Liver Transplant

A liver transplant is a treatment for advanced stages of primary biliary cholangitis (PBC). You may need a liver transplant if doctors notice signs of liver scarring or failure. Liver transplants have high success rates for people with PBC.¹

This article covers how liver transplants are used to treat PBC. It also explains potential side effects and risks. Talk to your doctor about what to expect with a liver transplant.

What is a liver transplant?

A liver transplant is a type of surgery. During a liver transplant, doctors will remove your liver. They will replace it with a healthy liver from a donor. The donor is typically someone who has passed away.²

If you need a liver transplant, your doctor will put you on a waiting list. There are more people on the waiting list than available donors. Researchers are exploring ways to reduce the waiting time. An option is to use a portion of a liver from a living donor. This is called a “living donor liver transplant”.^2,3

How does a liver transplant help treat primary biliary cholangitis?

A liver transplant may be needed to treat advanced stages of PBC. Liver function can get worse even while taking PBC medications. Over time, this can lead to liver scarring and liver failure.¹

If this happens, a liver transplant may be the only treatment option. Doctors try to refer you for a transplant before PBC causes serious complications. They will use blood test results to assess your need for a transplant. You may hear your doctor talk about:¹

• Mayo model – a model developed by Mayo Clinic to predict survival using bloodwork and other test results
• Model for End-Stage Liver Disease (MELD) – a score that uses bloodwork results to prioritize people waiting for liver transplants
• GLOBE score – includes how well you respond to treatment with ursodeoxycholic acid (UDCA)

Liver transplants have excellent results for people with PBC. The survival rate after 1 year is over 90 percent. The survival rate after 10 years is 81 percent. Liver transplants may also reduce PBC symptoms. Fatigue and itchiness improve for many people after a transplant.^1,4

The number of liver transplants done to treat PBC is decreasing. Early treatment with medications reduces the need for transplants. The average age at which people with PBC get a liver transplant is 55 years old.¹

What are the possible side effects of a liver transplant?

Just like any surgery, serious side effects are possible with a liver transplant. The risk depends on your overall health. The Mayo model can help you understand your risk. Possible side effects of a liver transplant include:²

• Bile duct leaks or shrinking of the bile ducts
• Bleeding or blood clots
• Failure of the donated liver
• Infection
• Rejection of the donated liver
• Confusion or seizures

After a liver transplant, you will have to take medicines to prevent rejection of the donated liver. These drugs reduce your immune system activity and can cause side effects.²

PBC can recur (come back) in the transplanted liver. This happens for about 20 percent of people within 5 years of the transplant. UDCA may reduce your risk of PBC recurrence.^1,4

These are not all the possible side effects of liver transplants. Talk to your doctor about what to expect. Call your doctor if you have any changes that concern you.

Other things to know about liver transplant

Transplants are typically performed at a transplant center. Your doctor may refer you to a center. You can also choose a center. The best choice depends on your insurance, their services, and other personal factors.²

Before the transplant, doctors at the center will confirm that you are eligible. They will make sure you are healthy enough for surgery. You may also meet with counselors to plan for care after treatment.²

Time on the waiting list varies. Some people wait a few days. Others wait months. The waiting time depends on your MELD score. People with higher MELD scores are usually offered a donated liver first. While you wait, your doctor will continue to treat your PBC.²

During treatment, you will be under general anesthesia. This means you will be in a sleep-like state. Surgery can take up to 12 hours. You may stay in the intensive care unit for a few days after the procedure. You may then stay in the hospital for 5 to 10 days to recover.²

Recovery time varies. It can take 6 months or more to feel fully healed. You will have checkups as you recover. Talk to your doctor about what to expect for your recovery.²