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Conditions Leading to Liver Failure

Our integrated team approach and medical and surgical expertise give liver transplant patients at Barnes-Jewish Hospital more options than ever before. Our liver specialists are often able to develop strategies for patients that postpone their need for a transplant – sometimes forever. Conditions that can lead to liver transplantation include:

Liver transplants are used to treat patients with end-stage liver disease for whom standard medical and surgical therapies have failed. Each patient is evaluated individually for transplant to ensure the patient is healthy enough to survive the operation and is likely to do well for a long time after receiving a transplant.


  • Chronic hepatitis C is the most common indication for liver transplantation in the United States. The transplanted liver is infected with the virus 100% of the time. Antiviral medication can be used to treat the hepatitis C following the transplant;
  • Alcoholic liver disease is an indication for transplantation as long as the patient has not been drinking for at least 6 months prior to the transplant. Counseling, attendance at Alcoholics Anonymous meetings, and regular blood tests for alcohol may be required;
  • Autoimmune liver diseases, such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis, account for 15-20% of liver transplants;
  • Fatty liver disease (NAFLD) is a growing indication for transplantation. Obese patients are usually required to lose weight prior to transplantation;
  • Iron overload from hereditary hemochromatosis and copper overload from Wilson’s Disease lead to a small percentage of transplants each year.


Hepatocellular carcinoma (HCC), cancer of the liver cells, is the fifth most common cancer in the world. Unlike cancer that starts elsewhere in the body and then spreads to the liver, HCC starts in the liver. Individuals with cirrhosis, or scarring of the liver, are at particular risk for HCC. As a result of the increased number of people infected with hepatitis C, HCC is becoming more common in the United States.

The good news is that while liver cancer was once considered a death sentence, there is now effective treatment when HCC is caught at an early stage.

Individuals at risk for HCC:

  • Cirrhosis is the number one cause of HCC. Cirrhosis leads to an inability of the liver to function normally;
  • Alcohol-induced cirrhosis raises the risk for developing HCC 10-fold;
  • Individuals with hepatitis C have a 100-fold increased risk for developing HCC. Those with chronic hepatitis B infections and those who have suffered from hepatitis B for an extended time are also at high risk for HCC.
  • Individuals with hemochromatosis, an inherited disorder that causes the body to absorb and store too much iron leading to damage of the liver, are also at high risk for HCC.


Advanced treatments offered as alternatives to liver transplantation include:

  • liver resection or surgical removal of the cancer;
  • chemo-embolization - drugs are injected directly into the tumor to kill cancer cells and cut off the blood supply;
  • radio-embolization - radioactive microscopic glass spheres are injected into the tumor;
  • radio frequency (RF) ablation - a probe placed into the tumor uses radio waves to kill cancer cells and shrink the tumor.

Treatment options for those with HCC were once limited. But patients suffering from early liver cancer are now at a higher priority to receive donated livers. The average time on the waiting list for a donor liver averages 9-12 months.

While potential recipients are waiting, Barnes-Jewish hospital liver specialists use the latest treatments, including chemoembolization, radio-embolization or radiofrequency ablation, to shrink or even kill the tumor. Individuals with a tumor that has not spread to other organs and without cirrhosis may be able to undergo surgery in order to remove the tumor.

Those who are candidates for liver transplant to treat HCC include:

  • Patients whose primary liver cancer has not spread to other organs in the body;
  • Patients with Stage II (early stage) cancer with a single tumor less than 5 cm in size;
  • Patients with Stage II cancer with up to three tumors, each of which are no larger than 3 cm in size.

Liver tumors, however, are often found when they have already grown bigger than the size criteria for transplant. In these situations, treatments may be performed to reduce the size of the tumors to meet the criteria for a liver transplant. These treatments include:

  • Chemo-embolization
  • Radio-embolization
  • Radio frequency ablation

Survival after a liver transplant is promising. Once a patient receives a liver transplant, the chance of recurrence of cancer in the liver is very low.


Cholangiocarcinoma is cancer of the bile ducts - the tubes that drain bile from the liver into the small intestine. Cholangiocarcinoma is an uncommon cancer, with only about 2,000 cases diagnosed in the U.S. each year. Because the early symptoms of this cancer are silent, it can be hard to diagnose until the cancer is advanced.

If cholangiocarcinoma is diagnosed before the cancer has spread beyond the liver, liver transplantation is an option. The Washington University/Barnes-Jewish Hospital Liver Transplant team is one of just a handful of centers in the country with established cholangiocarcinoma treatment and transplant protocols.

For more information on the liver transplant program at Barnes-Jewish Hospital, call (866) 867-3627

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Find a doctor or make an appointment: 866.867.3627
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