Liver Transplantation and Life After Transplantation

The liver is one of the most vital organs in the human body, performing more functions than any other organ. From digestion and immunity to nutrient storage, waste elimination, and blood clotting, the liver plays a central role in a wide array of bodily processes. When the liver becomes unable to perform its functions due to various diseases, the condition is known as liver failure. At a certain stage, the only viable treatment for liver failure is a liver transplant.

What Is a Liver Transplant?

A liver transplant, medically known as liver transplantation, can be performed using a liver from either a deceased donor (cadaveric) or a living donor. The majority of liver transplants are performed due to liver cirrhosis. When done at the right time and with a successful operation, liver transplantation has a high success rate.

Liver transplantation involves replacing a malfunctioning liver with a healthy one, either from a deceased person who has been declared brain dead or from a living donor. This life-saving procedure is carried out by general surgery units, particularly in cases of end-stage or acute liver failure.

Besides chronic liver failure and cirrhosis (its most common cause), liver transplantation may also be necessary to treat certain inherited or metabolic diseases. To perform the procedure, the patient’s non-functioning liver must first be completely removed. Then, a suitable portion of the donor’s liver (either the right or left lobe, depending on the patient’s weight) is transplanted.

In transplants from living donors, the donor generally does not experience liver insufficiency after surgery, thanks to the liver’s unique ability to regenerate. However, liver transplantation is one of the most complex and demanding surgical procedures. It must be carried out in fully equipped hospitals by specialized transplant teams. The process involves not only the surgery itself but also extensive pre- and post-operative care and monitoring.

For more details about the Florence Nightingale Liver Transplant Center: Liver Transplant Center

Who Needs a Liver Transplant?

Most commonly performed for liver failure, liver transplantation may be required for both acute and chronic conditions. Acute liver failure can develop rapidly due to drug use or fungal infections, necessitating an urgent transplant. Chronic liver failure, on the other hand, may result from conditions such as malnutrition, liver cancer, hepatitis B and C infections or carrier states, bile duct diseases, excessive alcohol consumption, iron overload (hemochromatosis), and cirrhosis. In advanced stages, liver transplantation is often the only treatment option.

Rare congenital metabolic disorders may also require liver transplantation. In cases where life expectancy is less than one year due to end-stage cirrhosis, a transplant is strongly recommended. Factors like the type of disease, the patient’s age, and overall health condition are taken into account. For patients with a living donor, an earlier transplant may be planned. Though it is a serious and complex procedure, when done at the right time, liver transplantation has a success rate of 75–80%.

How Is a Liver Transplant Performed?

A compatible liver from a living donor (with the same blood type) or a cadaveric donor who has pledged organ donation is required. In cadaveric transplants, patients are placed on a waiting list based on urgency and other criteria like age. If a living donor is available, the surgery can be scheduled accordingly.

Anyone in good health and with the same blood type can potentially be a living liver donor. A familial relationship up to the fourth degree between donor and recipient increases the success rate. Prior to surgery, donors undergo extensive medical evaluations to rule out any condition that might prevent donation. People with diabetes, heart or kidney disease, hypertension, certain psychological disorders, infections, or those under 18 years of age cannot donate.

If no issues are found, a surgical plan is made, and the recipient is typically hospitalized a few days before the procedure for thorough medical assessment. Since the transplant requires a large volume of blood, blood donations may be requested from the recipient’s relatives beforehand. On the day of surgery, the donor and recipient are operated on simultaneously in separate operating rooms. The donor’s surgery begins first. Once the liver is confirmed to be structurally suitable, the recipient’s operation begins.

A portion of the donor’s liver appropriate for the recipient’s weight is transplanted. While the transplant is completed in the recipient, the donor is taken to intensive care for monitoring.

How Long Does a Liver Transplant Surgery Take?

Liver transplant surgery is among the most challenging surgical procedures. While it typically lasts between 6 to 8 hours, it can extend up to 18 hours in some cases. A multidisciplinary team with advanced training and experience in transplantation is crucial for a successful outcome. The procedure should be carried out in fully equipped hospitals with access to all necessary medical departments.

The medical center must also be equipped with advanced imaging technologies, a well-furnished operating room, and a specialized intensive care unit. After surgery, the recipient is taken to intensive care just like the donor. If there are no complications, the donor typically recovers and is discharged within a few days to a maximum of 10 days.

The recipient is monitored in intensive care until their vital functions stabilize and is then transferred to the general ward to continue treatment.

What Are the Risks for the Donor?

One of the most commonly asked questions is about the risks faced by living donors. Generally, the risk of death for donors in liver transplant surgeries is below 0.5%, which is considered low. However, if any complications arise during surgery, the operation may be terminated.

If excessive fat in the liver, anatomical abnormalities, or unexpected masses are detected, the surgical incision may be closed and the operation ended without proceeding. This is why the recipient’s surgery only begins after confirming that the donor’s liver has no structural issues.

Rare complications after donor surgery may include bile leakage or bleeding. Although uncommon, these may require additional interventions such as reoperation or blood transfusion, and donors are informed about these risks beforehand. As with any surgery, minor infections at the incision site, digestive issues like constipation or gas pain, and nausea or vomiting from anesthesia are possible temporary side effects.

Since the liver can regenerate, the donor’s liver typically returns to its normal size within about 6 weeks. Consequently, long-term complications are very rare in uneventful cases.

What Happens After the Transplant?

Following the transplant, the recipient is initially monitored in intensive care and then moved to the general ward. After approximately 10 days of treatment, the patient is discharged with detailed guidance on post-operative care. As with all organ transplants, the risk of organ rejection is a significant concern after a liver transplant.

To prevent rejection, patients must take lifelong immunosuppressive (immune-suppressing) medications. Even with medication, signs of rejection can sometimes occur and are usually diagnosed via liver biopsy. Most of these episodes can be managed effectively with timely medical intervention.

The overall surgical risk depends on the patient’s condition. Most transplant candidates are individuals with advanced liver failure, often severely ill and with reduced body reserves. Given the scale of the surgery, the risk level directly correlates with the severity of the patient’s illness. Studies suggest that survival rates are higher in patients receiving liver transplants from living donors compared to deceased donors. However, shorter waiting times for living donor transplants and longer wait times for cadaveric donors (during which the patient’s condition may deteriorate) may also affect outcomes.

During transplantation, major blood vessels are cut and reconnected, which poses a risk of serious bleeding. Infection is another critical risk, particularly because the immunosuppressive drugs can weaken the body’s ability to fight infections. Therefore, following the healthcare team’s recommendations to minimize infection risk is crucial.

What Is Life Like After a Liver Transplant?

A key question for many is how long and how well patients live after a transplant. This depends heavily on the timing and success of the operation, as well as the patient’s individual circumstances, including any other health conditions.

In general, about 75% of patients who undergo successful liver transplantation by an experienced team live for five years or more. However, the transplant journey doesn’t end with surgery. Lifelong medication adherence and regular follow-up visits are essential for maintaining health and maximizing the longevity of the transplant.

If you’re preparing for a liver transplant, closely following your doctor’s recommendations is crucial for a smooth recovery. If you already have liver disease, keeping up with routine checkups can help detect failure early or even prevent it. You can also give hope to those awaiting transplants by becoming an organ donor yourself or encouraging others to do so.

For more information about liver transplants, you can contact the expert team at Group Florence Nightingale Hospitals using the communication form.