A liver transplant involves surgically removing a liver that is no longer functioning properly, and replacing it with a healthy liver, or a portion of one, from a donor.
Most donated livers come from people who have died. They come from registered organ donors or people whose next of kin consent to them becoming a donor. Less commonly, liver transplants involve a living donor, often a friend, family member, or stranger whose tissue matches, and who donates a segment of their liver.
Typically, surgeons will only perform a liver transplant when all other treatment options have been ruled out. Nevertheless, liver transplants are the second most common type of transplant surgery after kidney transplants, with more than 157,000 carried out in the United States since 1988.
In 2015 alone, 7,100 liver transplants took place, with 600 of those surgeries performed on people 17 years of age or younger.
Though liver transplants carry a risk of significant complications, the procedure has a high success rate. The operation typically helps save or greatly extend the lives of people with severe liver conditions.
Due to a variety of complicated factors, it is almost impossible to predict an individual's chances of having a successful liver transplant or how long they will survive afterward.
However, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) list the following average survival rates for people who have had liver transplant surgery from a deceased donor:
- 86 percent still alive 1 year after surgery
- 78 percent still alive 3 years after surgery
- 72 percent still alive 5 years after the surgery
- 53 percent still alive 20 years after the surgery
Reported survival rate estimates vary depending on the type of information used, as well as when and how they were calculated.
Although liver transplants have high success and survival rates, an individual's chances of surviving and thriving after the surgery depend on a mix of critical factors.
- body mass index (BMI) and major fluctuations in body weight
- how healthy a person is before the surgery
- severity of their liver failure and how many other organs are involved, especially the kidneys
- cause of the liver failure
- medical history
- additional health conditions
Age and BMI
Age and BMI are two significant factors that influence survival rates after liver transplants.
A 2017 study found that long-term survival rates were lower in older people and those whose BMIs were above normal and who were designated as overweight.
Cause of liver failure
According to a 2013 study, the cause of the liver failure may also influence the outcome of a liver transplant.
The study concluded that children and adults whose liver failure was caused by genetic conditions had higher survival rates than those whose conditions were due to lifestyle choices or infection.
The process of finding a donor liver can be extremely challenging, stressful, and lengthy.
Once someone is approved for a liver transplant, their doctor will contact the non-profit organization United Network for Organ Sharing (UNOS), and ask for the recipient's name to be added to the national organ donor waiting list.
Some people have to wait up to 5 years or longer for a match with a donor liver.
When looking for a matching donor liver, doctors consider several factors, including:
- severity of a person's liver failure
- their blood type
- a person's overall health
- a person's body size
- location, as some U.S. states have bigger populations, donor bases, and donor centers than others
- availability of matching livers in the national waiting list system
The severity of someone's liver failure is measured according to a model for end-stage liver disease (MELD) score, or pediatric end-stage liver disease (PELD) score for those under 12 years of age. The scores range from 6 to 40.
How many people are waiting
On average, roughly 15,000 Americans are estimated to be on the waiting list for a liver donor each year.
While the number of people needing a liver transplant is increasing, the number of new donor livers available is decreasing.
The number of people who have died while waiting for a donor liver or have been taken off the waiting list because they have become too sick to undergo the treatment has also increased by 30 percent in the last decade.
Liver transplants typically involve the surgical removal of any diseased, dead, or injured liver tissue, including removal of the entire organ. Surgeons will then reconnect a whole donor liver or a segment of a deceased donor's liver.
Segmental liver transplants allow the use of live donors and for two people to receive transplants from one donor liver. However, this procedure is higher risk due to more frequent complications.
In 2013, 96 percent of liver transplants used deceased donor livers, while just 4 percent used segments from a living donor.
As more people become aware of segmental liver transplant surgery, it may occur more frequently and become safer.
A liver transplant is a major surgery that comes with several risks and potential complications, ranging in severity and including:
- blood clots in the hepatic artery that supplies blood to the liver
- organ rejection, where the body does not accept the donor liver (most common during the first 3 to 6 months after surgery)
- failure of the donor liver
- bile duct leakage or damage
- bacterial infection
- hernia or rupturing of the cuts made in surgery during healing
- lung failure
- multiple organ failures
Immediately after surgery, most people will stay in the intensive care unit (ICU) for a day or two. They will remain on a ventilator to help them breathe and be closely monitored to ensure the new liver is working properly.
They will also be given immunosuppressant (anti-rejection) medications to help prevent their body from destroying the donor liver. People who have an organ transplant must take immunosuppressant drugs for the rest of their lives.
When the person is ready, doctors will move them from the ICU to a regular room in the hospital. After the surgery, a person who has had a liver transplant will need to spend around 2 weeks in the hospital before going home.
Many people require 2 or 3 months before they feel well enough to return to everyday activities. Also, it can take years for the full effect of the surgery to be realized.
Most people who have donor livers will also need to make certain lifestyle changes to keep their new liver healthy.
These changes include:
- eating a healthful, balanced diet, given to them by a nutritionist or dietitian as part of the transplant process
- staying hydrated
- quitting smoking
- avoiding alcohol
- taking all medications exactly as prescribed
- attending all medical appointments
- avoiding raw or undercooked eggs, meats, and seafood
- avoiding unpasteurized foods
- cutting down on foods that are hard for the liver to digest, such as fats, cholesterol, sugars, and salt
- avoiding contact with people who are sick
- talking with a doctor immediately if sick
- avoiding exposure to dirt by wearing shoes, socks, long pants, etc.
- avoiding known allergens
- avoiding contact with reptiles, rodents, insects, and birds
- avoiding eating grapefruits and drinking grapefruit juice
- avoiding strenuous activity within the first 3 months after surgery and talking to a doctor before resuming vigorous activities or exercises
- talking to a doctor before using any new over-the-counter medications, vitamins, or supplements
- wearing insect repellent when outside in the spring or summer and not spending a lot of time outdoors during dawn or dusk
- avoiding swimming in lakes and other freshwater bodies
- talking to a doctor before planning any trips, especially to developing nations
- talking to a doctor before using contraceptives or trying to get pregnant
Infection and rejection
Infection and organ rejection can lead to sepsis, multiple organ failure, and death. Therefore, it is essential that people with donor livers know how to recognize the signs of these potential complications. They should always seek medical attention as soon as possible to prevent further complications.
Signs of infection include:
Organ rejection does not always cause noticeable symptoms, but symptoms can include:
- exhaustion, regardless of the amount of sleep
- yellowing of the skin and whites of the eyes
- pain and tenderness in the abdomen
- very dark urine
- lighter than normal stools
Liver transplants are reasonably safe procedures with good survival rates. However, many factors can influence an individual's chances of a successful surgery, and determine how long they live after the surgery. These factors include their overall health, lifestyle habits, and additional conditions.
Recovery time for people who receive a liver transplant will vary but mean between 3 and 6 months before they can return to everyday activities.
As long as they take immunosuppressant drugs, as prescribed for them and make the recommended lifestyle changes, most people can enjoy a good quality of life for decades after liver transplant surgery.