Liver transplant - Why a liver transplant is needed

A liver transplant becomes necessary when the liver has been damaged to such an extent that it cannot perform its normal functions. This is known as liver failure.

Although liver failure can usually be managed by medication for a short while, a liver transplant is currently the only cure.

Unlike the kidney, heart or lungs, there is no mechanical device, such as a dialysis machine, that can replicate the function of the liver.

Why liver failure happens

There are two main ways that a liver can fail:

• chronic liver failure, where the liver fails because of damage over many months or years
• acute liver failure, where extensive damage to the liver happens over a short period of time – this is rarer than chronic liver failure and most cases in England occur in younger adults due to paracetamol overdose

The main causes of chronic liver failure are listed below.

Alcoholic liver disease

Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood. Each time your liver filters alcohol, some of the liver cells will die.

The liver can grow new cells, but if you drink heavily for many years, your liver will lose this ability and the dead cells will build up and scar your liver (cirrhosis).

If too much of your liver becomes scarred, it will lose its ability to function and liver failure will occur.

In most cases of alcoholic liver disease, you will have no symptoms until liver failure occurs.

Hepatitis C

Hepatitis C is a bloodborne virus that you can catch if you come into contact with the blood or, less commonly, body fluids of someone who is infected. Drug users sharing needles are at particular risk.

The virus can cause swelling and scarring of the liver tissue. In some cases it causes significant liver damage.

An estimated one in seven people who contract hepatitis C will have liver failure, often 20 to 30 years after contracting the initial infection.

Primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is a type of long-term liver disease thought to be caused by a build-up of bile inside the liver. Bile is a liquid produced inside the liver that helps the body digest fats.

PBC is a relatively rare condition, affecting around 24 in every 100,000 people in England. But it is one of the most common reasons why a person requires a liver transplant.

Hepatitis B

Hepatitis B is a less common type of viral hepatitis that can be spread during unprotected sex or by sharing needles.

An estimated 2-10% of people will go on to develop a chronic (long-term) infection where the virus stays in their body, although they may not necessarily have any symptoms.

Without treatment, an estimated 15-25% of people with chronic hepatitis B experience liver failure.

Primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a type of liver disease that causes long-lasting inflammation of the liver. It usually leads to liver failure.

PSC is a rare condition that affects about 1 in 16,000 people. It usually occurs in people who are 30-50 years old.

Autoimmune hepatitis

Autoimmune hepatitis is a rare cause of long-term hepatitis. The white blood cells attack the liver, causing inflammation and damage. This can lead to more serious problems, such as liver failure. The reason for this reaction is not known.

Only 1 in 100,000 people will develop autoimmune hepatitis in the UK in any given year.

Biliary atresia

Biliary atresia is a rare childhood condition where babies are born with blockages in their bile ducts. This leads to a build-up of bile, similar to PBC, which results in scarring and, eventually, liver failure.

Biliary atresia affects only 1 in every 18,000 births, but is the most common reason why a child would need a liver transplant.

Liver cancer

Liver cancer is a rare and aggressive type of cancer.

In England, an estimated 4,000 new cases of liver cancer are diagnosed every year. Most cases of the condition affect older adults aged 65 or above.