Liver transplant surgery involves replacing an unhealthy liver with a healthy one from a living or deceased donor. Recovery can take up to 1 year, and 5-year survival rates can be as high as 75%.
A person will work with a multidisciplinary medical team throughout the transplant process. This team will evaluate a person’s eligibility for a transplant, find a suitable donor, and help the person cope with the surgery and recovery.
This article explains how liver transplant surgery works, what a person can expect after surgery, and a person’s outlook following a liver transplant.
A liver transplant is a type of surgery during which a surgeon removes a person’s damaged liver and replaces it with a healthy liver from another person, the donor.
A donor can be living or recently deceased. Living donors will donate only part of their liver — a “graft.” If the donor is deceased, a surgeon can use the whole liver in the transplant.
Both adults and children can have liver transplants, and the aim of the surgery is to lengthen a person’s life. Receiving a liver transplant
According to the Health Resources and Services Administration (HRSA), surgeons performed 9,236 liver transplants in 2021.
The HRSA also states that the liver is one of the most commonly transplanted organs and that liver transplant numbers have set new records each year for the past 9 years.
Find out more about how organ transplants work.
The two types of liver transplant are deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT).
In DDLT, a surgeon removes the recipient’s liver and replaces it with a healthy liver from a deceased donor. The surgeon then connects the veins and arteries and reconstructs the bile duct.
In LDLT, a surgeon can use several portions of the liver, including the:
- left lateral sector
- left lobe
- right lobe
In some cases, a surgeon will transplant two left lobes from two donors into one recipient. This is called a dual graft.
People may be eligible for liver transplant surgery if their liver fails after an injury or a period of illness.
A number of conditions may
- Cirrhosis: Cirrhosis is scarring of the liver, often as a result of alcohol misuse or hepatitis.
- Alcohol-related liver disease: This condition can occur if a person overconsumes alcohol, which damages their liver. People with alcohol-related liver disease will need to stop drinking alcohol and have 6 months of mental health support before receiving a liver transplant.
- Acute hepatic necrosis: This is the death of liver tissue, possibly as a result of acute infection or medication side effects.
- Biliary atresia: This is a rare congenital liver and bile duct disease that affects newborns. It is the
most commonreason for liver transplants in children.
- Hepatitis: Hepatitis is a viral infection that affects the liver. Medical professionals categorize hepatitis into five strains: A, B, C, D, and E. Some strains cause short-term infections, while others cause chronic infections.
- Autoimmune hepatitis: In this condition, a person’s immune system targets their liver, causing cirrhosis and liver failure.
- Liver cancer: People with a type of cancer called hepatocellular carcinoma can be eligible for liver transplantation if they meet certain criteria, such as if their tumor is less than 5 centimeters (cm) in diameter or if they have multiple tumors less than 3 cm in diameter.
- Acute liver failure: A person may develop acute liver failure if they take too much acetaminophen. Other causes of this uncommon condition are blood vessel blockages, genetic disorders, autoimmune diseases, and reactions to medication.
A person will need to work with a doctor to find out whether they are eligible for a liver transplant. Generally, a doctor will recommend a liver transplant only after they rule out all other treatment options and if they believe the person is healthy enough for the procedure.
If a person is eligible for a liver transplant, a doctor will refer them to a transplant center. A transplant team will assess the person using a range of tests and exams, including blood and urine tests, imaging tests, and tests that evaluate heart, lung, and kidney function.
A transplant team may include:
Once a transplant team approves a person’s evaluation and recommends the person for liver transplant surgery, they will add the person to a national waiting list for a deceased donor.
According to the
A person’s position on the waiting list depends on a variety of eligibility criteria, including their test results and how urgently they need a new liver.
Doctors position people on the waiting list using the Model for End-Stage Liver Disease (MELD) scoring system. A person’s score estimates their risk of dying within 90 days if they do not receive a transplant.
If a person has a willing living donor, the transplant team will evaluate whether the potential donor is a good match, considering the donor’s blood type and whether the recipient and potential donor have similar body sizes. A donor will need to be aged 18–60 and have an emotional tie to the recipient. A living donor can be a family member, spouse, or friend.
The liver transplant surgery procedure involves three main steps: preparation, surgery, and recovery.
The preparation stage differs depending on whether the donor is living or deceased.
With a deceased donor, the transplant coordinator will call the recipient as soon as the transplant team finds a matching liver. The recipient must go to the hospital right away.
With a living donor, the medical team will schedule the surgery
The recipient’s transplant coordinator will inform them of what they need to do to prepare.
If the liver comes from a deceased donor, the surgical procedure begins when the liver arrives at the hospital.
If the liver comes from a living donor, the medical team schedules the procedures in advance and the recipient and donor have surgery at the same time.
Before the surgery, the transplant recipient will receive a general anesthetic. This means they will be asleep during surgery.
To replace the liver, a surgeon cuts across the recipient’s abdomen and toward their chest. They then remove the damaged liver and insert the new one, connecting it to the recipient’s blood vessels and bile ducts, which are the tubes connecting the liver to the small intestine. The surgeon then closes the wound with clips or stitches.
After surgery, the medical team takes the recipient to the intensive care unit (ICU). Living donors also spend a day in the ICU.
Specialist doctors and nurses monitor recipients and donors closely.
Healthcare professionals perform blood tests and medical tests to check the recipient’s heart, lung, and kidney function. The recipient also begins taking immunosuppressant medication to stop their immune system from harming the new liver. They will need to take this medication for the rest of their life.
The medical team will encourage the recipient to get out of bed and sit in a chair the day after surgery and to walk short distances when they feel able to.
The transplant team will work with the recipient and donor so they know how to look after themselves when they leave the hospital.
Liver transplant surgery can take up to
Recipients can expect to stay in the hospital for
The length of a person’s hospital stay will depend on how quickly they recover.
Recovery starts in the hospital. The transplant team teaches the transplant recipient how to care for themself before discharging them. This includes guidance on:
- follow-up medical care
- things they need to do to care for their new liver
- potential problems they may experience with their new liver
According to the United Kingdom’s National Health Service (NHS), it can take 1 year or more for some people to fully recover, but most people can get back to their usual activities within a few months.
According to the American Liver Foundation, the 5-year survival rate for liver transplants is 75% and liver transplant survival rates are continually improving.
For the best chances of a successful outcome, a person who has undergone a liver transplant should:
- attend all medical checkups
- take their medications as their doctor has prescribed
- be aware of the symptoms of organ rejection and infection and tell their doctor immediately if they experience any
- avoid people who have contagious illnesses such as the common cold or flu
- eat a healthy diet and get regular exercise
- avoid alcohol and tobacco
Learn more about liver transplant survival rates.
Liver transplant surgery involves replacing a person’s damaged liver with a healthy liver from a donor. Donors can be living or deceased. Living donors provide a portion of their liver, and deceased donors provide the entire liver.
A liver transplant can treat a variety of health conditions, including cirrhosis, alcohol-related liver disease, and hepatitis. The surgery can have a 75% survival rate, and survival rates are improving.
A person will work with a transplant team first to determine whether they are eligible for a liver transplant and then throughout their surgery and recovery if they choose to have a transplant.