A liver transplantation is a surgery that removes a diseased or malfunctioning liver and replaces it with a healthy donor liver from another person. Because there is currently no artificial solution that can fully replace the liver, transplantation is the only viable cure for liver failure.
- Liver transplantations are usually performed when there are no other treatment options available. This is most often the case in people with end-stage liver disease.
- The majority of donor livers come from deceased donors, which require most recipients to be put on a waiting list. Waiting times will depend on a variety of factors.
- Liver transplantations often produce excellent outcomes, although this procedure does come with risks. Recipients will also have to take anti-rejection medication afterwards.
Liver transplantations are performed in people who have end-stage liver conditions that cannot be treated or cured any other way. This means that the only way for them to have a functioning liver is to surgically remove their diseased liver and replace it with a healthy donor liver.
End-stage liver disease can be caused by a variety of conditions. However, they can be divided into two general categories:
- Chronic Liver Disease: These conditions are characterized by repeated damage to the liver, which causes healthy tissue to be replaced by scar tissue. This can eventually lead to cirrhosis and liver failure. It often takes several years to develop. Conditions that can cause chronic liver disease include alcohol abuse and hepatitis.
- Acute Liver Failure: This is a rare condition characterized by a massive sudden injury to a healthy liver. It is most often caused by overdosing on medication or ingesting toxic substances. Because it can develop so quickly, patients with acute liver disease receive priority for liver transplantations.
Learn more about the different liver conditions on the Conditions & Treatments page.
A liver transplantation is a complex and serious operation. The following is the general process most patients will undergo when getting this procedure.
After receiving a diagnosis of end-stage liver disease, patients will need to be evaluated in order to determine if they are physically and mentally able to undergo a liver transplantation. The goal of this evaluation is to determine the following:
- If the patient can survive the operation and any potential postoperative complications.
- If the patient will take all required medications and comply with all required clinic visits and tests.
- If the patient will not damage their new liver with alcohol, drugs, or other illicit behavior.
During the evaluation process, patients will discuss any existing medical issues, as well as take a number of different tests. These may include:
- Blood Tests: This is to confirm blood type, evaluate serum chemistries, screen for clotting factors and hepatitis, test for other viruses (including HIV), and more.
- Cardiac Evaluation: This is to ensure the heart is strong enough for a transplantation operation. It may include an echocardiogram (EKG), stress test, and cardiac angiogram.
- Pulmonary Evaluation: This may be necessary for smokers or patients with a lung disorder. It will include tests to determine the blood’s ability to carry oxygen.
- Psychiatric Evaluation: This assesses underlying mental health issues, such as depression, and helps the patient and their family prepare for the transplant process.
- Radiologic Tests: These will help determine the patient’s overall health. They may include chest x-rays, CT scans, MRIs, and more.
- Substance Abuse Screening: This is determine if the patient is currently using any alcohol or illicit drugs.
In addition, patients may also undergo an insurance analysis to review their policy, determine if it can cover the costs of transplantation, and to suggest other options to assist with the cost.
When a patient is determined physically and mentally able to undergo a liver transplantation and its postoperative requirements, they will be placed on a national waiting list.
This is not a static list. Instead, it is a database that contains medical information (e.g., blood type, body size, and medical urgency) for anyone in need of a new organ in the United States and Puerto Rico. Whenever a new donor organ becomes available, its characteristics (e.g., size and blood type) are matched against the medical information of each candidate in the database. This generates a unique, one-time list.
Wait times can range from a few days to over a year. Patients with acute liver disease receive the highest priority. All other patients are prioritized based on their MELD (Model of End-Stage Liver Disease) score, which combines factors such as the severity of their condition, chance of survival, distance from the donor hospital, and the results of several different lab tests.
Learn more on the Liver Transplant Waiting List page.
Liver transplantation surgery involves the removal of the donor liver, the removal of the diseased liver, and the implantation of the donor liver. Successfully implanting the donor liver requires the surgeon to reestablish all of the liver’s vital veins, arteries, and bile duct connections. The entire process will usually take 6 to 12 hours to complete.
The following is the general step-by-step process of a liver transplantation:
- Preparation: When a patient is matched with a donor liver, the transplantation operation will begin as soon as possible. The patient will be asked to come to the hospital for a final physical exam and so staff can start preparing them for surgery.
- Anesthesia: Just before surgery, an anesthesiologist will give the patient general anesthesia. This will put them into a deep sleep for the entirety of the operation.
- Incision: The surgeon will begin by making a long incision across the abdomen to gain access to the liver. The size of this incision will depend on the patient.
- Evaluation: The diseased liver is evaluated for any abnormalities (like an undiagnosed infection) that would prevent a transplantation.
- Removal: All existing connections are severed from the diseased liver. The surgeon removes the liver from the patient.
- Implantation: The donor liver is implanted inside the patient. This involves attaching it to their body’s veins, arteries, and bile ducts.
- Closure: When all bleeding is controlled, the surgeon sews the incision closed.
The following are some of the types of doctors that may be involved in a liver transplantation:
- Anesthesiologist: A specialist in administering sedatives and anesthetics.
- Gastrointestinal Oncologist: A specialist in cancer within organs involved in digestion.
- Hepatologist: A specialist in the liver, pancreas, and gallbladder.
- Radiologist: A specialist in imaging organs.
- Transplant Surgeon: A specialist in removing and implanting organs.
Currently, few alternatives to liver transplantation exist. While some medications and therapies may be able to delay liver failure or alleviate symptoms, liver transplantation is usually the only viable way to cure end-stage liver disease.
However, living donor liver transplantation is a potential alternative to traditional transplantation surgery. Instead of using a whole liver from a deceased donor, living donor liver transplantation uses a partial liver from a living donor. This is possible because the liver has the unique ability to regenerate and grow back into a complete organ.
Living donor liver transplantation offers several benefits over traditional liver transplantation:
- Shorter Waits: Typically, living donors are a family member or loved one of the recipient. This means there is no need to remain on a waiting list.
- Faster Recovery: Living donor recipients experience shorter hospital stays and are less likely to require blood transfusions or dialysis after their surgery.
- Improved Outcomes: Recipients of living donor livers have an average 5 percent better long-term survival rate than recipients of deceased donor livers.
Learn more on the Living Donor Liver Transplantation page.
Risks and Complications
Liver transplantation is a major operation, which means it may produce serious complications. These risks can be related to the surgery itself or to the drugs recipients must take afterwards.
The following are some of the risks associated with liver transplantations:
- Bile duct complications (leaks or shrinkage)
- Blood clots
- Donated liver failure or rejection
- Internal bleeding
- Mental confusion
What to Expect Afterwards
After a liver transplantation, most people experience excellent outcomes. However, the length of recovery will vary according to each patient’s age, overall health, and behavior. All recipients will also likely have to take some form of medication for the rest of their lives.
Typically, patients remain hospitalized for 7 to 10 days after surgery. During this time, the transplant team closely monitors them for any signs of possible complications. Afterwards, they can return home to recuperate. It will take about 3 to 6 months before they are recovered and ready to fully resume their normal lives.
Patients will have to take a variety of medications after their surgery, some for the rest of their lives. In general, these medications can be divided into three categories:
- Anti-Rejection: Also called immunosuppressants, these medications weaken the immune system so that it does not reject the new liver.
- Anti-Infective: Because the immunosuppressants weaken the immune system, patients will need to take anti-infective medicine to protect against infection.
- Miscellaneous: Additional medications may include ones to treat the side effects of the immunosuppressants or help with other medical conditions.
Immediately after surgery, patients will take a combination of these medications. As they heal, the dosage amounts and number of medications will be reduced. By six months, it is normal for patients to only be taking one or two medications. Immunosuppressants will likely have to be taken for the rest of their lives so that their bodies don’t reject their donor liver. If this medication is not taken as prescribed, organ failure may result.
According to data compiled by the Organ Procurement and Transplantation Network (OPTN), the national survival rate for deceased donor liver transplants between 2008 and 2015 was:
- 91 percent one year after surgery
- 83 percent three years after surgery
- 75 percent five years after surgery
Note: These statistics are the average survival rate for all ages, including the very old and very young, as well as the critically ill. It is not unusual for recipients to lead normal lives for 30 years or more after an operation.
Read the FAQ to learn more about life after transplantation surgery.
Our center is a nationally recognized leader in liver transplantation. Many recent advances in transplantation surgery are the result of scientific and clinical research conducted at Columbia University Irving Medical Center. These include improved surgical techniques, replacement organ procurement, and medical management. Every year, we continue to develop transplantation procedures that help prolong and improve the lives of patients with liver disease.
Our transplantation teams take advantage of the most sophisticated medical knowledge and surgical technology available today. This has made us experts in procedures like living donor transplantation, partial liver transplantation, advanced organ preservation, liver transplantation in HIV and hepatitis C co-infected individuals, and antiviral therapy to prevent or treat recurrent hepatitis C after liver transplantation.
Call us at (877) LIVER MD/ (877) 548-3763 or use our online form to schedule an appointment.