The liver is unique: It is the only organ that can regrow.
This is good news for many people with primary biliary cholangitis (PBC). While treatment is increasingly able to slow disease progression, liver transplants are still needed in some cases. The liver’s ability to regrow means that waiting for a liver from a deceased donor isn’t the only option — you can receive part of a liver from a donor who is living.
What is a living donor transplant in PBC?
A living donor transplant involves taking a portion of a healthy person’s liver (up to 60%) and transplanting it into someone with PBC to replace their diseased liver. The liver in both the donor and the recipient then grows and regenerates.
By six weeks after surgery the liver will regain most of its original size, and it will continue to slowly grow for up to a year. The regrown liver will work the same as before the surgery (though there is enough of an impact that a living liver donor can only safely donate once in their lives).
Living donor transplants have many benefits for the recipient, from shorter wait times to faster recovery and excellent outcomes.
Who can be a living donor liver transplant?
Not everyone can be a living donor: There are several criteria that must be met. Those considering being a living donor must:
- Be between the ages of 18 and 60.
- Be in good physical and mental health.
- Have a compatible blood type with the recipient.
- Have a healthy liver.
- Have no history of substance abuse.
- Be free from major health issues such as cancer, hepatitis, organ disease or chronic infection.
- Have a BMI less than 32.
Are there risks?
A liver transplant is a major surgery for both the donor and the recipient. It is generally safe, but complications may occur.
Risks for the living donor include:
- Bleeding and/or infection at the incision site.
- Bile duct complications, such as leaks.
- Blood clots such as deep vein thrombosis or pulmonary embolism.
- Emotional stress.
- Issues with the regeneration of the liver (rare).
- Death (but this is rare).
For the liver recipient, the main risks are:
- Bleeding or infection as a result of the surgical intervention.
- Bile duct problems.
- Blood clots in the hepatic artery or portal vein.
- Rejection of the liver or graft failure.
- Infection due to reduced immunity.
- Recurrence of PBC.
- Long-term side effects of immunosuppressants.
To help ensure the best outcome, both the donor and recipient will need to stay in the hospital for around a week after the procedure. Recovery from surgery will take several weeks. The donor and recipient will need to prioritize rest during this time: They may need several weeks off from work, and must avoid heavy lifting, among other recommendations.
When is a liver transplant necessary in PBC?
In many cases, a liver transplant is the only effective treatment for end-stage liver disease. In people living with PBC, if other treatments are unsuccessful in slowing progression, over time the disease can eventually lead to liver failure.
Many factors go into determining if a person with PBC should receive a liver transplant. To be an eligible recipient, a patient with PBC must be in good overall health, be able to undergo major surgery and have a good support system.
Sign up here to get the latest news, perspectives, and information about PBC sent directly to your inbox. Registration is free and only takes a minute.
