Liver Transplantation
Tufts Medical Center surgeons performed the institution's first liver transplant in 1984. Since then more than 650 adult, pediatric and live-donor liver transplants have been performed, making our liver transplantation program one of the largest in New England.
Our success is reflected in the program's outstanding patient survival statistics. Patient survival at one year is currently greater than 90%, which includes all patients-from the most critically ill to the relatively stable.
Not all patients considered for liver transplantation can actually be helped by a transplant. On the other hand, some patients may improve substantially with rigorous medical treatment and in certain cases transplantation can be postponed for years or rendered unnecessary. Approximately 10 percent of the liver transplantation patients referred to us have avoided surgery thanks to the multidisciplinary nature of our Transplantation Services. Through assertive medical management of patients' chronic liver disease, these non-transplant success stories save millions of dollars in medical and surgical costs and preserve donor organs for those most in need.
Liver Research
In the last decade, Tufts Medical Center has conducted research on a variety of liver diseases such as primary biliary cirrhosis, hepatitis C, and hepatocellular carcinoma as well as the use of anti-rejection and anti-infection treatments. Ongoing studies by the transplant team include early medical treatment with both innovative and investigational drugs for patients whose livers-native or transplanted-have failed.
Referrals
Patients, their primary care physicians, specialists or insurers can initiate referrals for liver transplantation through a single call to the Division of Transplant Surgery at 617-636-5592. Timing is a key element in the survival of liver transplant patients and it is important that patients be referred to our transplant program for evaluation as early as possible to minimize the risk of the liver disease progressing sufficiently to compromise a patient's chance for a successful outcome.
Evaluations
For patient convenience and to help manage costs, our transplant teams encourage patients to undergo as many tests as possible close to home and deliver the results to the Medical Center prior to evaluation. For patients whose conditions are stable, the evaluation process generally takes one-and-a-half days of outpatient visits. For those in unstable condition, hospitalization at the Medical Center may be required for evaluation and treatment of evolving symptoms. Patients meet with members of the liver transplant team including Hepatology, Surgery, Social Services and Nursing during the evaluation process. Should the team require further exploration of a patient's condition, the patient is encouraged to obtain the necessary information close to home and transmit the results to Tufts Medical Center.
Waiting period
Waiting times for liver transplantation vary widely and depend on the level of clinical urgency the patient faces. For those who, with medical therapy, are able to get by at home, the wait for an organ can be as long as one to two years. When a patient must be hospitalized to manage intractable symptoms, the wait can be as short as two to three weeks. For patients with life-threatening complications, the wait for a donor liver is usually two to seven days.
Recovery
The length of hospital stay after surgery largely depends on a recipient's condition prior to transplant, but is typically two to three weeks. Individual patients' circumstances differ after liver transplantation, so during their final few days in the hospital, Tufts Medical Center's transplantation team devises a customized outpatient program for each patient. While some patients are asked to stay in the Boston area for a short time after discharge, most return directly to their homes.
Outpatient Care
For the first few months following liver transplantation, the liver transplant clinic at Tufts Medical Center manages outpatient care, with transplant physicians, surgeons and nurses working side-by-side to streamline the process. Initial follow-up is at weekly intervals, but is broadened over time to monthly intervals. For those who come from the south or west of Boston, we offer satellite clinics (manned by Tufts Medical Center staff) in Providence, Rhode Island. In addition, every effort is made to coordinate home-based follow-up care through the referring physician.
One year after a transplant, clinic visits become less frequent, eventually reaching a once or twice yearly follow-up schedule.
Indications for Liver Transplantation
Tufts Medical Center is a founding member of the Boston Center for Liver Transplantation (BCLT), a unique consortium of four premier institutions providing liver transplantation services. The consortium cooperates on matters of organ transplantation including protocols, patient selection and scientific study, and has a mandate from the Commonwealth of Massachusetts to function under a set of guidelines for choosing liver recipients. These include the following:
Indications
- Non-alcoholic cirrhosis: Primary biliary cirrhosis, secondary biliary cirrhosis, cryptogenic cirrhosis, chronic active hepatitis with cirrhosis, primary sclerosing cholangitis.
- Metabolic disorders: Alpha-1-antitrypsin deficiency, Wilson's disease, hemochromatosis, galactosemia, tyrosinemia, glycogen storage diseases.
- Congenital hepatobiliary disorders: Biliary atresia, congenital hepatic fibrosis, Byler's disease, neonatal hepatitis.
- Nonmetastatic primary hepatobiliary tumors: hepatocellular carcinoma, cholangiocarcinoma, hepatoblastoma, angiosarcoma, epithelioid hemangioendothelioma, multiple or massive hepatic adenoma. (These patients can be accepted as candidates only if exhaustive studies, usually including a preliminary exploration, exclude extrahepatic spread.)
- Vascular disorders: Hepatic vein thrombosis (Budd-Chiari syndrome), if an underlying lymphoproliferative disorder can be readily controlled.
- Alcoholic cirrhosis: Patients with alcoholic cirrhosis can be considered as candidates for transplantation if they meet strict criteria for abstinence and reform. Criteria to be taken into account in evaluating individual patients include documented abstinence for a period of approximately 6 months or longer, established record of medical compliance, absence of a history of abusive, antisocial, or criminal behavior, strong social supports, absence of alcoholic dementia or cardiomyopathy, and documented regular participation in a group or individual counseling program. All such patients must be evaluated both by the Transplantation Team psychiatrist as well as by a psychiatrist representative of a substance abuse dependency program.
- Viral chronic hepatitis: Postnecrotic cirrhosis following infection with hepatitis B or C.
- Fulminant hepatitis: Resulting from viral, toxic, anesthetic-induced, or medication-induced liver injury.
Relative Contraindications
- Delta hepatitis, HBeAg positivity in patients with hepatitis B.
- Extensive mesenteric venous thrombosis.
- Intrahepatic or biliary sepsis.
- Severe hypoxemia resulting from right-to-left shunts.
- Uncontrolled serious psychiatric disorder which would impair the patient's ability to undergo transplantation or to cooperate with immunosuppressive therapy.
- HIV seropositivity (without active AIDS).