Liver Transplantation Series Part 2: What Happens at End-Stage Liver Disease (ESLD)
If you missed it, check out Part 1 of our Liver Transplantation Series: The 4 Stages of Alcohol-Induced Liver Disease (ALD).
A diagnosis of End-Stage Liver Disease (ESLD) is one of the most devastating moments in a person’s life. It marks the point at which the liver can no longer function properly, and without intervention, survival becomes uncertain. But while this diagnosis is serious, it does not mean all hope is lost. Liver transplantation offers a path forward, and understanding the process can help patients and their loved ones navigate this difficult journey with courage and determination.
How Doctors Diagnose End-Stage Liver Disease
The diagnosis of ESLD is based on a combination of medical history, physical examinations, laboratory tests, and imaging studies. Doctors look for clear signs that the liver has sustained irreversible damage. Blood tests, known as liver function tests (LFTs), often reveal elevated bilirubin levels, low albumin, and increased liver enzymes. A crucial measure, the Model for End-Stage Liver Disease (MELD) score, helps assess the severity of liver failure and determines a patient’s priority for transplantation.
As liver function declines, symptoms of decompensation appear. Patients may develop jaundice, characterized by yellowing of the skin and eyes due to an excess of bilirubin. Ascites, a buildup of fluid in the abdomen, can cause significant discomfort and can lead to infections. Hepatic encephalopathy, a condition where toxins accumulate in the brain, results in confusion, personality changes, and difficulty concentrating. Additionally, internal bleeding from varices—enlarged blood vessels in the esophagus or stomach—can be life-threatening. Imaging tests such as ultrasounds, MRIs, or even liver biopsies may be used to confirm cirrhosis and assess the extent of damage.
The Emotional Toll of an ESLD Diagnosis
Being told that your liver is failing is an overwhelming experience. Fear and uncertainty often take hold, not only for the patient but also for their loved ones. For those whose liver failure is alcohol-related, emotions can be further complicated by guilt and regret. It is not uncommon for patients to feel hopeless, and some may even consider returning to drinking, believing that their fate is already decided. However, it is crucial to resist this temptation. Drinking alcohol after an ESLD diagnosis can immediately disqualify a patient from receiving a transplant.
The emotional burden of ESLD can be alleviated through counseling, liver transplant support groups, and open conversations with doctors and transplant coordinators. Many people who receive a liver transplant go on to live full and meaningful lives, making it vital to maintain hope and focus on the steps needed to qualify for this life-saving procedure.
Liver Transplant: The Only Viable Treatment
Unlike kidney disease, where dialysis can serve as a temporary solution, there is no equivalent treatment for liver failure. Once the liver reaches a critical state, the only cure is a transplant. Without one, the disease will continue to progress, leading to severe complications such as multi-organ failure and eventual death. For this reason, early evaluation for transplantation is essential for those diagnosed with ESLD.
The Process of Getting on the Transplant List
Being placed on the transplant list is not automatic; patients must undergo an extensive evaluation at a transplant center. This process includes medical tests to ensure the individual is healthy enough for surgery, as well as psychological assessments to determine emotional and mental readiness. Transplant teams also assess a patient’s ability to adhere to lifelong post-transplant care, including taking immunosuppressant medications and making necessary lifestyle changes.
For individuals with alcohol-related liver disease, maintaining documented sobriety is often a requirement. Many transplant centers enforce a minimum period of six months without alcohol before considering a patient for transplantation. Patients must also demonstrate that they have a strong support system in place, as recovery from a liver transplant requires caregivers who can assist during the postoperative period. Once a patient is deemed eligible, they are added to the United Network for Organ Sharing (UNOS) transplant list, where priority is determined based on their MELD score—the higher the score, the more urgent their need.
How Sobriety and Addiction Treatment Can Improve Candidacy
For patients with alcohol-related ESLD, entering an alcohol treatment program can significantly improve their chances of qualifying for a transplant. Rehabilitation programs, support groups like Alcoholics Anonymous (AA), and therapy sessions demonstrate a commitment to long-term sobriety, which is essential for ensuring that a transplanted liver remains healthy. Some transplant centers require active participation in such programs as a condition for listing a patient. By addressing addiction and maintaining sobriety, patients not only increase their eligibility for transplantation but also set the foundation for a healthier future post-surgery.
The Odds of Receiving a Liver Transplant & Life Expectancy with ESLD
The waiting time for a liver transplant varies widely. Some patients receive an organ within months, while others wait for years, depending on their MELD score, blood type, body size, and organ availability. Unfortunately, not all patients receive a transplant in time, and some succumb to complications of ESLD before a suitable liver becomes available.
Without a transplant, life expectancy in ESLD depends on the severity of liver failure and how well symptoms can be managed. Some patients can survive for several months or even a few years with medical treatment, while others deteriorate rapidly. Receiving a transplant dramatically improves survival rates, with many recipients going on to live decades post-surgery.
The Journey to Transplantation: Medical Treatments Leading Up to Surgery
While waiting for a transplant, patients undergo various medical treatments to manage their symptoms and maintain the best possible health. Medications such as diuretics help reduce fluid buildup from ascites, while lactulose helps prevent toxin accumulation in the brain, reducing the risk of hepatic encephalopathy. Patients at risk for internal bleeding may receive beta-blockers or undergo endoscopic procedures to manage varices. Regular medical checkups, proper nutrition, and staying as active as possible all contribute to better overall health, increasing the likelihood of a successful transplant when the time comes.
What Happens on Liver Transplant Surgery Day?
When a liver becomes available, the patient is called to the hospital immediately. Pre-operative preparation includes additional medical tests, IV fluid administration, and discussions with the surgical team. Once under anesthesia, the diseased liver is carefully removed, and the donor liver is implanted. Surgeons connect the new liver’s blood vessels and bile ducts, ensuring that it functions properly in its new home. The procedure typically lasts several hours, followed by intensive care monitoring to ensure the body does not reject the organ.
A New Beginning
A liver transplant — much like recovery from alcoholism — offers not just survival, but a second chance at life. The journey is long and often difficult, but for those who remain committed to their health and sobriety, the rewards are immeasurable. With the right medical care, emotional support, and personal determination, individuals who once faced a dire diagnosis can go on to live full, meaningful lives beyond ESLD.
Keep an eye out for Part 3 of our Liver Transplantation Series, in which we’ll discuss what life entails post surgery and beyond.If you or someone you know is struggling with alcohol or substance addiction, hope and healing are available. Get help today by calling (888) 339-5756 or emailing admissions@northstarrecoverycenter.com.
