Transplant Services | Liver Transplantation

The Program  |  Eligibility  |  Treatment Options  |  Expectations  |   Patient Stories  |  Our Team  |  Patient Resources


The Hartford Hospital Transplant Program performed its first liver transplant operation in November, 1984.

The Program

The goal of the Hartford Hospital Liver Transplantation Program is to restore patients with advanced liver disease to their optimum level of health and to return them to a productive life. It is very important for patients and families to be well informed about the relative risks and benefits of liver transplantation. Patient education is, therefore, an integral part of the program.
Patient education is an ongoing process centered on the multifaceted needs of the transplant patient and family. The focus is placed on adequate preparation of the patient for effective and confident management of their individual health maintenance program. The pre-operative and post-operative aspects of care, the long-term follow-up, and the support services and resources available for the patient are reviewed and reinforced throughout the process. Patient preferences, values, and needs are respected and supported through their involvement in decision-making and issues involving their plan of care. Individualized patient support is provided on a continuum, allowing needs to be met effectively at all stages of care.
Our Transplant Program values cohesive and collaborative teamwork, ensuring high quality patient-centered care. Most transplant candidates are referred to the program by their gastroenterologist or hepatologist.

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Eligibility

Evaluation
All transplant candidates begin the program with a comprehensive series of tests conducted by our multidisciplinary team of specialists. Some of these tests are required for any operative procedure (history and physical, chest x-ray, EKG, etc.) while others (such as specific blood tests) are required for transplantation surgery.

Once the evaluation is complete, the transplant team will recommend treatment options and discuss if liver transplant is the best option. The risks and benefits will be discussed with each patient. After a candidate is accepted for transplantation, the patient is then placed on the national transplant waiting list maintained by the United Network for Organ Sharing (UNOS). Because of the ongoing shortage of donor organs in this country, candidates may be on waiting lists for a year or longer. The time may be shorter or longer depending on the donor supply and the patient waiting list. While waiting, the patient is followed in the liver transplant clinic periodically to assist with any medical issues that may arise.

A Network of Support
During the initial stages of evaluation, the patient undergoes many tests and sees many specialists. This is also the time when the patient is first introduced to the support network. The transplant coordinators, social worker, and Financial Coordinator play an extremely important role in providing this support.
The transplant coordinators are involved in the pre-transplant screening and stay involved throughout the years of follow-up care. In this way, patients benefit from having the same people throughout their participation in the program. Our patients tell us that the transplant coordinators, because of the range of their involvement and the depth of their concern, are essential participants in the support network.

Our social workers are a resource, advocate and a link between patients and all the services designed to assist them. The social worker helps patients and their families address the many complex social and personal that arise for transplant patients. The services range from helping with personal and psychological issues that result from living with a chronic medical condition, to lodging, joining support groups and receiving vocational rehabilitation.

The financial coordinator assists patients with financial and insurance issues related to transplantation. The services include assessing patient insurance for hospital and pharmacy benefits, identifying and attempting to resolve patient financial problems, and helping patients in requesting and applying for assistance from transplant resource programs.

Eligibility
Patients with end stage liver disease that has failed standard medical and surgical therapy can be considered for liver transplantation. Signs and symptoms of end stage liver disease include jaundice, ascites, edema, variceal bleeding, low platelet count, fatigue, severe itching and worsening mental confusion. A number of acute and chronic diseases of the liver can result in end stage liver disease. Appropriate patient selection is paramount to the overall success of liver transplantation.
Due to limited availability of donor livers, the procedure is contraindicated for patients who are unlikely to survive the procedure or receive long-term benefit. Patients are considered individually and their candidacy is assessed by a formal multidisciplinary evaluation process.

Common Indications for Liver Transplantation

  • Cholestatic Disease: Primary biliary cirrhosis, sclerosing cholangitis, secondary biliary cirrhosis, biliary atresia, cystic fibrosis.
  • Chronic Hepatitis: Hepatitis B, hepatitis C, Hepatitis D, autoimmune chronic active hepatitis, cryptogenic cirrhosis, chronic drug toxicity or toxin exposure.
  • Laennec’s Cirrhosis: Patients with alcoholic cirrhosis are considered for transplant if they meet current criteria for abstinence and rehabilitation:
  • Metabolic Diseases: Hemochromatosis, Wilson’s disease, Alpha-1-antitrypsin deficiency, glycogen storage disease, tyrosinemia, familial amyloidotic polyneuropathy, and other metabolic disorders treatable by liver replacement.
  • Fulminant Acute Hepatic Necrosis: Viral hepatitis, drug toxicity, toxin, and Wilson’s disease.
  • Primary Hepatic Tumors: Selected patients with hepatocellular carcinoma.
  • Failed Prior Transplant
  • Idiopathic autoimmune liver disease
  • Cryptogenic Cirrhosis

Contraindications for Liver Transplantation
While each patient is evaluated on an individual basis, the presence of one or more of the following will frequently preclude acceptance as a candidate for liver transplantation. 

  • Active alcohol or substance abuse
  • Systemic infections
  • Life limiting co-existing medical conditions: Advanced heart, lung or neurologic conditions
  • Uncontrolled psychiatric disorder, psychiatric disorders that impair the patient's ability to give informed consent and be compliant
  • Inability to comply with pre- and post-transplant regimens
  • Uncontrolled bacterial or fungal infections outside the hepatobiliary system
  • Active malignancy outside the hepatobiliary system, with the exception of neuroendocrine tumors
  • Multiple uncorrected congenital anomalies
  • Advanced and uncorrectable cardiopulmonary disease
  • Active noncompliance
  • Hepatocellular carcinoma greater than 5 cm.
  • Cholangiocarcinoma
  • HIV positive
  • Portal vein and Superior mesenteric vein thrombosis
  • Smoking

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Treatment Options

The Transplant Procedure
When a compatible organ becomes available, the transplant patient is immediately contacted by a transplant coordinator or surgeon and admitted to the hospital. At this time, a history is taken of any medical events that may have occurred since the initial transplant evaluation. Appropriate testing ensures the patients readiness for surgery.

The liver transplant surgery lasts approximately five to eight hours. When the surgery is completed, the patient is transported to the Surgical Intensive Care Unit. Once stable, the patient is transferred to the transplant patient care unit on Bliss 5.

The length of stay in the hospital is determined by a number of factors, including overall health of the patient before surgery. The average length of stay in the ICU is 1-2 days. Hospital stays generally extend from 7-14 days.

Careful, comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ. Patient education is a major focus of the post transplant care. Patients must understand their medical regimen and be responsible for their follow-up care.

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Expectations

Outpatient Visits
Follow-up care initially involves returning to the Hartford Hospital Transplant Program office several times per week during the first month after leaving the hospital. A series of blood tests and occasionally liver biopsies are conducted to closely monitor the patient’s progress. This is a period when medications are precisely adjusted to reach a point of effective stability. As time goes on, blood tests and office visits are extended. Monthly blood tests and three-month office visits are required indefinitely.

The Patient’s Responsibility
While transplantation can greatly improve the recipients’ quality of life, it also demands much of them. Recipients must become active participants in preserving their health. In addition to regular follow-up, patients must call the Hartford Hospital Transplant Program Office with any concerns or questions that they have about their health. For the rest of their lives, they must take their medications especially immunosuppression (anti-rejection) medications.

Immunosuppressive Medication
Transplantation has become increasingly successful in recent years in large part through the development of new, more effective drugs, which prevent the body from rejecting the donated organs. These drugs inhibit the body’s immune system from identifying the new organ as foreign. It is necessary for all patients to take immunosuppressive medication for the rest of their lives following the transplant. A successful transplant can be undermined very quickly if patients fail to take their medications appropriately and responsibly.

A program that changes lives
Hartford Hospital’s Transplant Program has saved and greatly improved the lives of hundreds of people in recent years. By replacing organs that have ceased to function effectively, the program has given new life, new energy, and new possibilities to people whose lives have been restricted by debilitating conditions. We have worked to build a team of committed and gifted physicians, nurses, researchers, counselors, and social worker whose special expertise guarantees that our patients receive the best treatment available. We are dedicated to providing the comprehensive care from the time a patient is referred and indefinitely after the transplant.

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"I am a 10-year survivor of a liver transplant at Hartford Hospital's Liver Transplant Program. I had enjoyed good health and traveled in many countries in Europe and Asia until three years ago when my kidney function started deteriorating. I am now on kidney dialysis and have applied for a kidney transplant at Hartford Hospital's Kidney Transplant Program. Nevertheless, my liver is still functioning well. I appreciated Hartford Hospital's Liver Transplant Program for everything they have done for me."

- Liver Transplant Patient

Videos

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Meet our Kidney and Liver Transplantation Specialists:

Name Specialties Location
Maneckshana, Bejon T., MD
860.696.2030
  • Transplant Surgery
  • General Surgery
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  • Hartford
Rochon, Caroline, MD, FACS
860.696.2030
  • Transplant Surgery
  • General Surgery
Show Less
  • Hartford
Serrano, Oscar K., MD
860.696.2030
  • Transplant Surgery
  • General Surgery
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  • Hartford
Sheiner, Patricia Ann, MD, FACS
860.696.2030
  • Transplant Surgery
  • General Surgery
Show Less
  • Hartford