Risks

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
• Bleeding
• Blood clots
• Failure of donated liver
• Infection
• 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
• Diabetes
• Diarrhea
• Headaches
• 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

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

Evaluation

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.

Results

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.

Overview

Overview

A living-donor liver transplant is a surgical procedure in which a portion of the liver from a healthy living person is removed and placed into someone whose liver is no longer working properly.

The donor's remaining liver regrows and returns to its normal size, volume and capacity within a couple of months after the surgery. At the same time, the transplanted liver portion grows and restores normal liver function in the recipient.

Why it's done

The number of people waiting for a liver transplant greatly exceeds the number of available deceased-donor livers. Living-donor liver transplant offers an alternative to waiting for a deceased-donor liver.

Having a living liver donor also allows the recipient to avoid some possible health complications while waiting for a transplant. People who have a living-donor liver transplant seem to have fewer medical problems after the procedure than those who receive a deceased-donor liver, as well as a longer survival rate of the donated organ.

Living-donor liver transplants are more common among children who need a liver transplant than among adults because suitable deceased-donor organs are scarce.

Most living liver donors are close family members or friends of the liver transplant candidates.

What you can expect

Before the procedure

To be considered for a living-donor liver transplant, both the donor and recipient must undergo a thorough health and psychological evaluation at a transplant center. Separate transplant teams will care for the donor and recipient during the evaluation process and will discuss the potential benefits and risks of the procedure in detail.

For example, while the procedure often may be lifesaving for the recipient, donating a portion of a liver carries significant risks for the donor.

Matching of living-donor livers with recipients is based on age, blood type, organ size and other factors.

During the procedure

On the day of the transplant, surgeons will remove a portion of the donor liver for transplant through an incision in the abdomen. The specific part of the liver donated depends on the size of the donor liver and the needs of the recipient.

Next, surgeons remove the diseased liver and place the donated liver portion in the recipient's body, connecting the blood vessels and bile ducts to the new liver.

The transplanted liver in the recipient and the portion left behind in the donor regrow rapidly, reaching normal liver volume and function within a couple of months.

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 get a living-donor liver usually have a shorter wait for a transplant and aren't as sick as those who receive a deceased-donor liver.