Liver Transplant Procedure
Overview
Individuals interested in becoming living donors for liver transplantation can start by completing a health history questionnaire. This step helps determine if someone is a suitable candidate for donation.
Both living and deceased donor options exist for those with liver failure. A deceased individual can donate a whole liver, or a living donor can provide a partial liver, thanks to the liver’s unique ability to regenerate and restore its normal size after surgery.
Key Roles of the Liver:
- Processes nutrients, medications, and hormones.
- Produces bile for digesting fats, cholesterol, and fat-soluble vitamins.
- Makes proteins important for blood clotting.
- Removes bacteria and toxins from the bloodstream.
- Supports immune system functions and prevents infections.
Doctors mainly recommend liver transplantation for people with advanced, long-term liver disease or, in rare cases, for those with sudden severe liver failure. In the United States, the number of people waiting for a liver transplant far exceeds the number of available deceased-donor livers. As a result, living-donor liver transplant has become a vital alternative for many patients.
| Year | Total Liver Transplants | From Living Donors | Waiting List Total |
|---|---|---|---|
| 2018 | 8,200 | 390 | 12,800 |
People considering donation should start the evaluation process to help address the gap between liver transplant needs and available donors.
Types
- Living Donor Transfer: A healthy person gives part of their liver to someone who needs a new liver.
- Whole Organ From Donor: The entire liver from a deceased donor is used for the recipient.
- Split Liver Transplant: One donor liver is divided and used for two different people.
- Combined Organ Transplant: Sometimes, a patient receives a liver and another organ from a donor.
Reasons for Liver Transplantation
Doctors consider liver transplantation when a person’s liver cannot work properly due to severe illness or injury. The main goal is to help people who have no other effective treatment options.
Common Medical Conditions Requiring Transplant
Liver failure can develop suddenly, known as acute liver failure, or gradually, known as chronic liver failure. Acute liver failure may result from reactions to certain medicines, but this is rare. Most often, doctors perform transplants for chronic liver failure, which gets worse over time and does not get better with other treatments.
A major reason for chronic liver failure is cirrhosis. Cirrhosis means the healthy tissue of the liver is replaced with scar tissue, which stops the liver from working as it should. Some of the main causes of cirrhosis include:
- Long-lasting hepatitis (such as hepatitis B and hepatitis C), which are viral infections that attack the liver.
- Alcoholic liver disease, related to heavy and long-term drinking.
- Nonalcoholic fatty liver disease, where fat collects in the liver and causes swelling or cell damage.
- Inherited problems, like hemochromatosis (too much iron in the liver) and Wilson’s disease (too much copper in the liver).
- Diseases of the bile ducts, such as primary biliary cirrhosis, primary sclerosing cholangitis, and biliary atresia. Biliary atresia is most common in children needing a transplant.
Doctors also use liver transplants to treat certain types of liver cancer when all or part of the liver is affected and other options will not work.
Table: Common Liver Diseases Leading to Transplant
| Condition | Description | Who It Often Affects |
|---|---|---|
| Hepatitis B and C | Viral infections causing liver damage | Adults, sometimes children |
| Cirrhosis | Scarring in the liver that stops it working well | Mostly adults |
| Biliary atresia | Bile ducts missing or blocked | Mostly children |
| Alcoholic liver disease | Liver damage from too much alcohol | Adults |
| Fatty liver disease | Fat buildup causes swelling and scarring | Adults |
| Genetic disorders | Issues like hemochromatosis or Wilson’s disease cause metal build-up | All ages |
| Liver cancer | Certain cancers limited to the liver | Adults, rare in children |
Dangers Linked to Liver Transplant
Liver transplant procedures can cause several problems. Common risks include bleeding and the development of blood clots, such as hepatic artery thrombosis. Patients may also deal with infections or leaks in the bile ducts. Sometimes, the bile ducts may start to get smaller, causing more issues.
There is a chance the new liver may not work as expected or the person’s immune system may attack the organ (rejection). In some cases, confusion or seizures may happen. The same liver disease that caused the need for surgery can come back in the transplanted organ.
Key Risks
- Bleeding
- Blood clots
- Infection
- Bile duct problems
- Organ rejection
- Seizures or confusion
Effects of Immune-Suppressing Medicines
To stop the body from rejecting the new liver, patients must take special drugs called immunosuppressants. These medicines weaken the immune system, raising the chance of infections. Other possible side effects include feeling tired, losing bone strength, high blood pressure, diabetes, headaches, high cholesterol, and stomach problems.
| Side Effect | Description |
|---|---|
| Bone thinning | Weaker bones, higher fracture risk |
| Diabetes | Trouble controlling blood sugar |
| High blood pressure | Heart and vessel strain |
| High cholesterol | Increased heart risk |
Getting Ready for a Liver Transplant
Picking a Transplant Program
When someone needs a liver transplant, the first step is usually to choose the right transplant program or center. It is important to look at several factors before making a decision. Potential patients can ask their primary care physician or hepatologist for advice, or look at a list provided by their insurance. Things to think about when choosing a program:
- Number of Surgeries: Find out how many liver transplants the program performs each year.
- Experience and Results: Ask about their survival rates for transplant patients.
- Compare Data: Use the database from the Scientific Registry of Transplant Recipients to compare different centers.
- Costs: Check what costs will come up during each part of the process. This can include:
- Blood tests and lab work
- Organ procurement
- Surgery fees
- Hospital stays
- Follow-up visits
- Support Services: See if the program helps with things like:
- Support groups
- Travel and local housing for patients and families
- Referrals to helpful resources
- Modern Care: Ask if the program uses up-to-date techniques and new transplant technology.
After choosing a transplant center, patients complete an evaluation so the center can decide if the patient is a good fit for the program. Each program has its own rules about who can qualify. The main things the evaluation looks at:
| What is Checked | Why It Matters |
|---|---|
| General Health | To make sure the patient can handle surgery |
| Lifelong Medication | To see if the patient can take medicine long term |
| Other Medical Conditions | To check for problems that could cause complications |
| Ability to Follow Care | To make sure the patient will follow instructions |
Tests and Consultations
- Blood and urine tests to check the health of all organs, not just the liver.
- Imaging scans such as liver ultrasound.
- Heart testing to make sure the heart is strong enough.
- Routine health exams including checks for cancer and other illnesses.
- Nutritional counseling, where a dietitian helps plan healthy eating before and after surgery.
- Psychological assessment to look for depression, anxiety, or stress, and to confirm that the patient understands the risks.
- Social support review by a social worker to ensure there is family or friends who can help after surgery.
- Addiction counseling for those who need help stopping alcohol, drugs, or tobacco.
- Financial counseling to explain costs, what insurance covers, and what the patient may need to pay out of pocket.
Throughout this process, several key people participate, including transplant coordinators, the transplant surgeon, and specialists such as hepatologists or primary care doctors. These team members work together to address all questions and concerns.
After completing the evaluation, a special committee at the program reviews all the results. They decide if a transplant is the best choice and if the patient is healthy enough to move forward. If both are true, the patient joins the waiting list for a liver transplant.
What You Can Expect
A person who needs a liver transplant goes through several tests to determine how sick their liver is and how urgently they need surgery. Doctors use a scoring system called the MELD score for adults, which ranges from 6 to 40. The higher the score, the more urgently the patient needs a new liver. Children under 12 get a different score called PELD.
Getting on the waiting list depends on the MELD or PELD score, blood type, and how long someone has been waiting. When a liver from a deceased donor becomes available, doctors offer it first to those with the most urgent need, based on their MELD score. In certain cases, doctors can request extra points for people with special medical conditions, like liver cancer, if they meet strict guidelines.
Some patients might have acute liver failure, which means the MELD score system does not apply the same way. These cases may get higher priority based on how severe the illness is. While waiting for a transplant, doctors work to treat problems caused by liver failure, such as jaundice, infections, and fluid buildup. Patients may need to be in the hospital often during this time.
Patients can also receive a liver from a living donor. In these surgeries, surgeons remove part of a healthy person’s liver and give it to the patient. The liver can regrow in both the donor and the person receiving the transplant. Most living donors are family or close friends, but anyone who is healthy, the right blood type, and organ size could be a potential match. Living donors undergo thorough physical and mental health checks to make sure surgery is safe for them.
In rare cases, doctors may recommend a domino transplant. In this operation, a person with a condition called familial amyloidosis donates their liver to someone else after they get a new one. The donated liver works well at first, but may cause amyloidosis in the new recipient after many decades.
While on the waiting list, patients should stay as healthy as possible. This involves taking all prescribed medications, following diet and exercise instructions from their care team, attending appointments, and staying active when possible. It is important to keep in touch with the healthcare team and make practical arrangements, like having a hospital bag packed and transportation ready.
Common Steps Before Liver Transplant Surgery
| Step | Details |
|---|---|
| Scoring | MELD/PELD score, blood type, health history |
| Waitlist | Priority set by urgency, time, and availability |
| Living donor evaluation | Health tests for potential donor, match checks |
| Staying healthy | Medication, diet, exercise, hospital visits |
| Preparation | Keep contact with transplant team, plan for admission |
What Happens During Surgery Day
Once a liver becomes available, or surgery is scheduled for a living donation, the hospital asks the patient to come right away. Before surgery starts, doctors check the patient’s health to be sure they are ready for the procedure.
The surgical team performs the operation under general anesthesia, so the patient sleeps and does not feel pain. The surgeon makes a long cut across the belly area to reach the liver. The exact size and placement of the incision depend on the patient and the surgeon’s plan.
In the operating room, the team removes the damaged liver. The surgeon then places the healthy donor liver (or part of a liver from a living donor) in the body. The team connects blood vessels and bile ducts to ensure the new liver works properly. Connecting the bile ducts is important because they help move bile from the liver to the intestines, which aids digestion.
Sometimes, the team takes a biopsy during or after surgery to make sure the new liver tissue is healthy and there are no unexpected problems. Doctors also use an abdominal ultrasound to check the blood flow and look for issues before closing the incision. The surgery can take several hours, often up to 12 or more, especially if complications or unexpected findings occur. After the transplant, the team closes the incision with staples and stitches.
After surgery ends, the patient goes to the intensive care unit (ICU) for close monitoring. The health team watches for bleeding, infection, and any problems with blood vessels, bile ducts, or the new liver. Key steps during the procedure:
- Patient arrives at the hospital and the team completes final health checks.
- The team gives anesthesia and puts the patient to sleep.
- The surgeon makes an incision across the abdomen.
- The team removes the damaged liver.
- The surgeon places the donor liver in the body.
- The team connects blood vessels and bile ducts.
- The team may perform a biopsy or abdominal ultrasound.
- The team closes the incision with stitches or staples.
- The team moves the patient to the ICU for monitoring.
Risks during surgery include bleeding, infection, and damage to nearby blood vessels or nerves. These risks are rare but possible.
What Recovery Looks Like After Surgery
When the liver transplant surgery ends, recovery begins in the hospital. Patients usually stay in the intensive care unit for a few days, where doctors and nurses monitor vital signs. They check for complications, such as bleeding, infection, or issues with the new liver. The team regularly performs blood tests to make sure the liver is working. Often, doctors use an abdominal ultrasound to check the blood flow to the transplanted liver and spot problems early.
After leaving the intensive care area, patients often stay in the hospital for about five to ten days. The length of the hospital stay depends on how the person is healing and if there are any complications. Some people may need to stay longer if they have difficulties, like infections or issues with the bile ducts.
Patients feel sore in the abdomen, especially around the place where the surgeon made the incision. Some numbness near the incision is normal. Nurses and doctors help manage pain with medications. The team encourages patients to get up, walk, and eat as soon as possible to help recovery.
Doctors also watch for rejection, which is when the body’s immune system tries to attack the new liver. To prevent this, patients must take medicines called immunosuppressants for the rest of their lives. These medicines lower the risk of rejection but can raise the chance of infections. It is very important to take all prescribed drugs as instructed. The most common steps after surgery often include:
| Recovery Step | What Happens |
|---|---|
| ICU stay | Monitoring vital signs, liver function, complications |
| Regular blood tests | Check if transplanted liver is working well |
| Abdominal ultrasound | Looks for blood flow and bile duct problems |
| Pain management | Medications for soreness, help with movement |
| Early movement | Walking, eating, and self-care as soon as possible |
| Hospital stay | Typically 5-10 days, sometimes longer |
| Lifelong medications | Drugs to prevent rejection, help protect liver |
| Follow-up visits | Routine checkups, blood and liver tests |
At home, patients need frequent follow-up visits. At first, they may go to the clinic a few times each week for blood tests and exams. If progress is good, the number of visits slowly decreases. During these appointments, the transplant team checks the function of the new liver, monitors for signs of rejection, and looks for side effects from medication. Other daily routines after surgery include:
- Taking all medications exactly as prescribed.
- Watching for signs of infection or organ rejection, such as fever, yellowing skin (jaundice), or extreme tiredness.
- Following a balanced diet and drinking enough water.
- Reporting any new symptoms to the transplant team right away.
- Preventing exposure to germs and protecting the abdominal area against injury.
- Attending rehabilitation or physical therapy if advised.
Patients should avoid activities that could hurt the new liver or incision area during the early months. Heavy lifting and intense exercise are usually not allowed until the care team says it is safe. Returning to work, school, and normal life may take several months, depending on individual recovery. Typical post-surgery checkup schedule:
| Time after surgery | Clinic visit frequency | Main focus |
|---|---|---|
| First 2 months | 1-3 times each week | Liver function, medication levels |
| 2-6 months | Every 1-2 weeks | Ongoing recovery, labs |
| After 6 months | Monthly or as needed | Long-term follow-up care |
Possible Complications After a Liver Transplant
- Rejection of the new liver
- Infection due to weakened immune system
- Problems with blood flow to or from the liver
- Bile duct leaks or blockages
- Bleeding or blood clots
Most people can eventually return to their normal routines, but they must keep up with their medicine and follow up with their health care team to have the best chance for success after transplant surgery. Regular appointments, lab tests, and imaging such as abdominal ultrasound help the team watch for problems. The transplant team provides education and guidance so patients and families know what to do after going home.
Findings on Liver Transplant Success
Most people who get a liver transplant survive at least five years after surgery. About 75 out of every 100 patients live for five years or more. That means about 25 people out of 100 pass away within this time.
| Years After Transplant | Percentage Surviving |
|---|---|
| 5 | Around 75% |
Livers from living donors usually lead to better early survival numbers than those from deceased donors. This may be because patients with living donors tend to get transplants sooner and may not be as ill.
Survival results can differ depending on the hospital or transplant center. Data on how different centers perform is available at resources like the Scientific Registry of Transplant Recipients.
Coping and Support
Managing stress before and after a liver transplant helps with recovery and long-term health. Feelings like anxiety and worry are common during this time. Connecting with family and friends can make these challenges easier to handle. Support from these relationships can reduce feelings of isolation and increase emotional strength. People going through a transplant can try several coping strategies:
- Support Groups: Meeting others who have also received a transplant can be reassuring. In a group, sharing stories and advice helps ease worries.
- Social Media Connections: Joining online communities or groups can help people feel supported even from home.
- Rehabilitation Services: For those ready to go back to work, social workers may offer help by connecting them with vocational rehabilitation services in their state.
- Setting Goals: By creating realistic and meaningful goals, people can focus on progress, not perfection. Small steps matter.
- Learning More: Asking questions and understanding the process helps people feel more confident and prepared.
| Coping Strategy | Benefit |
|---|---|
| Support Groups | Reduces fear, shares experiences |
| Social Media | Builds connections, offers guidance |
| Rehabilitation Services | Aids return to work, boosts confidence |
| Goal Setting | Encourages progress, sets expectations |
| Self-Education | Increases control, decreases anxiety |
Turning to these resources and practices, whether provided by loved ones or organizations can make the process less overwhelming and help people adjust to changes in their lives.
Diet and nutrition
Maintaining healthy eating habits after a liver transplant supports healing and keeps the new liver working well. Dietitians often guide patients to choose meals that are low in salt, cholesterol, sugar, and unhealthy fats. Avoiding alcohol in all forms is important to protect the new liver.
Eating at least five servings of different fruits and vegetables each day is recommended. Certain foods, such as grapefruit, grapefruit juice, and Seville oranges, should be avoided because they can interfere with common medications after transplant. Healthy eating choices include:
| Food Group | Better Choices | Tips |
|---|---|---|
| Protein | Lean meats, poultry, fish | Avoid fried and high-fat options |
| Grains | Whole grains (brown rice, whole wheat) | Limit processed and packaged foods |
| Dairy | Low-fat or fat-free products | Supports good calcium and phosphorus |
| Vegetables/Fruits | Colorful, fresh options | Eat a variety for more nutrients |
Choosing foods high in fiber and following food safety guidelines are also suggested. Drinking enough water helps the body function properly. These steps, along with professional advice from the care team, help support a strong recovery and long-term health.
Physical Activity After a Liver Transplant
Staying active benefits people who have had a liver transplant. Regular movement supports both the body and mind. Early on, walking offers the best choice. It is gentle and helps the body get used to activity again. As recovery continues, people can add other types of exercise. Some good options include:
- Walking
- Bicycling
- Swimming
- Low-impact strength training
Always consult the transplant care team before making any big changes to an exercise plan. Choosing enjoyable activities increases the chances of staying active long term.
