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Liver Transplantation

By

Martin Hertl

, MD, PhD, Rush University Medical Center

Last full review/revision Jun 2020| Content last modified Jun 2020
Click here for the Professional Version

Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions.

Liver transplantation is the second most common type of organ transplantation procedure. It is the only option for people whose liver no longer functions.

A whole liver can be obtained only from a person who has died, but a living donor can provide a part of the liver. A donated liver can be stored for up to 18 hours.

Many people die while waiting for a suitable liver, but after transplantation, the percentage of liver transplant recipients who survive is

  • At 1 year: 86 to 90%

  • At 3 years: 79%

  • At 5 years: 73%

People whose liver has been destroyed by alcoholism Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more Alcohol-Related Liver Disease can receive a transplant if they stop drinking. Liver transplantation is also done for some people who have liver cancer that is not too far advanced.

Although hepatitis C and autoimmune disorders tend to recur in the transplanted liver, survival is still good.

Donors

Some transplants come from living donors, who provide part of a liver. A few transplants come from people who are brain dead and whose heart has stopped beating. However, the liver from such donors is often damaged because it was not receiving blood.

Procedure for Liver Transplantation

The damaged liver is removed through an incision in the abdomen, and the new liver is connected to the recipient’s blood vessels and bile ducts. Usually, blood transfusions are required.

Typically, the operation lasts 4 1/2 hours or more, and the hospital stay is 7 to 12 days.

Drugs to inhibit the immune system (immunosuppressants Suppression of the Immune System Transplantation is the removal of living, functioning cells, tissues, or organs from the body and then their transfer back into the same body or into a different body. The most common type of... read more ), including corticosteroids, are started the day of transplantation. These drugs can help reduce the risk that the recipient will reject the transplanted liver. Compared with transplantation of other organs, liver transplantation requires the lowest doses of immunosuppressants.

Complications of Liver Transplantation

Rejection

Liver transplants are rejected somewhat less vigorously than transplants of other organs, such as the kidney and heart. Nonetheless, immunosuppressants must be taken after transplantation.

If the recipient develops an enlarged liver, nausea, pain, fever, jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Jaundice in Adults , or abnormal liver function (detected by blood tests), doctors may do a biopsy using a needle. Biopsy results help doctors determine whether the liver is being rejected and whether immunosuppressant therapy should be adjusted.

Rejection can be treated with corticosteroids or, if they are ineffective, other immunosuppressants (such as antithymocyte globulin). Another liver, if available, may be transplanted if drugs are ineffective.

Hepatitis

Most people are given a liver transplant because they had cirrhosis due to viral hepatitis Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more . Immunosuppressants, which are needed to help prevent rejection of the transplanted liver, also make the body less able to defend against infections. As a result, hepatitis B or C recurs in nearly all liver transplant recipients. However, newer antiviral drugs are effective in treating hepatitis that occurs in liver transplant recipients.

Other complications

Some complications of liver transplantation can occur within 2 months. For example, the liver may malfunction, blood clots may block blood vessels to or from the liver, or bile may leak out of the bile ducts. Complications that occur soon after transplantation typically cause fever, low blood pressure, and abnormal results on tests done to evaluate the liver.

Later, the most common complication is scarring and narrowing of the bile ducts. This disorder can cause jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Jaundice in Adults , dark urine, light-colored stools, and itchiness all over the body. Sometimes the narrowed ducts can be reopened, but often, another transplant is required.

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