For patients with advanced hepatitis C liver disease, liver transplants can offer just such a second chance, however, most Black patients are not referred for liver transplants at the same rate as other patients. Cirrhosis of the liver caused by HCV infection is the leading reason for liver transplants. The surgery is complicated and can be risky. Yet it saves lives. About 73 to 77 percent of adult patients survive the operation and resume normal lives. Some 90 percent of liver transplants in children are successful. And new advances in the surgery, including the use of combination anti-viral therapy and “live donor” liver transplants, are improving those odds.
Who qualifies for transplantation?
Because donated organs are in short supply, doctors carefully screen patients before putting them on the list to receive a liver.
In general, transplants are offered to patients who can’t be treated using drugs or other therapies, and whose disease has become life-threatening. For HCV-infected patients, the most common reason for a transplant is severe cirrhosis, or scarring of the liver. Performing transplants on patients with liver cancer is less common and can be controversial. By the time cancer is detected, it has often spread too far to be cured by a liver transplant.
Transplants are usually not offered to people with ongoing drug or alcohol abuse problems, since the likelihood of success would be small.
Timing is critical for patients who may need a liver transplant. Although transplantation is a last resort, it is important not to wait too long. If a patient’s condition has seriously deteriorated, the chances of a successful liver transplant are lessened. Typically, a team from the liver transplant center determines, in consultation with the patient and family, whether a liver transplant is appropriate. Most centers have medical review boards that assess a patient’s health information and make the final decision.
If a patient is approved, he or she is placed on the national waiting list for liver transplants. The wait can be a long one. It often takes more than a year to find a suitable donor.
Weighing the risks
Like all major surgeries, liver transplants carry risks of infection and bleeding. During the surgery, doctors sometimes have difficulty removing the diseased liver. Problems can also arise if the blood vessels connected to the new liver develop clots, reducing blood supply to the transplanted organ. Once the surgery is completed, there is a risk that the immune system will reject the organ. This danger can usually be minimized with drugs that suppress the rejection mechanism.
The chances of surviving a liver transplant vary depending on the age and condition of a patient. On average, about three out of four transplant patients survive the first five years after transplantation. Those might not seem like very good odds. But among patients who are in good condition, the survival rate is as high as 90 percent. Among critically ill patients, the survival rate is about 50 percent.