Liver Transplantation at BIDMC
A liver transplant may be considered as a treatment option for people with advanced or
end-stage liver disease, who have deteriorating liver function and quality of
life, and who are unable to benefit from other medical and surgical treatments.
Many different
diseases can harm the liver. Some of these diseases are "acute,"
working quickly in just days or weeks, while others are "chronic" and
take years to do damage. The liver has an amazing ability to regenerate, or
make new liver tissue. However, extensive damage to liver cells - from acute or
chronic illness or injury - can lead to scarring, which can prevent tissue
regeneration.
Cirrhosis occurs because of chronic liver damage. Cirrhosis causes broad bands of scarring tissue to develop, and
surround, regenerating liver tissue. The progressive scarring destroys liver
cell function. Cirrhosis also impairs blood flow to the liver, so that
gradually the liver loses its ability to clean the body of toxins, manufacture
proteins and clotting substances, and process nutrients and hormones. Scar
tissue can also put pressure on the liver's portal veins, leading to portal
hypertension, or high blood pressure, within the liver. A serious condition,
portal hypertension may cause fluid to collect throughout the body, affect the
kidney and other organs, and lead to intestinal bleeding.
Transplantation for Patients with HIV
The Transplant Institute at BIDMC is one of 20 transplant centers in the United States - and the only center in New England - participating in a National Institutes of Health (NIH) sponsored clinical trial of kidney and liver transplantation in patients who test positive for the human immunodeficiency virus (HIV). HIV is responsible for acquired immunodeficiency syndrome or AIDS.
Until recently, these patients, who have a high risk for end-stage liver disease, typically were not considered for transplantation because of their poor long-term prognosis. However, new treatments, such as highly active antiretroviral therapy (HAART), have improved the outlook for HIV, and that, in turn, has opened the door for transplantation to more people who test positive for this virus.
When Transplant is Not an Option
Unfortunately, not all people with severe liver illness are candidates for transplant. Possible barriers to liver transplantation include:
Active drug and/or alcohol abuse
Extensive cancer
Advanced heart or lung disease
An inability to follow medical instructions
Not enough social support
Uncontrolled or untreated psychiatric condition
Untreated Portopulmonary Syndrome, a condition in which liver cirrhosis causes high blood pressure in the right side of the heart and can lead to heart failure
Liver tumors that do not meet the Milan criteria (that is, are greater than 5 centimeters in diameter)
Other active illness(es) that would compromise the success of your transplant, such as infection, obesity, recent malignancy, and limited physical mobility without the likelihood for successful rehabilitation
Patient Commitment
A Lifetime without Alcohol or Drugs
All patients with a history of substance abuse or dependency must be willing to commit to a life without alcohol or drugs to be considered for liver transplantation. During one of your clinic visits, the social worker or psychologist will review our Patient Responsibility Agreement with you. You must be willing to agree to the terms and conditions of our substance abuse policy to be consider for liver transplantation here at BIDMC.
Liver Expertise at BIDMC
The Transplant Institute works closely with BIDMC's world-class Liver Center, which offers personalized care and advanced, multidisciplinary treatment options to patients with all types of liver conditions and diseases. The physicians at the Liver Center are leading authorities in novel research, diagnostics and treatment for hepatitis and for hepatocellular cancer, among other liver conditions.
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BIDMC Transplant Institute Meet Our Team
