Frequently Asked Questions About Liver Transplants

What Is a Liver Transplant?

With a liver transplant, the surgeon removes the diseased liver and replaces it with a healthy liver. A liver transplant is used for tumors that cannot be completely removed, either because of the size or location of the tumors or because the liver is too diseased for regular surgery. A transplant is possible only if the tumors are small (either 1 tumor smaller than 5 centimeters across or 2 to 3 tumors no larger than 3 centimeters) and have not invaded nearby blood vessels.

The 5-year survival rate for patients who have had a transplant is between 60% and 70%. Before any liver transplant, the doctor will first test for possible hepatitis B or C infections. If you are infected with either hepatitis B or hepatitis C, you will be treated with antiviral medicines before the transplant. The antiviral medications will be continued after surgery for a certain amount of time to prevent your healthy liver from becoming infected.

What Are the Types of Liver Transplants?

Orthotopic Liver Transplantation is when the diseased liver is replaced by a healthy liver from a donor who has recently died. This is the most common procedure for liver transplants.

Living Donor Transplantation is when a living person donates a part of his or her liver to someone who needs a new liver. This procedure has been increasingly successful, but it carries risks for the donor, and only a small number of living donor transplants are available for patients with liver cancer.

What Happens when I Am on a Transplant Waiting List?

Currently there are more people who need a new liver than there are donors. Therefore, most people will be placed on a transplant waiting list. While you are on the waiting list, the transplant team will regularly monitor your liver’s health and provide other treatments if needed, such as surgery, embolization, or ablation.

What Happens During Liver Transplant Surgery?

During transplant surgery, the transplant team replaces the diseased liver with a donated, healthy liver. The blood type and body size of the donor have to match the person receiving the transplant. Liver transplant surgery usually takes between 4 and 12 hours. Most patients stay in the hospital for up to 3 weeks after surgery.

What Happens After Transplant Surgery?

After the transplant surgery, you may need to stay in the hospital for several weeks while your health care team monitors how well your body is accepting the new liver. You'll take medicines to control any pain. You will start taking immunosuppressive drugs to prevent your body's immune system from rejecting the new liver.

If you have chronic hepatitis B infection, you will continue the antiviral drug therapy you had started before the transplant surgery to stop the virus from becoming active. Hepatitis B reactivation can be a very serious, sometimes even deadly, complication.

You will need the most medicines during the first 3 months after transplantation. It is important for you to be familiar with the medicines and to report any side effects. Not every patient having a liver transplant takes the same medicines or has the same side effects.

After a liver transplant, you will undergo regular blood tests and occasional liver biopsies to make sure your body is not rejecting the new liver. In addition, these tests will show whether the liver cancer is in remission or returning. It is very important that you closely follow the instructions from your transplant team.

What Are the Risks and Side Effects of a Liver Transplant?

A liver transplant, like all major surgery, has possible serious risks such as bleeding, infection, and complications from anesthesia. In addition, people who have a liver transplant may have side effects from the immunosuppressive drugs they need to take. These medicines weaken the immune system so the body does not reject the new liver. This means, however, that a patient may be at increased risk for developing other serious infections. Some of the immunosuppressive drugs can also cause high blood pressure and cholesterol, diabetes, and weaken the bones and kidneys. Regular health care checks with the transplant team are critical to staying as healthy as possible after a liver transplant.