Liver transplantation: procedure, stages and survival

Liver transplant surgery involves replacing a diseased liver with a healthy liver from a living or deceased donor. Recovery can take up to 1 year and 5-year survival rates can be as high as 75%.

One person will work with a multidisciplinary medical team throughout the transplant process. This team will assess a person’s eligibility for a transplant, find a suitable donor, and help the person deal with surgery and recovery.

This article explains how liver transplantation works, what a person can expect after surgery, and a person’s outlook after liver transplantation.

A liver transplant is a type of surgery in which a surgeon removes a damaged liver from a person 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 ‘transplant’. If the donor is deceased, a surgeon can use the whole liver for the transplant.

Both adults and children can have liver transplants, and the goal of the surgery is to prolong a person’s life. Receive a liver transplant can extend the life of a 15 year old.

According to the Health Resources and Services Administration (HRSA), surgeons performed 9,236 liver transplants in 2021.

The HRSA also reports that the liver is one of the most commonly transplanted organs and the number of liver transplants has set new records every year for the past 9 years.

Learn more about how organ transplants work.

The two types of liver transplant are deceased donor liver transplant (DDLT) and living donor liver transplant (LDLT).

DDLT is more common than LDLT. Doctors previously reserved LDLT for pediatric cases, but the growing demand for liver transplantation means that doctors are now also using LDLT in adults.

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 may use several parts of the liver, including:

  • left lateral sector
  • left lobe
  • right lobe

In some cases, a surgeon will transplant two left lobes from two donors into a recipient. This is called a double transplant.

People may be eligible for a liver transplant if their liver fails after an injury or a period of illness.

Uses

A number of conditions can cause liver disease, including:

  • Cirrhosis: Cirrhosis is scarring of the liver, often due to alcohol abuse 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 receive mental health support for 6 months before receiving a liver transplant.
  • Acute liver necrosis: This is the death of liver tissue, possibly as a result of an acute infection or side effects from medications.
  • Biliary atresia: It is a rare congenital disease of the liver and bile ducts that affects newborns. It’s the The most common reason for liver transplants in children.
  • Hepatitis: Hepatitis is a viral infection that affects the liver. Health professionals classify 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 may be eligible for a liver transplant if they meet certain criteria, such as if their tumor is less than 5 centimeters (cm) in diameter or if they have multiple tumors smaller than 3cm in diameter.
  • Acute liver failure: A person can develop acute liver failure if they take too much acetaminophen. Other causes of this rare condition are blood vessel blockages, genetic disorders, autoimmune diseases, and drug reactions.

Eligibility

A person will need to work with a doctor to find out if they are eligible for a liver transplant. Generally, a doctor will only recommend a liver transplant after ruling out all other treatment options and if they feel 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 assess heart, lung, and kidney function .

A transplant team may include:

Once a transplant team approves a person’s evaluation and recommends the person for a liver transplant, they will add the person to a national deceased donor waiting list.

According to National Institute of Diabetes and Digestive and Kidney Diseasesa person in the United States can be on the waiting list for less than 30 days up to more than 5 years.

A person’s position on the waiting list depends on various eligibility criteria, including their test results and how urgently they need a new liver.

Doctors place people on the wait 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 consenting living donor, the transplant team will assess whether the potential donor is a match, taking into account the blood type of the donor and whether the recipient and potential donor have similar body sizes. A donor must be between the ages of 18 and 60 and have an emotional bond with the recipient. A living donor can be a family member, spouse or friend.

The liver transplant surgery procedure consists of three main steps: preparation, surgery and recovery.

Preparation

The preparation step differs depending on whether the donor is alive or deceased.

In the case of a deceased donor, the transplant coordinator will call the recipient as soon as the transplant team finds a compatible liver. The beneficiary should go to the hospital immediately.

With a living donor, the medical team will plan the surgery 4 to 6 weeks in advance.

The recipient’s transplant coordinator will advise them on what to do to prepare.

Operation

If the liver is from a deceased donor, surgery 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 both the recipient and the donor are operated on at the same time.

Prior to surgery, the transplant recipient will receive general anesthesia. This means that they will be asleep during the 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.

Recovery

After the surgery, the medical team takes the recipient to the intensive care unit (ICU). Living donors also spend a day in intensive care.

Specialized doctors and nurses closely monitor recipients and donors.

Healthcare professionals do blood tests and medical tests to check the recipient’s heart, lung, and kidney function. The recipient also starts taking immunosuppressive drugs to prevent their immune system from harming the new liver. They will have to take this medicine for the rest of their lives.

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.

The transplant team will work with the recipient and donor so they know how to take care of themselves when they leave the hospital.

Liver transplantation can take up to 12 hours and sometimes longer.

Beneficiaries can expect to stay in hospital for 2 weekswhile donors can go home after 1 week.

The length of a person’s hospital stay will depend on how quickly they recover.

Recovery begins in the hospital. The transplant team teaches the transplant recipient how to take care of themselves before discharging them. This includes advice on:

  • follow-up medical care
  • what they need to do to take care of their new liver
  • potential problems they may have with their new liver

According to the UK’s National Health Service (NHS), some people can take a year or more to fully recover, but most people can return 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.

To have the best chance of success, a person who has had a liver transplant should:

  • attend all medical examinations
  • take their medications as prescribed by their doctor
  • be aware of symptoms of organ rejection and infection and tell their doctor immediately if they experience any
  • avoiding people with contagious illnesses such as colds or flu
  • eating a healthy diet and exercising regularly
  • 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 part of their liver and deceased donors provide all of the liver.

A liver transplant can treat a variety of health issues, including cirrhosis, alcohol-related liver disease, and hepatitis. Surgery can have a 75% survival rate, and survival rates are improving.

A person will first work with a transplant team to determine if they are eligible for a liver transplant, and then throughout their surgery and recovery if they choose to have a transplant.

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