What are the most common reasons for a liver transplant in adults and children?

A liver transplant is a life-saving surgical procedure where a diseased liver is replaced with a healthy one from a donor, whether from a recently deceased donor or a living donor who provides a portion of their liver [1]. This operation is considered a definitive solution when the liver fails to perform its vital functions, which exceed 400 tasks daily, such as producing bile, manufacturing blood clotting proteins, detoxifying the body, and storing sugars and vitamins [1].

Common Reasons for Liver Transplant in Adults

The causes leading to liver transplantation in adults are varied, but the most common cause is cirrhosis. Cirrhosis occurs when liver tissue becomes scarred, preventing it from functioning efficiently, and it may progress to liver failure [1]. Key causes of cirrhosis include:

• Chronic Viral Hepatitis: Long-term infection with hepatitis B or C viruses is a major cause of cirrhosis [1].
• Excessive Alcohol Consumption: Prolonged excessive alcohol intake leads to liver damage and cirrhosis [1].
• Metabolic Dysfunction-Associated Steatohepatitis (MASH): Previously known as non-alcoholic steatohepatitis (NASH), this is a condition where fat accumulates in the liver, causing inflammation and damage [1].
• Autoimmune Hepatitis: A condition where the body's immune system mistakenly attacks liver cells [1].
• Biliary Diseases: Such as primary biliary cholangitis and primary sclerosing cholangitis, which affect the liver's drainage system [1].
• Metabolic Disorders: Such as Wilson's disease (copper accumulation) and hemochromatosis (iron accumulation) [1].
• Acute Poisoning: Such as paracetamol overdose or consuming toxic mushrooms, leading to acute liver failure [1].

Common Reasons for Liver Transplant in Children

For children, the most common reason requiring a liver transplant is biliary atresia [1]. This condition is a rare congenital defect where the bile ducts inside or outside the liver are blocked or entirely absent, preventing bile drainage and eventually leading to liver damage and cirrhosis [2]. In most of these cases, the liver donor is often a living donor, such as a parent [1].

When is a Liver Transplant Not Recommended?

A liver transplant is not recommended in certain situations, such as the presence of certain active infections (e.g., tuberculosis or osteomyelitis), severe heart or lung disease, or a history of cancer. Additionally, an inability to commit to taking immunosuppressive medications for life, or having risky lifestyle habits such as smoking or substance abuse, may prevent the procedure from being performed [1].

Next Steps and Preparing for Transplant

If you are a candidate for a liver transplant, you will be referred to a specialized transplant center. The transplant team will thoroughly evaluate your condition through multiple visits, blood tests, and imaging to ensure you are a suitable candidate [1]. Once approved, your name will be placed on the national waiting list to receive a liver from a deceased donor. Your position on the list depends on factors such as the type of liver problem, the severity of the disease, and the likelihood of transplant success [1]. During the waiting period, it is essential to adhere to the medical team's instructions, including following the recommended diet, avoiding alcohol, drugs, and smoking, maintaining a healthy weight, and taking all prescribed medications [1]. You must inform the team immediately of any medication changes or worsening symptoms. For more information on what happens after the operation, you can visit Liver Transplant: When is it the Last Resort and What Happens After the Operation? (Arabic).

Medical references

• Liver transplant
• Liver Transplantation