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School of Medicine
Liver Transplant Program
Why Come to Johns Hopkins for a Liver Transplant
Transplant surgeon Benjamin Philosophe, M.D., Ph.D., talks about the complex care required to treat patients for a liver transplantation, our living donor liver transplant program, and our expertise in treating infants and children with liver disease.
- Why would I need a liver transplant?
- Am I eligible for a liver transplant?
- How long will I wait for a new liver?
- What is the surgery like?
There are several situations where a liver transplant may be considered a viable option. These include, but are not limited to:
- End-Stage liver disease
- Autoimmune hepatitis, Hepatitis C
- Liver damage from overdose of medications toxic to the liver, including alcohol
- Primary Sclerosing Cholangitis (PSC)
- Primary Biliary Cirrhosis (PBC)
- Acute hepatic necrosis
- Biliary atresia
- Metabolic disease
- Liver cancer
You will need to go through a referral process. Read the frequently asked questions about liver transplant referrals.
To determine if you are eligible for transplant, you must first have a transplant evaluation. This critical step helps decide whether or not transplantation is the correct course of action for your health. During the evaluation, you will meet with several members of the transplant team, including physicians, surgeons, and specialists from transplant hepatology, surgery, social work, nutrition, psychology, and many more. You will also meet your transplant coordinator who will help guide you through the evaluation process. During your evaluation you will be required to complete additional testing. Some testing may be completed at outside facilities when appropriate.
Once you have completed your evaluation, your health status and history will be presented to the transplant committee. Many of the team members you meet during your evaluation are on the committee. These experts will make the final decision on whether or not transplantation is a good option for you. Generally, most prospective patients are eligible for transplant; candidates who have no chance of surviving the surgical procedure are not eligible for transplant at Johns Hopkins.
The evaluation time takes approximately one to two months.
The waiting time for a liver transplant depends on a number of factors, including organ availability, organ matching and the sickness of a patient. Each patient is given a Model for End-Stage Liver Disease (MELD) score. Pediatric patients receive a Pediatric End-Stage Liver Disease (PELD) score. This score is used by the United Network for Organ Sharing (UNOS) to prioritize organ allocation.
The Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD) are numerical scales that are used by the liver transplant community to help place available organs to patients awaiting transplantation. The scores are calculated factoring severity of the patient’s medical condition and a host of key indicators in the patient’s blood. The purpose of the scoring systems is to objectively place organs to the sickest individuals in the shortest amount of time.
The range of the MELD/PELD score is from 6 to 40. As the score increases, the patient moves higher up the transplant list. MELD scores are determined using a mathematical formula based on serum creatinine, total bilirubin and INR levels (blood tests measured each time liver patients get their blood work drawn pre-transplant.) PELD scores add the additional tests of serum albumin, factors in growth, and whether the child is less than one year old.
Over time, a MELD/PELD score can fluctuate, so regular testing may be necessary.
Because a liver being transplanted is only viable for a few hours, patients awaiting a liver transplant can be called into the hospital for surgery at any time. Prior to surgery, you will be asked to review and sign an informed consent form. Liver transplant surgery can take anywhere from four to eight hours, but patients may be under anesthesia for up to two hours before surgery begins. After surgery, you’ll be placed in the intensive care unit; eventually you’ll be moved to the transplant unit. The average post liver transplant hospital stay is ten to twelve days, with two of those days spent in the intensive care unit. It may be up to three months before patients feel normal.
Contact us for more information on liver transplants.
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