Is Logan’s Liver In For The Long Haul?

I’ve had daily conversations with the doctors and surgeons about almost everything related to my condition. When I was relisted for a transplant on April 21, my current liver – the one from Logan – was not doing well. The hepatic artery collapsed twice and still hasn’t opened; and it probably never will. This is a serious complication and basically means there is poor blood flow in the liver.  This is called “Small-for-size syndrome“, and there is plenty of medical literature trying to make heads and tails of it, reduce the risk, and understand it better.

Short term, it’s more difficult for the liver to function and even harder to grow to full size. This was evident in the liver function blood tests they did at the time and there was a real concern on whether it would continue working. Luckily for me, Logan never gives up and neither did her liver. “The little liver that could” has been chugging away, the liver profile is much better, and I’m no longer in dire straits, but currently stable with a mostly functioning and growing liver. The small liver in me still has its complications. The major one is the ascites, or “liver sweat”. The liver is not big enough yet and doesn’t have enough protein to filter all the junk travelling through my system, so it sweats out liquid instead of trying to process it inside the liver. I’m hooked up to a low pressure wall vacuum which collects the approximately 2 liters of “liver sweat” produced every day.  I’m also hooked up to an IV for saline to replenish the loss of fluid because let’s be serious – I could not drink enough fluid to keep up with the liver sewat. The doctors say it’ll take about a month of eating and my body processing the food to regrow the liver, add the necessary protein, and eliminate the ascites problem. If this current liver is in for the long haul, it’s still got a lot of growing to do before I get to take it home.

Long term, there is an unknown quality issue. It could be fine, but there could be complications from the hepatic artery thrombosis.  One example given was secondary sclerosing cholangitis – basically the disease that was supposed to be eradicated with this liver transplant, but instead of “primary”, it’s “secondary”.  There are also other complications they’ve talked about that could cause hospitalizations in a few months or years after I’m discharged with the “live donor healthy liver”. The surgeons are very aware that I’m 34 years old, and they want a known good liver that will last me another 40+ years with no questions.  Since I have a decent functioning liver, they can afford to be choosy and get the best option when it comes along, not just something that’s questionable integrity or settle with what I currently have.

In an ideal world, there would be the perfect cadaver liver and although surgery is no walk in the park, installing a full cadaver liver is more fool proof than live organ donation. For one, there are two lobes being installed – twice the number of veins and arteries! – and after surgery there is no need for regrowth; it’s already full size. But it’s been 3 weeks of waiting and the perfect liver has not been found yet.  I have discussed this with the surgeons, who are surprised at the wait time and dearth of organ donors right now.  But, that will all be discussed in a separate post later on.

To answer the initial question: Is Logan’s Liver In For The Long Haul?  I don’t think so.  I think the surgeons will replace Logan’s liver with a cadaver liver because that’s viewed as the best option for long term survivability with no complications. Until then, Logan’s liver still needs to chug away to keep me healthy and give the team a chance to find that perfect liver. And if the perfect liver doesn’t exist, this liver just might do the job.