psychologist.
We know that when patients
have an entire team results are better.
Our goal is not just to perform a liver transplant,
it's to restore sick patient
to their normal state of health and well-being.
To make sure that the patient really thrives
we know that we do best with a multi-disciplinary approach.
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