When does a liver transplant need to be done? This is a very complex issue and must be answered on a case-by-case basis. Anyone with hepatitis C should be followed by a physician regularly. If signs of progressive disease appear, the person needs to be referred to a gastroenterologist (specialist in digestive diseases and liver diseases). Since hepatitis C is known to progress very slowly, it is not necessary to have a liver transplant until the disease has reached “end stage.” Factors to be assessed include the rate of progression of the disease, whether or not complications of liver failure have occurred and laboratory values including albumin, bilirubin, and prothrombin time.
What are my chances with a liver transplant? The survival rate after liver transplant overall is approximately 80% at one year, and 70% at five years. The odds for hepatitis C are approximately the same as for the average liver transplant for another reason.
How long will a new liver last? No one knows how long a transplanted liver can last. The longest reported transplant survival is 25 years. Ten-year survival is commonplace. Hopefully improvements in techniques and medications that are continually occurring will allow most patients receiving liver transplants today to have long productive lives.
Will the hepatitis C be cured by a liver transplant? No. Hepatitis C can live in cells other than in the liver. Once the old liver is removed and the new one is connected the hepatitis spreads back into the liver within the first weeks to months after the transplant. This is the bad news: at present we have no way to make the hepatitis C go away completely. The good news is that overall results with hepatitis C after liver transplantation are good. Although the disease comes back it does not seem to greatly damage the liver in the majority of cases. It is possible for the hepatitis to return so severely that the new liver fails, but this is uncommon. Long-term results (ten years) are difficult to interpret since we have only been able to diagnose hepatitis C since 1990. Many people that were transplanted in the 1980’s may have gotten hepatitis C at the time of transplant, since the blood supply was contaminated then. These people may have different chances compared to those that had transplant because of hepatitis C. Realistically it is likely that hepatitis C will be a long term problem in liver transplant recipients that harbor the virus. We do not yet know how bad a problem this will be.
What can be done for hepatitis C that comes back in a transplanted liver? No treatment has been shown to change the course of the disease. Interferon alpha is being tried in experimental settings.
I have hepatitis B and hepatitis C. Can a transplant still be done? Yes, some transplant centers are currently doing liver transplants for this indication.
Where do donated livers come from? Livers are donated, with the consent of the next of kin, from individuals who have brain death, usually as the result of a head injury or brain hemorrhage. There have also been real successes with living liver donors, where a part of the liver of the donor (still alive) is given to another family member.
How can I donate my organs? If you wish to be an organ donor, carry an organ donor card and place an organ donor sticker on your medical identification card. In Canada, it is permissible for HCV positive persons to donate their organs to other HCV positive persons.
Some Statistics: US: There are 6,684 on waiting list for livers; there were 3,922 done in 1995; 804 died waiting. CAN: (Nov 98) “There are currently more than 220 adults and children across Canada on waiting lists for liver transplants. It is estimated that there are 250,000 to 300,000 Canadians infected with the Hepatitis C virus. Low Canadian organ donation rates mean that 30% of people on waiting lists for liver transplants will die while waiting for an organ to become available.” (Canada Newswire).
