(See also Overview of Transplantation Overview of Transplantation 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 .)
Liver Liver The wedge-shaped liver is the largest—and, in some ways, the most complex—organ in the body. It serves as the body's chemical factory, performing many vital functions, from regulating the levels... read more 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: 90% to 95%
At 3 years: 80 to 85%
At 5 years: around 75%
Most recipients are people whose liver has been destroyed by cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more 
(replacement of liver tissue with scar tissue), often due to infection with hepatitis C virus 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 . Other reasons for liver transplantation include primary sclerosing cholangitis Primary Sclerosing Cholangitis Primary sclerosing cholangitis is inflammation with progressive scarring and narrowing of the bile ducts in and outside the liver. Eventually, the ducts become blocked and then obliterated.... read more (scarring of the bile ducts, causing cirrhosis), autoimmune liver disorders, and, in children, partial or complete destruction of the bile ducts (biliary atresia Biliary Atresia Biliary atresia is a birth defect in which the bile ducts progressively narrow and become blocked after birth, preventing bile from reaching the intestine. This defect causes bile to collect... read more ) and metabolic disorders.
People whose liver has been destroyed by an alcohol use disorder 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 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.
Both donors Donors 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 and recipients undergo pretransplantation screening Pretransplantation Screening 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 . This screening is done to be sure that the organ is healthy enough for transplantation and the recipient does not have any medical conditions that would prohibit transplantation.
Donors
Nearly all donated livers come from people who are brain dead Brain Death Brain death is the permanent loss of brain activity. As a result, people cannot breathe or maintain other vital functions on their own, and they permanently lose all awareness and capacity for... read more and whose heart is still beating. The blood type and heart size of the donor and recipient must match. Tissue type Tissue matching 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 does not always have to match exactly.
Some transplants come from living donors, who provide part of their liver, which is possible because even part of a healthy liver is enough. 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
Transplantation can cause various complications Complications After Transplantation 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 .
Rejection
Even if tissue types are closely matched, transplanted organs, unlike transfused blood, are usually rejected unless measures are taken to prevent rejection. Rejection results from an attack by the recipient's immune system on the transplanted organ, which the immune system recognizes as foreign material. Rejection can be mild and easily controlled or severe, resulting in destruction of the transplanted organ.
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 
, 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 corticosteroids 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, 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 , dark urine, light-colored stools, and itchiness all over the body. Sometimes the narrowed ducts can be reopened, but often, another transplant is required.
