What is a liver transplant?
A liver transplant is surgery to replace a diseased liver with a healthy liver from
another person. A whole liver may be transplanted, or just part of one.
In most cases the healthy liver will come from an organ donor who has just died (a
Sometimes a healthy living person will donate part of their liver. A living donor
may be a family member. Or it may be someone who is not related to you but whose blood
type is a good match.
People who donate part of their liver can have healthy lives with the liver that is
The liver is the only organ in the body that can replace lost or injured tissue (regenerate).
The donor’s liver will soon grow back to normal size after surgery. The part that
you receive as a new liver will also grow to normal size in a few weeks.
Why might I need a liver transplant?
You can’t live without a working liver. If your liver stops working correctly, you
may need a transplant.
A liver transplant may be advised if you have end-stage liver disease (chronic liver
failure). This is a serious, life-threatening liver disease. It can be caused by several
Cirrhosis is a common cause of end-stage liver disease. It is a chronic liver disease.
It happens when healthy liver tissue is replaced with scar tissue. This stops the
liver from working correctly.
Other diseases that may lead to end-stage liver disease include:
Acute hepatic necrosis. This is when tissue in the liver dies. Possible reasons include acute infections and
reactions to medicine, illegal drugs, or toxins.
Biliary atresia. A rare disease of the liver and bile ducts that occurs in newborns.
Viral hepatitis. Hepatitis B or C are common causes.
NAFLD (nonalcoholic fatty liver disease) or NASH (nonalcoholic steatohepatitis). With NAFLD, too much fat builds up in the liver and damages it. This is not caused
by alcohol use. NASH is a form of NAFLD that includes fat buildup, hepatitis, and
liver cell damage.
Metabolic diseases. Disorders that change the chemical activity in cells affected by the liver.
Primary liver cancers. These are cancer tumors that start in the liver.
Autoimmune hepatitis. A redness or swelling (inflammation) of the liver. It happens when your body’s disease-fighting
system (immune system) attacks your liver.
The transplant evaluation process
If your provider thinks you may be a good candidate for a liver transplant, he or
she will refer you to a transplant center for evaluation. Transplant centers are located
in certain hospitals all over the U.S.
You will have a variety of tests done by the transplant center team. They will decide
if your name should be placed on a national transplant waiting list. The transplant
center team will include:
A transplant surgeon
A transplant provider specializing in treating the liver (a hepatologist)
A social worker
A psychiatrist or psychologist
Other team members such as a dietitian, a chaplain, or an anesthesiologist
The transplant evaluation process includes:
Psychological and social evaluation. Many different issues are assessed. They include stress, financial concerns, and
if you will have support from family or friends after your surgery.
Blood tests. These tests are done to help find a good donor match and assess your priority on
the waiting list. They can also help improve the chances that your body won’t reject
the donor liver.
Diagnostic tests. Tests may be done to check your liver and your general health. These tests may include
X-rays, ultrasounds, a liver biopsy, heart and lung tests, colonoscopy, and dental
exams. Women may also have a Pap test, gynecology exam, and a mammogram.
The transplant center team will review all of your information. Each transplant center
has rules about who can have a liver transplant.
You may not be able to have a transplant if you:
Have a current or chronic infection that can’t be treated
Have metastatic cancer (cancer that has spread from its main location to 1 or more
other parts of the body)
Have severe heart problems or other health problems
Have a serious condition besides liver disease that would not get better after a transplant
Are not able to follow a treatment plan
Drink too much alcohol
Getting on the waiting list
If you are accepted as a transplant candidate, your name will be placed on a national
transplant waiting list. People who most urgently need a new liver are put at the
top of the list. Many people have to wait a long time for a new liver.
You will be notified when an organ is available because a donor has died. You will
have to go to the hospital right away to get ready for surgery.
If a living person is donating a part of their liver to you, the surgery will be planned
in advance. You and your donor will have surgery at the same time. The donor must
be in good health and have a blood type that is a good match with yours. The donor
will also take a psychological test. This is to be sure he or she is comfortable with
What are the risks of a liver transplant?
All procedures have risks. Some complications from liver surgery may include:
Blocked blood vessels to the new liver
Leakage of bile or blocked bile ducts
The new liver not working for a short time right after surgery
Your new liver may also be rejected by your body’s immune system. Rejection is the
body’s normal reaction to a foreign object or tissue. When a new liver is transplanted
into your body, your immune system thinks it is a threat and attacks it.
To help the new liver survive in your body, you must take anti-rejection medicines
(immunosuppressive medicines). These medicines weaken your immune system’s response.
You must take these medicines for the rest of your life. Some liver diseases can come
back after a transplant. To help the transplant be more successful, you may be started
on hepatitis B or C medicines ahead of time, if you have these diseases.
How do I get ready for a liver transplant?
Your healthcare provider will explain the procedure to you. Ask him or her any questions
you have about the surgery.
You may be asked to sign a consent form that gives permission to do the surgery. Read
the form carefully and ask questions if anything is not clear.
For a planned living transplant, follow any directions you are given for not eating
or drinking before the surgery. If your liver is from a donor who has just died, you
should not eat or drink once you are told a liver is available.
You may be given medicine to help you relax (a sedative) before the surgery.
Your healthcare provider may have other instructions for you based on your health
What happens during a liver transplant?
Liver transplant surgery requires a hospital stay. Procedures may vary depending on
your condition and your provider’s practices.
Generally, a liver transplant follows this process:
You will be asked to remove your clothing and given a gown to wear.
An IV (intravenous) line will be started in your arm or hand. Other tubes (catheters)
will be put in your neck and wrist. Or they may be put under your collarbone or in
the area between your belly and your thigh (the groin). These are used to check your
heart and blood pressure, and to get blood samples.
You will be placed on your back on the operating table.
If there is too much hair at the surgical site, it may be clipped off.
A catheter will be put into your bladder to drain urine.
After you are sedated, the anesthesiologist will put a tube into your lungs. This
is so that your breathing can be helped with a machine (a ventilator). The anesthesiologist
will keep checking your heart rate, blood pressure, breathing, and blood oxygen level
during the surgery.
The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.
The doctor will make a cut (incision) just under the ribs on both sides of your belly.
The incision will extend straight up for a short distance over the breast bone.
The doctor will carefully separate the diseased liver from the nearby organs and structures.
The attached arteries and veins will be clamped to stop blood flow into the diseased
Different surgery methods may be used to remove the diseased liver and implant the
donor liver. The method used will depend on your specific case.
The diseased liver will be removed after it has been cut off from the blood vessels.
Your surgeon will check the donor liver before implanting it in your body.
The donor liver will be attached to your blood vessels. Blood flow to your new liver
will be started. The surgeon will check for any bleeding where you have stitches.
The new liver will be attached to your bile ducts.
The incision will be closed with stitches or surgical staples.
A drain may be placed in the incision site to reduce swelling.
A sterile bandage or dressing will be applied.
What happens after a liver transplant?
In the hospital
After the surgery you may be taken to the recovery room for a few hours before being
taken to the intensive care unit (ICU). You will be closely watched in the ICU for
You will be hooked up to monitors. They will show your heartbeat, blood pressure,
other pressure readings, breathing rate, and your oxygen level. You will need to stay
in the hospital for 1 to 2 weeks or longer.
You will most likely have a tube in your throat. This is so you can breathe with the
help of a machine (a ventilator) until you can breathe on your own. You may need the
breathing tube for a few hours or a few days, depending on your situation.
You may have a thin plastic tube inserted through your nose into your stomach to remove
air that you swallow. The tube will be taken out when your bowels start working normally
again. You won’t be able to eat or drink until the tube is removed.
Blood samples will be taken often to check your new liver. They will also check that
your kidneys, lungs, and circulatory system are all working.
You may have IV drips to help your blood pressure and your heart, and to control any
problems with bleeding. As your condition gets better, these drips will be slowly
decreased and turned off. You may receive antibiotics.
Once the breathing and stomach tubes have been removed and you are stable, you may
start to drink liquids. You may slowly begin to eat solid foods as directed.
Your anti-rejection medicines will be closely watched to be sure you are getting the
right dose and the right mix of medicines.
When your provider feels you are ready, you will be moved from the ICU to a private
room. You will slowly be able to move about more as you get out of bed and walk around
for longer periods of time. You will slowly be able to eat more solid foods.
Your transplant team will teach you how to take care of yourself when you go home.
Once you are home, you must keep the surgical area clean and dry. Your healthcare
provider will give you specific bathing instructions. Any stitches or surgical staples
will be removed at a follow-up office visit, if they were not removed before leaving
You should not drive until your provider tells you to. You may have other limits on
Call your healthcare provider if you have any of the following:
Fever (this may be a sign of rejection or infection)
Redness, swelling, or bleeding or other drainage from the incision site
More pain around the incision site. This may be a sign of infection or rejection.
Vomiting or diarrhea
Yellowing of the skin and eyes (jaundice)
Your healthcare provider may give you other instructions, depending on your situation.
What is done to prevent rejection?
You must take medicines for the rest of your life to help the transplanted liver survive
in your body. These medicines are called anti-rejection medicines (immunosuppressive
medicines). They weaken your immune system’s response.
Each person may react differently to medicines. And each transplant team has preferences
for different medicines.
New anti-rejection medicines are always being made and approved. Your healthcare provider
will create a medicine treatment plan that is right for you. In most cases you will
take a few anti-rejection medicines at first. The doses may change often, depending
on how you respond to them.
Your provider will watch you closely and order blood work to watch for rejection.
If there is a concern about rejection, you likely will have a liver biopsy.
Anti-rejection medicines weaken the immune system. So people who have a transplant
are at a higher risk for infections. Some of the infections you will be at greater
risk for include:
For the first few months after your surgery, stay away from crowds or anyone who has
Each person may have different symptoms of rejection. Some common symptoms of rejection
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure