Catherine Spader, RN
What is a liver transplant?
A liver transplant is the surgical replacement of a damaged or diseased liver with a donor liver. It is a treatment for end-stage liver disease and other severe liver conditions. Liver transplantation is a life-saving surgery used when all other medical and surgical options have failed.
A liver transplant is a major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a liver transplant.
Types of liver transplant
The types of liver transplant surgery include:
Living donor transplants use a portion of a live person’s liver to replace the damaged or diseased recipient’s liver. Living donor transplants work because the liver is capable of regeneration or growing to meet the body’s needs. Living donors are usually a family member or close friend of the recipient.
Whole cadaver transplants use the entire liver from a deceased donor to replace the damaged or diseased recipient’s liver.
Split cadaver transplants use part of a deceased donor’s liver to replace the damaged or diseased recipient’s liver. In a split cadaver transplant, the donor’s liver is divided into two parts that are transplanted into two recipients. The recipients are usually children or petite adults.
Other procedures that may be performed
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Diseases that cause serious damage to the liver can also cause serious damage to other organs. These can include the kidney, lung and heart. For example, polycystic kidney disease (PKD) can damage both the liver and kidneys. Another organ may be transplanted during a kidney transplant in rare cases. Your doctor and transplant care team will determine if a combination transplant procedure is right for you.
Other transplant surgeries include:
Heart transplant replaces a diseased or damaged heart with a donor heart.
Kidney transplant replaces a diseased or damaged kidney with a donor kidney.
Lung transplant replaces a diseased or damaged lung with a donor lung.
Why is a liver transplant performed?
Your doctor may recommend a liver transplant to treat end-stage liver disease and other severe liver conditions. Normal liver function is crucial to your life and overall health.
Your doctor may only consider a liver transplant for you if other medical and surgical treatment options have failed. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a liver transplant.
Your doctor may recommend a liver transplant for:
Acute liver failure, which is liver failure that happens very quickly. It is usually due to poisoning or drug overdose. The most common cause of acute liver failure is drug-induced liver injury from acetaminophen (Tylenol).
Congenital defects, which are present at birth including biliary atresia. Biliary atresia causes absent, damaged or blocked bile ducts and is the most common reason for liver transplant in children.
End-stage liver disease, which is the most advanced form of chronic liver failure. Cirrhosis (irreversible scarring of the liver) is the most common cause of end-stage liver disease in adults. Cirrhosis is caused by hepatitis B and C, alcohol abuse, autoimmune liver diseases, hereditary liver diseases, bile duct diseases, and nonalcoholic fatty liver disease.
Liver cancer, which includes hepatocellular carcinoma, hepatoblastoma, and cholangiocarcinoma
Who performs a liver transplant?
Transplant surgeons and pediatric surgeons perform liver transplants. Transplant surgeons specialize in transplant surgery of the kidney, liver, pancreas, and other organs. Pediatric surgeons specialize in surgery for infants, children and adolescents.
How is a liver transplant performed?
Your liver transplant will be performed in a hospital. A liver transplant surgery can take up to 12 hours. It is an open surgery. It involves making an incision ribs in your upper abdomen across the bottom of both sides of your ribs. An open incision allows your doctor to directly view and access the surgical area. Your surgeon will remove your liver, place the donor liver, and reattach blood vessels and bile ducts through this incision.
What to expect while on the liver transplant waiting list
You will be placed on a liver transplant waiting list if you are eligible for a liver transplant.
A computer will calculate a Model of End-stage Liver Disease (MELD) score based on pre-transplant blood work results. Children receive a Pediatric End-stage Liver Disease (PELD) score. Your score determines your place on the list. Higher scores indicate sicker patients who are placed higher on the list. You will need periodic blood work to update your MELD score as you wait for a liver.
Patients who are critically ill with acute liver failure and are likely to die within one week are given the highest priority on the waiting list (status 1 patients).
Donors and recipients are matched based on compatible blood types and size. Once a donor liver is matched to you, it generally needs to be transplanted within eight hours. You may already be in the hospital because of your condition. If not, most transplant centers require you to be in immediate contact range while on the waiting list. Your transplant center may expect you to arrive at the hospital within two hours of contact.
Types of anesthesia that may be used
Your surgeon will perform a liver transplant using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your liver transplant
Your transplant center will call you when a liver is ready for you. Do not eat or drink anything after your transplant center has called you. When you arrive at the transplant center, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your anesthesia.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A catheter (tube) will be placed in your bladder to collect urine during and after the surgery.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a liver transplant?
As with all surgeries, a liver transplant involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of a liver transplant
Complications of a liver transplant include:
Bile duct problems including bile leak outside the bile ducts and biliary stenosis (narrowing) that may lead to blockage. Bile duct problems may require additional surgery to correct.
Complications from anti-rejection drugs including cancer and other side effects
Complications from not following your lifelong healthcare plan after transplantation
Failure of the donor liver
Recurrence of liver disease
Rejection of the liver
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns such as bleeding, fever, or increase in pain
Taking your medications and returning for follow-up care exactly as directed
How do I prepare for my liver transplant?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a liver transplant by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Getting preoperative procedures as directed. This may include endoscopy and colonoscopy to check for varices or enlarged veins in your digestive tract, a complication of serious liver disease. Varices can rupture and cause life-threatening bleeding. Your doctor may tie off any varices that he or she finds. The need for these procedures varies.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Staying in contact with your transplant center as directed and following guidelines for remaining in the area.
Taking or stopping medications exactly as directed. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a liver transplant? Are there any other options for treating my condition?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work? What type of activities and exercises can I perform and when?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How will these medications affect my lifestyle? What are the risks and complications of these medications?
How will you treat my pain?
What type of tests, regular monitoring, and care will I need after going home?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my liver transplant?
Knowing what to expect can help make your road to recovery after a liver transplant as smooth as possible.
How long will it take to recover?
You will move to an intensive care unit (ICU) after surgery. ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. It is usually removed it 24 to 48 hours. You may also have a sore throat. This is usually temporary, but tell your care team if you are uncomfortable.
You will also have a special drain attached to your body called a T-tube. A T-tube drains bile into a bag. Your transplant team will remove the bag after a week or two and cap the T-tube. The T-tube will likely remain in place for a few months in order to allow access for testing. Your transplant team will teach you how to care for your T-tube before you go home.
You will move to a hospital room outside the ICU as you recover. This room will have equipment to monitor your vital signs. A typical hospital stay after a liver transplant is seven to 14 days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors.
Your doctor may refer you to a support group program to help you through your recovery process. Full recovery takes six to 12 months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery/procedure. Your doctor will treat your pain so you are comfortable and can get the rest you need. Tell your doctor or care team if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a liver transplant. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness such as passing out, dizziness, unresponsiveness, or confusion
Changes in blood pressure. Your transplant team will teach you how to monitor your blood pressure, what your normal blood pressure readings should be, and when to contact the transplant center.
Dark urine, light-colored stools, or yellowing of the skin or eyes
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement or prolonged nausea and vomiting
Pain that is not controlled by your pain medication or any discomfort that is new, worsening or different
T-tube problems including a change in the length of the visible part of the T-tube, breakage of the suture (stitch) that holds the T-tube in place, or pain, redness, swelling or drainage at the T-tube site
Unexpected drainage, pus, redness or swelling of your incision
Weight gain, which may be a sign that you are retaining fluids. This can be serious.
How might a liver transplant affect my everyday life?
A liver transplant may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. However, a liver transplant can cause significant changes to your body that may affect your everyday life, such as the need to:
Carefully plan any attempt at pregnancy and work closely with all of your healthcare providers before, during and after a pregnancy
Follow a lifelong healthcare plan
Keep follow-up appointments and get routine liver function testing
Manage anti-rejection medications and their side effects
Prevent liver rejection with lifelong medications
Treat other conditions such as diabetes, high blood pressure, and high cholesterol
Watch for signs of rejection
Work through emotional issues and seek appropriate support
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