The most common reason for getting a liver transplant in the United States is chronic hepatitis C virus (HCV). The process of getting a liver transplant can be long and complicated. However, a successful liver transplant may be life-saving.1,2
What is a liver transplant?
A liver transplant involves replacing a liver that is not working with a new one. It is a surgery that takes place over many hours. New livers often come from deceased donors. It is also possible for a living person to donate.
The liver is able to regenerate, or regrow, to a certain extent. Because of this, a small portion of a living person’s liver may be taken out of their body and given to someone else. The parts of the liver in the donor and the person receiving the liver can both grow back.1
Why do some people with HCV need a liver transplant?
Over time, HCV causes severe damage to the liver. This damage (inflammation) leads to scar tissue forming. Scar tissue that is potentially reversible is fibrosis.3
Over time, fibrosis turns to permanent scar tissue. This is called cirrhosis. Cirrhosis prevents how well the liver works. When cirrhosis is severe enough, the liver can completely stop working. This is called liver failure, or end-stage liver disease.3
The liver is an important organ in the body. Without a working liver, a person can die. The liver helps your body:3
- Filter out waste
- Process fats
- Make proteins
- Break down and clot blood
This is why a liver transplant can be life-saving for someone with HCV-related liver failure. The percentage of people who survive 5 years after transplant is 60 to 80 percent.4
Does a liver transplant cure HCV?
A liver transplant is not a cure for HCV. If a person has not been treated for HCV before transplant, the new liver will become reinfected.4,5
But in some cases, it may not be possible to treat HCV before a transplant. This could be because the liver has failed so badly that there is no time for treatment. Or the liver could be too damaged for drug treatment to be safe.4
Deciding whether to treat before transplant needs to be case by case.
The process of getting a transplant
A doctor can refer a person for a liver transplant. However, this does not mean the person will automatically receive a liver.
A full physical and mental exam and lab tests are needed. There are also screenings for other health issues including certain infections. Some people may need additional vaccines. All of this is done to determine how safe it is to undergo surgery.
It is also to increase the chances that surgery is successful.1,2
Doctors will determine how severely the liver is damaged. This helps determine who is qualified for a transplant and how urgent a transplant is. One way this is done is through Model for End-stage Liver Disease (MELD) scoring. MELD scores take into account results from different tests related to the liver and other organs. The higher the score, the more urgent a transplant is.1
Some people may wait days or weeks for a liver. Others may wait months or years. The process can vary based on factors including:1,2
- Liver damage
- Cause of liver failure
- Availability of a donor
- Distance to a transplant hospital
One of the biggest risks of a liver transplant is organ rejection. This is when the new organ does not function well in the recipient’s body. Rejection can cause liver failure and other severe health issues.1,4,5
To prevent this, people who have liver transplants will take drugs called immunosuppressants. These drugs reduce the risk of rejection by preventing the immune system from attacking. But they have some side effects. They can also interact with DAAs. A unique plan is needed for each person undergoing a transplant.1,4,5
Who cannot get a liver transplant?
There are some people who cannot get a liver transplant. This is often because they have another medical issue that makes surgery risky. It could also be because they are at high risk of having the transplant fail. For example, certain cancers and widespread infections can make transplants impossible.2
In some cases, a person may not live close to a hospital that can do liver transplants. This can also make things challenging. In addition, those who drink heavily may not be able to undergo a transplant unless they have stopped drinking for a certain period. This is because heavy alcohol use can damage the new liver.1,3
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