Learn about the criteria for undergoing a liver transplant.
The liver is the largest organ inside the body, and given that it performs more than 500 functions regarding metabolism, digestion and more, it’s also one of the most crucial. That’s why a liver transplant is needed if the liver fails. But a liver transplant is a major procedure that requires a commitment to recovery post-surgery. What’s more, some lifestyle factors and health conditions may exclude some patients from being candidates for transplant.
“We want somebody to be in a state of health that if we were to do a liver transplant, they are set up for success afterwards,” explained Heather O’Dell, ANP, with Vanderbilt’s Liver Transplant program.
We asked O’Dell to outline some of the concerns that may preclude someone from receiving a liver transplant.
Inability to undergo a liver transplant
Patients must be able to pass certain health tests to show they are strong enough for the procedure. “Transplant is a big operation,” O’Dell explained. “And so we need to ensure that patients have robust heart and lung function to get them through a big procedure like that.”
Obesity
There is evidence that patients with very high body mass indices are at risk of adverse outcomes after liver transplantation, and high degrees of central obesity can increase the technical difficulty associated with liver transplantation. Therefore, patients may be required to lose weight prior to liver transplantation if it is determined that this is necessary to optimize the possibility of a successful operation. “People lose weight in time for a transplant all the time,” O’Dell said.
Advanced age
There is not an absolute age cutoff for receiving a transplant, but health matters. As people get older, the possibility of other health issues being present that may make a liver transplant difficult increases.
All patients undergo an extensive evaluation to determine their overall state of health. Frailty, or lack of strength, is an important consideration, so older patients are more likely to be candidates for liver transplantation if they are stronger. If a patient is frail at a much younger age, however, that may impact eligibility. “We try and pair patients with the rehabilitation resources necessary to get them more robust for transplant,” she added.
Mental illness
Mental health is important for recovery. If a patient has a mental illness that could interfere with their ability to follow instructions after surgery, that could complicate the liver tranplant, O’Dell explained. But this exclusion is rare.
Cancer or major disease outside of the liver
A patient’s liver is removed during a transplant; therefore, having cancer of the liver itself does not prevent someone from receiving a liver transplant (and may be, in fact, a reason to undergo the procedure). If the cancer has spread beyond the liver, however, or if a patient has cancer elsewhere, they will be unable to receive a transplant.
After a transplant, patients must take immunosuppressants so that their body does not reject the new organ. “If there is some type of other infection or cancer that’s going on outside the liver and we add immunosuppression to the mix,” O’Dell explained, “that often makes those conditions worse.”
Irreversible disease of other organs, such as the heart or kidneys, is another issue that may exclude someone from receiving a liver transplant. But there are exceptions. “We also do consider dual organ transplants,” O’Dell said, such as heart-liver transplantation or liver-kidney transplantation.
Tobacco use
“People do have to cease tobacco use,” O’Dell explained. “It interferes with wound healing and can lead to other known complications.”
Active alcohol abuse
“We try to partner with patients to connect them with the resources, support and coping tools they will need long-term to get healthy before transplant.”
“If someone is continuing to drink alcohol,” O’Dell said, “that automatically disqualifies them.” But someone who is committed to long-term sobriety is generally a candidate.
The requirement for undergoing a liver transplant is technically three months of abstinence, O’Dell explained. However, every patient is evaluated on a case-by-case basis. Therefore, if someone hasn’t had three months of sobriety and urgently needs a transplant, they may still meet criteria that predicts which patients will have good transplantation outcomes .
“We try to partner with patients to connect them with the resources, support and coping tools they will need long-term to get healthy before transplant,” O’Dell said.
The Vanderbilt Transplant Center‘s liver transplant specialists offer complete care for liver and bile duct diseases. The center’s surgeons have the expertise for dual-organ operations, including liver-heart and liver-kidney transplants, to help people with even the most complicated medical challenges. For more information, call 615-936-5321.
