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A liver transplant is a surgical procedure that removes a liver that no longer functions properly (liver failure) and replaces it with a healthy liver from a living or deceased donor.
Your liver is your largest internal organ and performs several critical functions, including:
- Removing bacteria and toxins from the blood
- Preventing infection and regulating immune responses
- Processing nutrients, medications and hormones
- Producing bile, which helps the body absorb fats, cholesterol and fat-soluble vitamins
- Making proteins that help the blood clot
Liver transplant is usually reserved as a treatment option for people who have significant complications due to end-stage chronic liver disease. In rare cases, sudden failure of a previously normal liver may occur.
The number of people waiting for a liver transplant greatly exceeds the number of available deceased-donor livers.
The human liver regenerates and returns to its normal size shortly after surgical removal of part of the organ. This makes living-donor liver transplant an alternative to waiting for a deceased-donor liver to become available.
In 2014, about 7,200 liver transplants were performed in the U.S. among both adults and children. Of those, about 330 involved livers from living donors. At the same time, nearly 15,000 people were registered on the waiting list for a liver transplant.
Mayo Clinic’s approach
Why it's done
Liver transplant is a treatment option for people with liver failure whose condition can't be controlled other with treatments and for some people with liver cancer.
Liver failure may happen quickly or over a longer period of time. Liver failure that occurs quickly, in a matter of weeks, is called acute liver failure (fulminant hepatic failure) and is usually the result of medication-induced liver injury.
Although a liver transplant may treat acute liver failure, it is more often used to treat chronic liver failure. Chronic liver failure occurs slowly over months and years.
Chronic liver failure may be caused by a variety of conditions. The most common cause of chronic liver failure is scarring of the liver (cirrhosis), a process in which scar tissue replaces normal liver tissue and impairs liver function. Cirrhosis is the most frequently cited reason for a liver transplant.
Major causes of cirrhosis leading to liver failure and liver transplant include:
- Hepatitis B and C.
- Alcoholic liver disease.
- Nonalcoholic fatty liver disease.
- Genetic diseases affecting the liver (including hemochromatosis and Wilson's disease).
- Diseases that affect the bile ducts (the tubes that carry bile away from the liver), such as primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia. Biliary atresia is the most common reason for liver transplant among children.
Liver transplant may also treat certain cancers that originate in the liver (primary liver cancers).
Complications of the procedure
Liver transplant surgery carries a risk of significant complications. There are risks associated with the procedure itself as well as with the drugs necessary to prevent rejection of the donor liver after the transplant.
Risks associated with the procedure include:
- Bile duct complications, including bile duct leaks or shrinking of the bile ducts
- Blood clots
- Failure of donated liver
- Rejection of donated liver
- Mental confusion or seizures
Long-term complications may also include recurrence of liver disease in the transplanted liver.
Anti-rejection medication side effects
After a liver transplant, you'll take medications for the rest of your life to help prevent your body from rejecting the donated liver. These anti-rejection medications can cause a variety of side effects, including:
- Bone thinning
- High blood pressure
- High cholesterol
Because anti-rejection drugs work by suppressing the immune system, they also increase your risk of infection. Your doctor may give you medications to help you fight infections.
How you prepare
Choosing a transplant center
If your doctor recommends a liver transplant, you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.
When you're considering transplant centers, you may want to:
- Learn about the number and type of transplants the center performs each year
- Ask about the transplant center's liver transplant survival rates
- Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients
- Understand the costs that will be incurred before, during and after your transplant. Costs will include tests, organ procurement, surgery, hospital stays, and transportation to and from the center for the procedure and follow-up appointments
- Consider additional services provided by the transplant center, such as coordinating support groups, assisting with travel arrangements, helping with local housing for your recovery period and offering referrals to other resources
- Assess the center's commitment to keeping up with the latest transplant technology and techniques, which indicates that the program is growing
Liver transplant consultation at Mayo Clinic
A thorough evaluation is necessary to determine whether you are eligible for a liver transplant.
After you've selected a transplant center, you'll be evaluated to determine whether you meet the center's eligibility requirements for a liver transplant. Each transplant center has its own eligibility criteria. If you aren't accepted at one transplant center, you may undergo evaluation at another center.
The goals of the evaluation process are to determine whether you:
- Are healthy enough to have surgery and tolerate lifelong post-transplant medications
- Have any medical conditions that would interfere with transplant success
- Are willing and able to take medications as directed and follow the suggestions of the transplant team
Specific tests, procedures and consultations you may undergo include:
- Laboratory tests, including blood and urine tests to assess the health of your organs, including your liver
- Imaging tests, such as an ultrasound of your liver
- Heart tests to determine the health of your cardiovascular system
- A general health exam, including routine cancer screening tests, to evaluate your overall health
- Nutrition counseling with dietitians who assess your nutritional status and make recommendations regarding nutritional intake before and after transplant
- Psychological evaluation to assess and treat any underlying issues, such as depression or anxiety, and determine whether you fully understand the risks of a liver transplant
- Meetings with social workers who assess your support network to determine whether you have friends or family to help care for you after transplant
- Addiction counseling to help people with alcohol, drug or tobacco addictions to quit
- Financial counseling to help you understand the cost of a transplant and post-transplant care and to determine what costs are covered by insurance
Once these tests and consultations are completed, the transplant center's selection committee meets to discuss your situation. It determines whether a liver transplant is the best treatment for you and whether you're healthy enough to undergo a transplant.
If the answer to both questions is yes, then you're placed on the liver transplant waiting list.
What you can expect
Before the procedure
Being placed on the waiting list
Doctors use results of liver function tests and other factors to determine your prognosis and your place on the liver transplant waiting list.
Your prognosis is often called your Model for End-Stage Liver Disease (MELD) or Pediatric End-Stage Liver Disease (PELD) score for children younger than age 12.
MELD scores range from 6 to 40. The scores estimate the risk of death within 90 days without a transplant. The higher your MELD score, the more dire your situation.
Organs are allocated according to MELD scores and stratified by blood type. People with higher MELD scores are generally offered donated livers first. Time spent on the liver transplantation waiting list is used to break ties among people with the same MELD scores and blood type.
Some liver conditions, such as liver cancer, may not result in a person getting a high MELD score. The transplant center can request additional MELD points for people with specific diseases if they meet defined exception criteria.
In addition, adults with acute liver failure are exempted from the MELD-based donor organ prioritization system and may be placed higher on the list according to their disease status.
Waiting for a new liver
The wait for a donor liver can vary greatly. Some people wait days, while other wait months or may never receive a deceased-donor liver.
As you wait for a new liver, your doctor will treat the complications of your liver failure to make you as comfortable as possible.
Complications of end-stage liver failure are serious, and you may be frequently hospitalized. If your liver deteriorates, your MELD score is updated.
Living liver donors
A small percentage of liver transplants are done each year using a portion of a liver from a living donor. Living-donor liver transplants were initially used for children needing a liver transplant due to the scarcity of appropriately sized deceased-donor organs. Now, it has also become an important option for adults who have end-stage liver disease.
While access to deceased-donor liver transplant is determined primarily by the severity of your liver disease, access to living-donor liver transplant is determined primarily by identification of a living donor who is healthy and able to safely undergo a major surgical procedure and is also the right size and blood type.
Most living liver donors are close family members or friends of the liver transplant candidate. If you have a family member or friend who is willing to donate part of his or her liver to you, talk to your transplant team about this option.
Living-donor transplants have good results, just as transplants using livers from deceased donors. But finding a good living liver donor match is difficult due to restrictions on the donor's age, blood type, size and health. The surgery also carries significant risks for the donor.
Your transplant team can discuss the benefits and risks with you and the potential donor.
Domino liver transplant
Another, less common, type of living-donor liver transplant is called a domino liver transplant. In a domino liver transplant, you receive a liver from a living donor who has familial (hereditary) amyloidosis. Familial amyloidosis is a very rare disorder in which abnormal protein deposits accumulate and eventually damage the body's internal organs.
The donor with familial amyloidosis receives a liver transplant to treat his or her condition. Then, the donor can give his or her liver to you in a domino liver transplant, because the liver still functions well. You may eventually develop symptoms of amyloidosis, but it usually takes decades to develop.
Doctors usually select recipients who are 60 years old or older and who aren't expected to develop symptoms before the end of their natural life expectancy. After your transplant, doctors will monitor you for signs of the condition.
Doctors will evaluate you to determine if you may be a candidate for a domino liver transplant or if another procedure would be more appropriate for your condition.
Whether you're waiting for a donated liver or your transplant surgery is already scheduled, work to stay healthy. Being healthy and as active as you're able can make it more likely you'll be ready for the transplant surgery when the time comes. It may also help speed your recovery from surgery. Work to:
- Take your medications as prescribed
- Follow your diet and exercise guidelines
- Keep all appointments with your health care team
- Stay involved in healthy activities, including relaxing and spending time with family and friends
Stay in touch with your transplant team, and let them know of any significant changes in your health. If you're waiting for a donated liver, make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy, and make arrangements for transportation to the transplant center in advance.
During the procedure
Deceased-donor liver transplant
If you're notified that a liver from a deceased donor is available, you'll be asked to come to the hospital immediately. Your health care team will admit you to the hospital, and you'll undergo an exam to make sure you're healthy enough for the surgery.
Liver transplant surgery is done using general anesthesia, so you'll be unaware during the procedure.
The transplant surgeon makes a long incision across your abdomen to access your liver. The location and size of your incision varies according to your surgeon's approach and your own anatomy.
The surgeon disconnects your liver's blood supply and the bile ducts and then removes the diseased liver. The donor liver is then placed in your body, and blood vessels and bile ducts are reattached. Surgery can take up to 12 hours, depending on your situation.
Once your new liver is in place, the surgeon uses stitches and staples to close the surgical incision. You're then taken to the intensive care unit to begin recovery.
Living-donor liver transplant
If you're receiving a liver transplant from a living donor, surgeons will transplant a portion of the donor's liver in your body.
Surgeons first operate on the donor, removing the portion of the liver for transplant. Then surgeons remove your diseased liver and place the donated liver portion in your body. They then connect your blood vessels and bile ducts to the new liver.
The transplanted liver portion in your body and the portion left behind in the donor's body regenerate rapidly, reaching normal volume within a couple months.
After the procedure
Liver transplant consultation at Mayo Clinic
After a liver transplant, doctors will test your liver function often and monitor you for signs of complications.
After a liver transplant
After your liver transplant, you can expect to:
- Possibly stay in the intensive care unit for a few days. Doctors and nurses will monitor your condition to watch for signs of complications. They'll also test your liver function frequently for signs that your new liver is working.
- Spend 5 to 10 days in the hospital. Once you're stable, you're taken to a transplant recovery area to continue recuperating.
- Have frequent checkups as you continue recovering at home. Your transplant team designs a checkup schedule for you. You may undergo blood tests a few times each week at first and then less often over time.
- Take medications for the rest of your life. You'll take a number of medications after your liver transplant, many for the rest of your life. Drugs called immunosuppressants help keep your immune system from attacking your new liver. Other drugs help reduce the risk of other complications after your transplant.
Expect six months or more recovery time before you'll feel fully healed after your liver transplant surgery. You may be able to resume normal activities or go back to work a few months after surgery. How long it takes you to recover may depend on how ill you were before your liver transplant.
Survival rates after liver transplant
Your chances of a successful liver transplant and long-term survival depend on your particular situation.
In general, about 70 percent of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 70 will live for five years and 30 will die within five years.
People who receive a liver from a living donor often have better short-term survival rates than those who receive a deceased-donor liver. But comparing long-term results is difficult because people who have a living donor usually have a shorter wait for a transplant and aren't as sick as those who receive a deceased-donor liver.
Survival rates among liver transplant recipients also vary among U.S. transplant centers and can be found online at the Scientific Registry of Transplant Recipients.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Coping and support
It's normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. Seeking the support of friends and family members can help you cope during this stressful time.
Your Mayo Clinic transplant team can also assist you with other useful resources and coping strategies throughout the transplant process, such as:
- Joining a support group for transplant recipients. Talking with others who have shared your experience can ease fears and anxiety.
- Sharing your experiences on social media. Mayo Clinic has a Transplantation at Mayo Clinic Facebook page dedicated to helping transplant recipients and donors connect to each other online.
- Finding rehabilitation services. If you're returning to work, your Mayo Clinic social worker may be able to connect you with rehabilitation services provided by your home state's department of vocational rehabilitation.
- Setting realistic goals and expectations. Recognize that life after transplant may not be exactly the same as life before transplant. Having realistic expectations about results and recovery time can help reduce stress.
- Educating yourself. Learn as much as you can about your procedure and ask questions about things you don't understand. Knowledge is empowering.
New medication options
Liver transplant research at Mayo Clinic
Mayo Clinic scientists, doctors and surgeons are actively engaged in developing new technologies, treatments and techniques to make transplants safer and available to more people.
Mayo Clinic scientists, doctors and surgeons are actively engaged in research to make liver transplants safer and available to more people and improve results after transplant by developing new medication options.
Current research topics include:
- Bioartificial liver. This innovation helps people cope as they await a donor liver. Developed by Mayo Clinic doctors and researchers, new bioartificial livers use living cells from pig livers to filter a patient's blood in a process similar to that of kidney dialysis. The device is being tested before it becomes available in clinics and hospitals.
- Immunosuppressive medications. This research examines the effect of antibody-mediated injury in liver-kidney transplants and how doing a multiorgan transplant may actually result in better outcomes.
- Cell therapies for liver disease. This research offers potential new treatments for several liver diseases and may improve the success of liver transplantation.
Read more about the many liver transplant research studies supported by the Transplant Research Center.
Diet and nutrition
Eating a well-balanced diet is especially important after liver transplant to help you recover and keep you healthy.
Your Mayo Clinic transplant team includes a nutrition specialist (dietitian) who can discuss your nutrition and diet needs and answer any questions you have after your transplant.
In general, your diet after liver transplant should be low in salt, cholesterol, fat and sugar.
To prevent damaging your new liver, it's important to avoid alcohol. Do not drink alcoholic beverages or use alcohol in cooking.
Your Mayo Clinic dietitian will also provide you with several healthy food options and ideas to use in your nutrition plan. Your dietitian's recommendations after kidney transplant may include these steps:
- Eat at least five servings of fruits and vegetables each day
- Avoid grapefruit and grapefruit juice, pomegranates, or Seville oranges due to their effect on a group of immunosuppression medications (calcineurin inhibitors)
- Have enough fiber in your daily diet
- Choose whole grain foods over processed ones
- Drink low-fat or fat-free dairy products, which is important to maintain optimal calcium and phosphorus levels
- Eat lean meats, poultry and fish
- Follow food safety guidelines
- Stay hydrated by drinking adequate water and other fluids each day
Exercise and physical activity should be a regular part of your life after a liver transplant to continue improving your overall physical and mental health.
While you are in the hospital, a Mayo Clinic physical therapist will teach you exercises to help you recover and avoid complications. The physical therapist can also talk with you about finding an appropriate exercise program to follow at home.
Soon after your transplant, you should walk as much as you can. Then, depending on your progress, you can start incorporating more physical activity into your daily life.
Walking, bicycling, swimming, low-impact strength training and other physical activities you enjoy can all be a part of a healthy, active lifestyle after transplant. But be sure to check in with your transplant team before starting or changing your post-transplant exercise routine.
Sept. 24, 2016