Liver transplant

Liver transplant is a surgical procedure performed to remove your diseased or injured liver and replace it with a whole or a portion of a healthy liver from another person, called the donor. Since the liver is the only organ in the body able to regenerate, a transplanted segment of a liver can grow to normal size within weeks ¹. If your liver stops working properly, called liver failure, a liver transplant can save your life.

In 2015, about 7,100 liver transplants were performed in the United States. Of these, almost 600 were performed in patients 17 years of age and younger ².

The donated liver may be from:

A donor who has recently died and has not had liver injury. This type of donor is called a cadaver donor.
Sometimes, a healthy person will donate part of his or her liver to a person with a diseased liver. For example, a parent may donate to a child. This kind of donor is called a living donor. The liver can regrow itself. Both people most often end up with fully working livers after a successful transplant.

The donor liver is transported in a cooled salt-water (saline) solution that preserves the organ for up to 8 hours. The necessary tests can then be done to match the donor with the recipient.

The new liver is removed from the donor through a surgical cut in the upper abdomen. It is placed into the person who needs the liver (called the recipient) and attached to the blood vessels and bile ducts. The operation may take up to 12 hours. The recipient will often need a large amount of blood through a transfusion.

Types of liver transplant

Deceased donor liver transplants

Most livers for transplants come from people who have just died, called deceased donors. During a deceased donor transplant, surgeons remove your diseased or injured liver and replace it with the deceased donor’s liver. Adults typically receive the entire liver from a deceased donor. However, surgeons may split a deceased donor’s liver into two parts. The larger part may go to an adult, and the smaller part may go to a smaller adult or child.

Living donor liver transplants

Sometimes a healthy living person will donate part of his or her liver, most often to a family member who is recommended for a liver transplant. This type of donor is called a living donor. During a living donor transplant, surgeons remove a part of the living donor’s healthy liver. Surgeons remove your diseased or injured liver and replace it with the part from the living donor. The living donor’s liver grows back to normal size soon after the surgery. The part of the liver that you receive also grows to normal size. Living donor transplants are less common than deceased donor transplants.

Most living liver donors are close family members or friends of the liver transplant candidate. If you have a family member or friend who is willing to donate part of his or her liver to you, talk to your transplant team about this option.

Living-donor transplants have good results, just as transplants using livers from deceased donors. But finding a good living liver donor match is difficult due to restrictions on the donor’s age, blood type, size and health. The surgery also carries significant risks for the donor.

Your transplant team can discuss the benefits and risks with you and the potential donor.

Domino liver transplant

Another, less common, type of living-donor liver transplant is called a domino liver transplant. In a domino liver transplant, you receive a liver from a living donor who has familial (hereditary) amyloidosis. Familial amyloidosis is a very rare disorder in which abnormal protein deposits accumulate and eventually damage the body’s internal organs.

The donor with familial amyloidosis receives a liver transplant to treat his or her condition. Then, the donor can give his or her liver to you in a domino liver transplant, because the liver still functions well. You may eventually develop symptoms of amyloidosis, but it usually takes decades to develop.

Doctors usually select recipients who are 60 years old or older and who aren’t expected to develop symptoms before the end of their natural life expectancy. After your transplant, doctors will monitor you for signs of the condition.

Doctors will evaluate you to determine if you may be a candidate for a domino liver transplant or if another procedure would be more appropriate for your condition.

Benefits of a living-donor liver transplant

In the U.S., more than 17,500 patients are waiting to receive a liver. Every day more patients are added to the waiting list. More than 6,000 patients receive transplanted livers every year, but more than 1,700 patients die each year while waiting. Liver transplants are given to patients on the basis of how sick they are. Each patient waiting for a liver transplant is given a “score” called the “Model for End-stage Liver Disease” (MELD). Patients with a higher MELD score are very sick, so they have a better chance of getting a liver transplant sooner.

A living-donor transplant means a patient can have a transplant before their liver failure gets worse. It means a shorter wait time for a liver. Because the surgery can be planned in advance, the chance for a successful transplant is better. Also, the quality of the liver may be better, because living donors are usually young, healthy adults who have gone through a complete medical evaluation. With a living-donor transplant, the preservation time (the time when the liver is without blood) is usually minutes, instead of hours.

How many living-donor liver transplants are performed each year?

In the past, less than 5% of all liver transplants in this country were living-donor transplants. Today, more than 200 patients get living-donor transplants every year, while about 6,000 have transplants from deceased donors.

Who can become a liver donor?

People who want to donate their liver go through a complete medical exam to make sure their liver is healthy and that it is safe for them to donate. Safety is important for both the donor and the recipient. The risk of death is real. Talk about the risks with your doctor.

In general, liver donors must:

Be at least 18 years old. Most donors are also under 60 years old.
Be in good health with no major medical or mental illnesses.
Be a non-smoker for at least four to six weeks before surgery.
Be able to understand and follow instructions before and after surgery.
Have a compatible blood type.
Have an emotional tie with the recipient.
Not have a selfish motive for donating. Paid donation is illegal in the U.S.
Have a similar body size.
Be able to go through certain medical tests like blood work, radiology studies, and possibly a liver biopsy.

A person should feel no pressure to donate part of his or her liver; nor should any money be given or received. It is against the law for people to sell their body parts.

What are the major risks of living donor liver donating?

Most living liver donors recover fully after the operation and can do normal activities within a few months after the surgery. However, as with any major surgery, there are risks.

A donor may develop some problems during or right after the operation. They might also experience problems months or years later. Removing more than half of the liver is a major operation that has some risks. Some of the risk involves specific problems that can occur in and around the liver after surgery. These problems include bleeding, infection, bile leaks, or damage to the bile tree (the ducts that run through the liver). Bile is a digestive juice made by the liver.

Other risks can come from anesthesia and general surgery. You could have a reaction to the anesthetic, or you could get pneumonia. You could have problems because of the tubes that will be inserted in your mouth, arteries, and veins. Your blood pressure could change during the operation. There is also a risk of blood clots in your legs.

Although there is a 38% chance a donor could have complications from the surgery, the most common problem is a bile leak. In rare cases, a donor may die as a result of the operation. Or, if the remaining piece of the liver is damaged, the donor may also need a liver transplant. The estimated risk of dying from the transplant operation is about 1 in 500.

Sometimes donors do not have problems until months or years after the surgery. One of the most common problems is stomach pain and bulges or hernias around the scar. The bulges can usually be fixed with surgery.

During your medical exam, ask the transplant team about these risks. You may also want to talk to a donor who has already gone through the surgery and can talk about his or her experiences.

What happens during living donor liver transplant surgery?

The donor’s liver is split into two parts. One part is removed for the transplant. The surgeon then closes the wound with sutures or staples. These are later removed at a follow-up visit to the surgeon’s office. The remaining liver begins to heal and grow new tissue. It takes about six to eight weeks for the liver to grow back to normal size.

How long does a living donor usually stay in the hospital?

Donors stay in the hospital from four to seven days after surgery, longer if problems occur. You will usually spend the first night after surgery in the intensive care unit (ICU). The next day, you may be moved to a surgical floor where nurses have experience caring for liver donors. The nurses will encourage you to get out of bed and sit in a chair the day after surgery and to walk as soon as you are able.

How long will a full recovery take for living liver donor?

For the most part, it takes about four weeks to recover from surgery. For a month after leaving the hospital, you will go to the clinic for frequent check-ups. Most people get back to work within eight to 10 weeks, but this differs from person to person. The medical staff will say when it is safe to return to normal life. Federal employees can get a special leave for being organ donors. Other employers have similar programs, so check with your boss to see if your company offers special leave.

What will it cost for me to donate my liver?

The recipient’s health insurance pays for the donor’s health care costs. This includes the costs of the check-up, doctors’ fees, hospital costs, and follow-up visits after surgery. However, certain costs are usually not covered by insurance or the hospital. These include travel, lodging, loss of income (from time off work), and other related expenses. In some cases, these costs may be several thousand dollars, depending on your distance from the transplant center and your loss of income. You should think about these important financial issues when you consider being a donor.

Orthotopic liver transplant

Orthotopic liver transplantation is when a donor liver is transplanted into normal anatomic position.

Heterotopic liver transplant

Heterotopic liver transplantation is when a donor liver is placed within the abdominal cavity with patient’s native organ occupying the normal liver anatomic position Problems with heterotopic liver transplantation is difficulty to accommodate an extra organ in abdomen with a complex blood supply with danger of multiple anastomosis leak, kinking or compromised blood flow.

What are reasons for a liver transplant

A healthy liver performs more than 400 jobs each day, including:

Making bile, which is important in digestion
Making proteins that help with blood clotting
Removing or changing bacteria, medicines, and toxins in the blood
Storing sugars (glycogen), fats, iron, copper, and vitamins
Making proteins that your body must have.
It helps use and store vitamins.
It makes chemicals that protect the body.

People need a liver transplant when their liver fails due to disease or injury.

The most common reason for a liver transplant in children is biliary atresia ².

The most common reason for a liver transplant in adults is cirrhosis ². Cirrhosis is scarring of the liver that prevents the liver from working well. It can worsen to liver failure. The most common causes of cirrhosis are:

Long-term infection with hepatitis B or hepatitis C
Long-term alcohol abuse
Cirrhosis due to non-alcoholic fatty liver disease

For adults in 2016 in the United States, the most common reasons for needing a liver transplant were ²:

Alcoholic liver disease
Cancers that start in the liver combined with cirrhosis
Fatty liver disease (nonalcoholic steatohepatitis)
Cirrhosis caused by chronic hepatitis C

Other illnesses that may cause cirrhosis and liver failure include:

Autoimmune hepatitis
Hepatic vein blood clot (thrombosis)
Liver damage from poisoning or medicines
Problems with the drainage system of the liver (the biliary tract), such as primary biliary cirrhosis or primary sclerosing cholangitis
Metabolic disorders of copper or iron (Wilson disease and hemochromatosis)

Doctors may consider a liver transplant to treat rare disorders such as urea cycle disorders and familial hypercholesterolemia ³.

People may also need a liver transplant due to acute liver failure. Acute liver failure is an uncommon condition most often caused by taking too much acetaminophen ⁴.

Other causes of acute liver failure include:

bad reactions to prescription medicines, illegal drugs, and herbal medicines
viral hepatitis
toxins
blockage of the blood vessels to the liver
autoimmune diseases
genetic disorders

Liver transplant for children

There are two main concerns about liver transplant for children. They are the cause of the liver failure in the first place, and if there are enough livers for children who need transplants.

There are several reasons a child might need a liver transplant:

Biliary atresia. This is a disease that destroys a child’s bile ducts within the first few months of life. It is the most common reason for liver transplants in children.
Problems digesting and using food. Children can be born with diseases called “inborn errors of metabolism.” They include:
- Alpha-1-antitrypsin deficiency, tyrosinemia, and Wilson’s disease.
- Lipid storage diseases (Gaucher’s disease, Niemann-Pick disease, Wolman’s disease, cholesterol ester storage disease)
- Carbohydrate storage diseases (galactosemia and glycogen storage diseases)
Liver cancers. Some liver cancers (hepatoblastoma) are found only in children.
Acute liver failure. This is a sudden liver failure that can cause death. Acute liver failure can come from many causes like toxins, too much medication, drugs or viruses. In this kind of liver failure, a liver transplant can cure the problem if it is done early.

What are the donor organ options for children?

Reduced-size liver graft. A piece of a liver is taken from a brain-dead person (deceased donor).
Split-liver transplant. A liver from a deceased donor is cut in two. A small piece is used for transplant in a child and a larger piece is used for transplant in an adult.
Living-donor transplant. A piece of a liver comes from an adult living donor and is used as a transplant for a child. Over the past 10 years, nearly 1,000 of these transplants have been done in the world. They have been just as successful as transplants of whole organs. There are some risks of adult donation for transplant to a child. These risks seem to be much smaller than the risks of a living donor transplant to an adult.

Is it difficult to do a transplant on a child?

Yes, for several reasons. First, the blood vessels in children are very small. Transplants on children under one year of age may be even harder to do. And, the care after surgery must be done in ICUs that can handle small children.

Do children get the same anti-rejection drugs as adults?

In general, children get the same type of drugs that adults get, but children may have different side effects. For this reason, doctors who specialize in this field should do the follow-up care.

What makes a transplant successful?

Three thing help make a transplant successful.

Good medical care
Doing exactly what the doctors tell you to do
Good communication between the patient, family, and medical teams

Children who get liver transplants will need to take drugs as prescribed and see their doctors often. They may need more tests and evaluation of their growth and development than children who have not had a transplant. Children can have long, healthy lives after transplant. As a parent, make sure you stay in touch with your child’s transplant team, and follow their advice. Ask for counseling when you have any problems.

When is a liver transplant not recommended

Liver transplant surgery is often not recommended for people who have:

Certain infections, such as tuberculosis or osteomyelitis
Difficulty taking medicines several times each day for the rest of their lives
Heart or lung disease (or other life-threatening diseases)
History of cancer
Infections, such as hepatitis, that are considered to be active
Smoking, alcohol or drug abuse, or other risky lifestyle habits.

The Liver Transplant Process

The liver transplant process has many steps, including talking with your doctor, visiting a transplant center, and getting evaluated.

Talk with your doctor about a liver transplant

The first step is to talk with your doctor to find out whether you are a candidate for a transplant. Your health care provider will refer you to a transplant center. Doctors at the transplant center will consider liver transplants only after they have ruled out all other treatment options. However, a liver transplant is not for everyone. Your liver transplant doctor may tell you that you are not healthy enough for surgery. You may have a medical condition that would make a liver transplant unlikely to succeed. If you and your doctor think a liver transplant is right for you, your doctor will refer you to a transplant center.

Your transplant team

Your transplant team has many members. The team will include all or some of the following people:

transplant coordinator—a specially trained nurse who will be your point of contact, arrange appointments, and provide information and education before and after your transplant.
transplant surgeons—specially trained doctors who perform the surgery and provide care before and after your transplant.
hepatologist—a doctor who specializes in liver disease and may provide care before and after your surgery.
insurance case manager—a person who will help you with your insurance coverage.
financial coordinator—a person who helps with financial matters.
social worker—a person who can help solve problems in your daily life and coordinate care needs after your transplant.
psychiatrist—a doctor who determines whether you are mentally and emotionally healthy and prepared for caring for a new liver.
dietitian—an expert in food and nutrition. A dietitian can teach you about the foods you should eat and how to plan healthy meals before and after your transplant.

Choosing a transplant center

If your doctor recommends a liver transplant, you may be referred to a transplant center. You’re also free to select a transplant center on your own or choose a center from your insurance company’s list of preferred providers.

When you’re considering transplant centers, you may want to:

Learn about the number and type of transplants the center performs each year
Ask about the transplant center’s liver transplant survival rates
Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients (https://www.srtr.org/)
Understand the costs that will be incurred before, during and after your transplant. Costs will include tests, organ procurement, surgery, hospital stays, and transportation to and from the center for the procedure and follow-up appointments
Consider additional services provided by the transplant center, such as coordinating support groups, assisting with travel arrangements, helping with local housing for your recovery period and offering referrals to other resources
Assess the center’s commitment to keeping up with the latest transplant technology and techniques, which indicates that the program is growing

Visit a transplant center

During your first visit to a transplant center, health professionals will provide information about:

the evaluation and approval process
placement on the national waiting list
reasons for being removed from the national waiting list
the waiting period
how people are selected for liver transplants
surgery and recovery
the long-term demands of living with a liver transplant, such as taking medicines for the rest of your life.

Get evaluated for a liver transplant

You will go through a series of evaluations at the transplant center, where you will meet members of your transplant team. You may need to visit the transplant center several times over the course of a few weeks or even months.

Your transplant team will ask you about your medical history and perform medical tests. These tests may include:

a physical exam
blood and urine tests
tests that provide pictures of organs inside your body, called imaging tests
tests to see how well your heart, lungs, and kidneys are working

Your transplant team will want to make sure that you are a good candidate for a liver transplant. You will make a few visits over several weeks or months. You will need to have blood drawn and x-rays taken.

Your transplant team will use the results of these tests to tell them:

how likely you are to survive transplant surgery
what other diseases and conditions you have
the cause and severity of your liver disease

Your transplant team will find out if you are healthy enough for surgery. Some medical conditions or illnesses can make a liver transplant less likely to succeed. You may not be able to have a transplant if you have:

a severe infection
alcohol or drug abuse problems
cancer outside the liver
serious heart or lung disease

Also, your transplant team will:

find out whether you or your caregivers are able to understand and follow your doctor’s instructions for care after your transplant. They need to be sure you are mentally prepared for caring for a new liver.
find out whether you have a good support system of family members or friends to help care for you before and after the transplant.
review your medical insurance and other financial resources. Many financial assistance programs are available to people receiving a liver transplant and their families to help with the cost of the surgery, medicines, and care.

If you are the person getting the new liver, the following tests will be done before the procedure:

Tissue and blood typing to make sure your body will not reject the donated liver
Blood tests or skin tests to check for infection
Heart tests such as an EKG, echocardiogram, or cardiac catheterization
Tests to look for early cancer
Tests to look at your liver, gallbladder, pancreas, small intestine, and the blood vessels around the liver
Colonoscopy, depending on your age

You may choose to look at one or more transplant centers to determine which is best for you.

Ask the center how many transplants they perform every year, and their survival rates. Compare these numbers to those of other transplant centers.
Ask what support groups they have available, and what travel and housing arrangements they offer.

Get approved for a liver transplant

The transplant center’s selection committee will review the results of your evaluation. Each transplant center has its own guidelines about who can get a liver transplant. Transplant centers often post their guidelines on their websites. The centers also follow national guidelines.

Keep in mind that you may choose not to have a transplant even though you have been approved.

If the transplant team thinks you are a good candidate for a liver transplant, you will be put on a national waiting list.

Your place on the waiting list is based on a number of factors. Key factors include the type of liver problems you have, how severe your disease is, and the likelihood that a transplant will be successful.
The amount of time you spend on a waiting list is most often not a factor in how soon you get a liver, with the possible exception of children.

Get placed on the national waiting list

If you are approved for a transplant and do not have a living donor, the transplant center will submit your name to be placed on the national waiting list for a liver from a deceased donor. If you have a living donor, the transplant center will not place you on the national waiting list.

The Organ Procurement and Transplantation Network (https://optn.transplant.hrsa.gov/) has a computer network linking all regional organ-gathering organizations—known as organ procurement organizations—and transplant centers. The United Network for Organ Sharing (https://unos.org/), a nonprofit organization, runs the Organ Procurement and Transplantation Network (https://optn.transplant.hrsa.gov/) under a contract with the Federal Government. When United Network for Organ Sharing (https://unos.org/) officially adds you to the national waiting list, the United Network for Organ Sharing (https://unos.org/) will notify you and your transplant center.

The United Network for Organ Sharing (https://unos.org/) policies let you register with more than one transplant center to increase your chances of receiving a liver. Each transplant center may require a separate medical evaluation.

Wait for a match

The waiting period for a deceased donor transplant can range from less than 30 days to more than 5 years ². How long you will wait depends on how badly you need a new liver. Other factors—such your age, where you live, your blood type and body size, your overall health, and the availability of a matching liver—may make your wait time longer or shorter. The United Network for Organ Sharing computer matches a deceased donor’s liver based on your blood type and body size.

The United Network for Organ Sharing policies rank people with the most urgent need for a new liver to prevent death at the top of the national waiting list.

When a matching liver from a deceased donor is found, your transplant team coordinator will call you right away, tell you what you need to do before going to the hospital, and ask you to come to the hospital right away.

While you are waiting for a liver, follow these steps:

Follow any diet your transplant team recommends.
Do not drink alcohol.
Do not smoke.
Keep your weight in the appropriate range. Follow the exercise program your provider recommends.
Take all medicines prescribed for you. Report changes in your medicines and any new or worsening medical problems to the transplant team.
Follow-up with your regular provider and transplant team at any appointments that have been made.
Make sure the transplant team has your correct phone numbers, so they can contact you immediately if a liver becomes available. Make sure that, no matter where you are going, you can be contacted quickly and easily.
Have everything ready ahead of time to go to the hospital.

Confirm living donor match if you choose this type of liver transplant

If a family member, spouse, or friend wants to be a living donor, the transplant team will determine whether you and the person have blood types that work together and a similar body size.

Your transplant team will:

ask the potential donor about his or her medical history
perform medical tests to make sure the person is in good general health, with no major medical or mental illnesses

The potential donor must be able to understand and follow instructions before and after surgery, be between the ages of 18 and 60, and have an emotional tie to the person receiving the liver transplant.

The Organ Procurement and Transplantation Network and the United Network for Organ Sharing provide detailed information on the organ transplant process.

Liver transplant surgery preparation

How you prepare for liver transplant surgery depends on the type of liver transplant you are having.

Deceased donor liver transplant. If you are on the national waiting list for a deceased donor liver, your transplant team coordinator will call you as soon as a matching liver is found. You must go to the hospital right away. Your transplant team coordinator will tell you what you need to do before going to the hospital.
Living donor liver transplant. If you are receiving a liver from a living donor, you will schedule your surgery 4 to 6 weeks in advance. Your transplant team coordinator will tell you and the donor what you need to do before going to the hospital for the operations.

Liver transplant criteria

Each transplant center has its own guidelines about who can get a liver transplant. Transplant centers often post their guidelines on their websites. The centers also follow national guidelines.

Your transplant team will ask you about your medical history and perform medical tests. These tests may include:

a physical exam
blood and urine tests
tests that provide pictures of organs inside your body, called imaging tests
tests to see how well your heart, lungs, and kidneys are working

Your transplant team will use the results of these tests to tell them:

how likely you are to survive transplant surgery
what other diseases and conditions you have
the cause and severity of your liver disease

Doctors use results of liver function tests and other factors to determine your prognosis and your place on the liver transplant waiting list.

Your prognosis is often called your Model for End-Stage Liver Disease (MELD) or Pediatric End-Stage Liver Disease (PELD) score for children younger than age 12.

MELD scores range from 6 to 40. The scores estimate the risk of death within 90 days without a transplant. The higher your MELD score, the more dire your situation.

Organs are allocated according to MELD scores and stratified by blood type. People with higher MELD scores are generally offered donated livers first. Time spent on the liver transplantation waiting list is used to break ties among people with the same MELD scores and blood type.

Some liver conditions, such as liver cancer, may not result in a person getting a high MELD score. The transplant center can request additional MELD points for people with specific diseases if they meet defined exception criteria.

In addition, adults with acute liver failure are exempted from the MELD-based donor organ prioritization system and may be placed higher on the list according to their disease status.

a severe infection
alcohol or drug abuse problems
cancer outside the liver
serious heart or lung disease

Also, your transplant team will:

find out whether you or your caregivers are able to understand and follow your doctor’s instructions for care after your transplant. They need to be sure you are mentally prepared for caring for a new liver.
find out whether you have a good support system of family members or friends to help care for you before and after the transplant.
review your medical insurance and other financial resources. Many financial assistance programs are available to people receiving a liver transplant and their families to help with the cost of the surgery, medicines, and care.

If you are the person getting the new liver, the following tests will be done before the procedure:

Tissue and blood typing to make sure your body will not reject the donated liver
Blood tests or skin tests to check for infection
Heart tests such as an EKG, echocardiogram, or cardiac catheterization
Tests to look for early cancer
Tests to look at your liver, gallbladder, pancreas, small intestine, and the blood vessels around the liver
Colonoscopy, depending on your age.

Liver transplant surgery

Doctors perform liver transplant surgery by removing your diseased or injured liver and replacing it with the donor’s liver. Liver transplant surgery can take up to 12 hours or longer. During the liver transplant surgery, the surgical team will:

give you general anesthesia
put intravenous (IV) and other types of lines into your body so you receive medicines and fluids
monitor your heart and blood pressure

If you are getting a liver from a deceased donor, your surgery will start when the donor liver arrives at the transplant center. If you are getting a liver from a living donor, the surgical team will operate on you and your donor at the same time.

Deceased-donor liver transplant

If you’re notified that a liver from a deceased donor is available, you’ll be asked to come to the hospital immediately. Your health care team will admit you to the hospital, and you’ll undergo an exam to make sure you’re healthy enough for the surgery.

Liver transplant surgery is done using general anesthesia, so you’ll be unaware during the procedure.

The transplant surgeon makes a long incision across your abdomen to access your liver. The location and size of your incision varies according to your surgeon’s approach and your own anatomy.

The surgeon disconnects your liver’s blood supply and the bile ducts and then removes the diseased liver. The donor liver is then placed in your body, and blood vessels and bile ducts are reattached. Surgery can take up to 12 hours, depending on your situation.

Once your new liver is in place, the surgeon uses stitches and staples to close the surgical incision. You’re then taken to the intensive care unit to begin recovery.

Living-donor liver transplant

If you’re receiving a liver transplant from a living donor, surgeons will transplant a portion of the donor’s liver in your body.

Surgeons first operate on the donor, removing the portion of the liver for transplant. Then surgeons remove your diseased liver and place the donated liver portion in your body. They then connect your blood vessels and bile ducts to the new liver.

The transplanted liver portion in your body and the portion left behind in the donor’s body regenerate rapidly, reaching normal volume within a couple months.

Liver transplant risks

Possible problems of liver transplant surgery should be discussed with your surgeon.

Risks for any anesthesia are:

Problems breathing
Reactions to medicines

Risks for any surgery are:

Bleeding
Heart attack or stroke
Infection

Some possible problems associated with liver transplant include:

bleeding
blood clots in your liver’s blood vessels
damage to the bile ducts
failure of the donated liver
infection
rejection of the donated liver

Liver transplant surgery and management after surgery carry major risks. There is an increased risk for infection because you must take medicines that suppress the immune system to prevent transplant rejection. Signs of infection include:

Diarrhea
Drainage
Fever
Jaundice
Redness
Swelling
Tenderness

Liver transplant complications

You will need more tests after leaving the hospital. These tests will help your doctors keep track of how you and your new liver are doing. You will have blood tests, ultrasounds, or x-rays. Your doctors will monitor you closely to help prevent and treat these conditions:

Acute rejection. Most rejection happens while you are still in the hospital, but it can happen at any time. Rejection can be treated with drugs. You may need a liver biopsy to confirm the presence of rejection and/or to monitor your response to treatment.
Your liver disease comes back. The diseases that damaged your liver in the first place may come back in the new liver. They can damage your liver a little bit or a lot. The disease can often be treated easily, but sometimes a second transplant is needed.
Cancer. People who have organ transplants are at a higher risk for some cancers, especially skin cancer. These cancers may spread faster than they do in people without transplants. Because of this, you will need to get screened for cancer.
Other medical complications. Transplant patients can get infections, high blood pressure, diabetes, high cholesterol, thinning of the bones, and become obese.

Anti-rejection medication side effects

After a liver transplant, you’ll take medications for the rest of your life to help prevent your body from rejecting the donated liver. These anti-rejection medications can cause a variety of side effects, including:

Bone thinning
Diabetes
Diarrhea
Headaches
High blood pressure
High cholesterol

Because anti-rejection drugs work by suppressing the immune system, they also increase your risk of infection. Your doctor may give you medications to help you fight infections.

Liver transplant recovery

After your liver transplant surgery, you will stay in an intensive care unit (ICU). Specially trained doctors and nurses will watch you closely while you’re in the ICU. You’ll begin taking medicines called immunosuppressants to prevent problems with your new liver.

Your doctors and nurses will perform:

blood tests often to make sure your new liver is working properly
medical tests to make sure your heart, lungs, and kidneys are also working properly

When your doctors feel you are ready, you will move from the ICU to a regular room in the hospital.

If you received a donated liver, you will likely need to stay in the hospital for a week or longer. After that, you will need to be closely followed up by a doctor for the rest of your life. You will have regular blood tests after the transplant.

The recovery period is about 6 to 12 months. Your transplant team may ask you to stay close to the hospital for the first 3 months. You will need to have regular check-ups, with blood tests and x-rays for many years.

Your transplant team will teach you how to take care of yourself before you get home. Transplant team members will give you information on follow-up medical care, the things you need to do to care for your new liver, and possible problems you may have with your new liver.

After a living donor’s surgery, the donor will stay in a recovery room for a few hours and spend his or her first night in an ICU. Specially trained doctors and nurses will watch the donor closely in the ICU. The day after surgery, the donor will usually move to a hospital room. The doctors and nurses will encourage the donor to get out of bed and sit in a chair the day after surgery and to walk short distances as soon as he or she is able.

When can I go home after liver transplant surgery?

You can likely go home about 2 weeks after your transplant surgery. A living donor can typically go home about 1 week after surgery.

Rules for going home

Stay away from people who are sick.
Tell your doctors if you are exposed to any disease.
Wash your hands often.
Always tell your doctors if you get a cold sore, rash, or small water blisters on your body.
Tell your doctors about any spots that show up in the back of your throat, or a white coating on your tongue. This coating is known as thrush. It is a fungal or yeast infection. Women can also get a vaginal yeast infection.
Stay away from crowds and rooms with poor circulation. Make sure vents in your home are cleaned often by professionals.
Learn the signs of infection.
Stay away from houseplants or garden soil during the high-risk period.
Do not swim in any lakes or community pools during the high-risk period.
Make sure your meat is cooked well, and remember to wash your hands after handling raw meat.
Be sure to follow your nutrition plan. What you eat and how well you eat after your transplant will affect how well you recover.

When can I go back to my normal activities?

Your doctor will let you know when you can go back to your normal activities. You can likely return to your normal activities after a few months. Most people are able to return to work, be physically active, and have a normal sex life. You will continue to have regular medical checkups to make sure that your liver is working properly and you have no other health problems. Doctors often recommend that women wait at least a year after their transplant before getting pregnant.

Although recovery times vary, most living donors can often return to their normal activities 1 month after surgery and can return to work within 4 to 6 weeks.

Liver transplant life expectancy

People who receive a liver transplant may reject the new organ. This means that their immune system sees the new liver as a foreign substance and tries to destroy it.

To avoid rejection, almost all transplant recipients must take medicines that suppress their immune response for the rest of their lives. This is called immunosuppressive therapy. Although the treatment helps prevent organ rejection, it also puts people at a higher risk for infection and cancer.

If you take immunosuppressive medicine, you need to be regularly screened for cancer. The medicines may also cause high blood pressure and high cholesterol, and increase the risks for diabetes.

A successful transplant requires close follow-up with your provider. You must always take your medicine as directed.

Liver transplant survival rate

Your chances of a successful liver transplant and long-term survival depend on your particular situation. For patients receiving liver transplants from deceased donors, the survival rates are ²:

86 percent at 1 year
78 percent at 3 years
72 percent at 5 years

The 20-year survival rate is about 53 percent ⁵.

In general, about 70 percent of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 70 will live for five years and 30 will die within five years.

People who receive a liver from a living donor often have better short-term survival rates than those who receive a deceased-donor liver. But comparing long-term results is difficult because people who have a living donor usually have a shorter wait for a transplant and aren’t as sick as those who receive a deceased-donor liver.

Survival rates among liver transplant recipients also vary among U.S. transplant centers and can be found online at the Scientific Registry of Transplant Recipients.

Living with a liver transplant

After a liver transplant, you will need to see your doctor often to make sure your new liver is working properly. You will have regular blood tests to check for signs of organ rejection and other problems that may damage your new liver.

What is organ rejection?

Organ rejection occurs when your immune system sees your transplanted liver as “foreign” and tries to destroy it. You have the highest chance of organ rejection in the first 3 to 6 months after your transplant.5

What are the signs and symptoms of organ rejection?

Abnormal liver blood test results may be the first sign of organ rejection. Rejection does not always cause symptoms you may notice. When symptoms of rejection are present, they may include:

feeling tired
pain or tenderness in your abdomen
fever
yellowing of the skin and the whites of your eyes
dark-colored urine
light-colored stools

You should talk with your doctor right away if you have symptoms of organ rejection. Your doctor will often perform a liver biopsy to see if your body is rejecting the new liver.

How can I prevent organ rejection?

To help keep your body from rejecting the new liver, you will need to take medicines called immunosuppressants. These medicines prevent and treat organ rejection by reducing your immune system’s response to your new liver. You may have to take two or more immunosuppressants. You will need to take these medicines for the rest of your life.

Rejection can occur any time the immunosuppressive medicines fail to control your immune system’s response to your new liver. If your transplanted liver fails as a result of rejection, your transplant team will decide whether another transplant is possible.

What are the side effects of immunosuppressants?

Immunosuppressants can have many serious side effects. You can get infections more easily because these medicines weaken your immune system. Other possible side effects include:

brittle bones
diabetes
high blood pressure
high levels of cholesterol and triglycerides in the blood
kidney damage
weight gain

Long-term use of these medicines can increase your chance of developing cancers of the skin and other areas of your body.

Prescription medicines, over-the-counter medicines, vitamins, and dietary supplements can affect how well immunosuppressants work. Tell your doctor if you are prescribed any new medicines. Talk with your doctor before using over-the-counter medicines, vitamins, dietary supplements or any complementary or alternative medicines or medical practices.

How do care for my new liver?

Do the following to help take care of your new liver:

Take medicines exactly as your doctor tells you to take them.
Talk with your doctor before taking any other medicines, including prescription and over-the-counter medicines, vitamins, and dietary supplements.
Keep all medical appointments and scheduled blood draws.
Stay away from people who are sick.
Tell your doctor when you are sick.
Learn to recognize the symptoms of rejection.
Have cancer screenings as recommended by your doctor.
Keep up to date with vaccinations; however, “live” vaccines should not be used.
Talk to your doctor, both before and after your liver transplant, about the use of contraceptives and the risks and outcomes of pregnancy.

Learn how to recognize the symptoms of infection. Symptoms of infection may include:

fever
chills
a stuffy nose
sore throat
cough
diarrhea
vomiting

Talk with your doctor right away if you have symptoms of infection.

Make healthy choices and protect yourself.

Eat healthy foods, exercise, and don’t smoke cigarettes
Don’t drink alcoholic beverages or use alcohol in cooking if you have a history of alcohol use disorder.
Protect yourself from soil exposure by wearing shoes, socks, long-sleeve shirts, and long pants.
Avoid pets such as rodents, reptiles, and birds.
Protect yourself against organisms that can transmit diseases, such as ticks and mosquitoes, by:
- using insect repellent
- wearing shoes, socks, long-sleeve shirts, and long pants
- not going outdoors at times when organisms are most likely to be active, such as at dawn and dusk
If you are planning on traveling, especially to developing countries, talk with your transplant team at least 2 months before leaving to determine the best ways to reduce travel-related risks.

Exercise

Exercise and physical activity should be a regular part of your life after a liver transplant to continue improving your overall physical and mental health.

While you are in the hospital, a physical therapist will teach you exercises to help you recover and avoid complications. The physical therapist can also talk with you about finding an appropriate exercise program to follow at home.

Soon after your transplant, you should walk as much as you can. Then, depending on your progress, you can start incorporating more physical activity into your daily life.

Walking, bicycling, swimming, low-impact strength training and other physical activities you enjoy can all be a part of a healthy, active lifestyle after transplant. But be sure to check in with your transplant team before starting or changing your post-transplant exercise routine.

What should I eat after my liver transplant?

You should eat a healthy, well-balanced diet after your liver transplant to help you recover and keep you healthy. A dietitian or nutritionist can help you create a healthy eating plan that meets your nutrition and diet needs.

What should I avoid eating after my liver transplant?

Grapefruit and grapefruit juice can affect how well some immunosuppressants work. To help prevent problems with some of these medicines, avoid eating grapefruit and drinking grapefruit juice.

If you have a history of alcohol use disorder, do not drink alcoholic beverages or use alcohol in cooking.

You should AVOID consuming the following:

water from lakes and rivers
unpasteurized milk products
raw or undercooked
eggs
meats, particularly pork and poultry
fish and other seafood

Your dietitian or nutritionist may recommend that you limit your intake of:

salt
cholesterol
fat
sugar

References

Liver Transplant. https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-disease/liver-transplant/
Organ Procurement and Transplantation Network. Health Resources and Services Administration, U.S. Department of Health and Human Services. https://optn.transplant.hrsa.gov/data/view-data-reports/build-advanced
Definition & Facts of Liver Transplant. https://www.niddk.nih.gov/health-information/liver-disease/liver-transplant/definition-facts
Sood GK. Acute liver failure. https://emedicine.medscape.com/article/177354-overview#a0156
Schoening WN, Buescher N, Rademacher S, et al. Twenty-year longitudinal follow-up after orthotopic liver transplantation: a single-center experience of 313 consecutive cases. American Journal of Transplantation. 2013;13(9):2384–2394.