The Liver

Your liver is your largest internal organ and forms part of your digestive system - getting rid of toxins, helping to regulate your blood sugar levels and producing bile. This wedge-shaped organ is located under your diaphragm, next to your stomach and above your right kidney.

Liver transplant facts

The cells in your liver carry out as many as 500 different functions - more than any other group of cells in your body
Your liver can lose 75% of its cells before it stops functioning
The liver is the only organ in your body that can naturally regenerate lost tissue. Even as little as 25% of a liver can re-grow to full size. Cirrhotic livers do not regenerate normally.

Common reasons for transplantation

Liver disease occurs when the liver cells die or when healthy liver tissue is replaced with scar tissue, which eventually prevents the liver from functioning properly. This consequence of long-term liver disease (cirrhosis of the liver) can become so severe that a liver transplant may be needed.

How it works

The liver plays a key role in your digestive system - performing as many as 500 different functions and breaking down harmful substances into by-products that leave your body in bile or into the blood and passed out into the urine.

When blood leaves your bowel it passes through the liver. Blood arrives at the liver from two sources: the hepatic portal vein and the hepatic arteries. The portal vein delivers nutrient-rich blood from the intestines and the arteries deliver blood from circulation. This blood flows through the liver tissue to the hepatic cells where many metabolic functions take place, including the production of bile. It is this processing of the blood that breaks down the nutrients and drugs into forms that are easier to use for the rest of the body. Blood then leaves the liver through the hepatic veins.

Your liver holds around 13 per cent of your body's blood supply at any time. It has two main lobes, both of which are made up of thousands of lobules. These lobules connect with increasing ducts to eventually form the common bile duct and this transports the bile to the gallbladder and duodenum (the first part of the small intestine).



The gall bladder

Attached to the right lobe of your liver is the gall bladder. The gall bladder is 7-10cm long and shaped like a pear. Bile produced by the liver's hepatic cells drains here and is concentrated and stored until needed for the digestion of fats.



When the liver goes wrong

Almost every organ in your body is supported by the liver and it is vital for survival - even 24 hours without liver function can be lethal. Because of its strategic location and multiple functions, the liver is also prone to many diseases. The most common diseases include:

  • Viral Infections such as hepatitis A, B, C, D, E
  • Alcohol damage
  • Fatty liver
  • Cancer

Diseases that interfere with liver function will lead to the malfunction of its processes - and may lead to a condition called cirrhosis of the liver. However, it has an amazing ability to regenerate and has a large reserve capacity. In most cases, the liver only produces symptoms after quite considerable damage.



Your liver's ability to regenerate

The liver is almost unique amongst the tissues of the body in its ability to regenerate. It is possible to remove three quarters of a normal liver and still expect it to grow back to full size. It is not quite a true regeneration however, as the growth returns the liver to original size, but loses some of the original form.

This regrowth helps your liver to deal with toxins and poisons like alcohol. However, every time your liver removes alcohol from your blood, some of its cells die. Your liver can grow new cells, but heavy use of alcohol will impair the liver's ability to regenerate - leading to scarring (cirrhosis). Often there are no symptoms of alcoholic liver disease until liver failure occurs.

Liver transplants

If your liver becomes damaged as a result of illness, infection or alcohol, this can cause the liver to become scarred, which is known as cirrhosis. At a certain level of damage, the liver gradually loses all of its functions. This is known as liver failure, or end-stage liver disease.

Although liver failure can usually be managed for a short while by medication, there is no mechanical device, like a dialysis machine, that can replicate the workings of your liver. For long-term survival, the only treatment for liver failure is a liver transplant.

There are three types of liver transplant:

  • Deceased organ donation - this involves taking a liver from a person who has recently died and using it to replace a damaged liver (an allograft)
  • Living donor transplant - this involves taking a section of a healthy person's liver and transplanting this to the recipient. This method relies upon the regenerative capability of the liver, meaning that both the transplanted section and the donor's remaining section of liver are able to regrow to a normal size
  • Split liver transplantation - one liver from a donor who recently died is split between two recipients. Both pieces of liver will then grow to normal size.


History and progress of liver transplantation

In 1962 a surgical team, led by Dr Thomas Starzl, performed the first human liver transplant in the United States of America. It took repeated transplant attempts for many years before short-term success was achieved in 1967 when the recipient first survived for longer than a year.

Liver transplantation survival remained at levels of short-term success throughout the 1970s until the introduction of ciclosporin, an immuno-suppressant drug that reduces the body's natural tendency to reject new organs. The success of ciclosporin in preventing organ rejection was shown in kidney transplants by Sir Roy Calne and colleagues at the University of Cambridge, and in liver transplants performed by Dr Starzl at the University of Pittsburgh Hospital.

With markedly improved patient outcomes, by the 1980s liver transplantation had become a recognised standard clinical treatment for both adult and paediatric patients whose conditions indicated the need for a transplant. However, it remains a formidable procedure and can lead to serious complications.

The first altruistic living liver donation in the UK was performed in December 2012 in St James University Hospital Leeds.

Living donors

An organ donor is usually a person who has died, but in some cases a living donor (or donors) may be used who is compatible in size with the recipient and has a matching blood group. A live organ can come from a family member, a friend or even from a stranger. Thanks to improved medications, a genetic link between the donor and recipient is no longer required to ensure a successful transplant.

Transplant staff will discuss with you and your family the benefits and risks of donating a portion of your liver and answer your questions.

For more information about becoming a living donor for kidney transplantation, please read

Living Kidney Donation


You may wish to read our FAQs about living kidney donation

FAQ

Mini Glossary

  • Allograft:
    The replacement of a diseased liver with a healthy liver from another person
  • Cirrhosis:
    The result of chronic disease of the liver
  • Cyclosporin:
    An immunosuppressant drug widely used in organ transplantation to prevent rejection
  • Hepatic:
    Of, or relating to, the liver
  • Living donor:
    A healthy donor who donates part of their liver to someone in need of a transplant
  • Regeneration:
    The ability of the liver to regrow from as little as a quarter of its original size

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