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Diseases of the liver that may lead to a transplant
You
can call (866) 548-3783 toll-free to make a referral to
the liver transplant program at the Shands Transplant Center
at the University of Florida. The indications for liver
transplantation change as technology evolves and alternate
or adjunct therapies become available. We now transplant
many patients with conditions once considered contraindications
to transplantation. Future developments will undoubtedly
change our perspective on the complicated issues
Hepatitis
C
Liver failure due to cirrhosis caused by hepatitis C virus
infection is a common problem. It accounts for 20 percent
of liver transplants in the United States and afflicts nearly
half the adult patients transplanted at Shands at UF. Recurrent
hepatitis C viral infection occurs in these patients following
transplant, but few develop aggressive liver injury. Studies
on new antiviral agents that may prevent reinfection of
the transplanted liver are now being conducted at Shands
at UF.
Hepatitis
B
Early experience with liver transplantation in patients
infected with hepatitis B virus was disappointing because
survival was limited by recurrence of infection and eventual
graft failure. Given this information, our program - like
many others in the country - elected to offer liver transplantation
only to patients without ongoing viral replication. Prolonged
administration of intravenous hepatitis B immune globulin
(HBIG) reduces the risk of recurrent disease in these patients.
Recently, potent new nucleoside analogues have enabled us
to effectively suppress viral replication in most patients
and offer liver transplantation to many patients for whom
it was previously not an option.
Alcoholic
cirrhosis
Although survival is excellent following liver transplantation
for alcoholic cirrhosis, this patient population presents
special management challenges. Abstinence and counseling
are prerequisites for transplantation. During the pre-transplant
evaluation, the Liver Transplant Team works in close collaboration
with the Shands Alcohol and Other Drug Abuse (AODA) program
to address the special needs of patients with cirrhosis
due to alcohol or substance abuse. Our clinical psychologists
and social workers assist in developing a management plan.
Malignancy
Patients with hepatic malignancies are generally considered
poor candidates for transplantation because of the high
risk of recurrent disease. Patients with hepatocellular
carcinoma that is small, unicentric or limited to fewer
than three lesions without evidence of metastasis or vascular
invasion have about a 50 percent five-year survival rate
and can be considered for transplantation. Some of these
may benefit from alcohol ablation, chemoembolization or
neoadjuvant and post-operative chemotherapy. Patients with
more unusual tumors, such as fibrolamellar carcinoma, epithelioid
hemangioendothelioma and some metastatic neuroendocrine
cancers, may do well following transplantation. Patients
with cholangiocarcinoma or metastatic adenocarcinoma do
not currently benefit from liver transplantation.
Hepatobiliary
disease is also a type of liver
disease.
Statistics
Success rate and various other statistics regarding the
Shands Transplant Center at UF are available from the Scientific
Registry of Transplant Recipients at ustransplant.org.
Contact
For more information about the Shands Transplant Center
at UF, call us toll-free at (866) 548-3783.
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