What is a liver transplant?
A liver transplant is an operation that places a liver from someone who died recently (a deceased or nonliving donor) into someone whose own liver failed because of disease, infection or alcohol or drug abuse. A partial liver transplant can also be done from a living donor. Many of the recipients of liver transplants are children .The liver will grow back to nearly its full size in both living donors and recipients.
The first human liver transplant was done in 1963. However, the procedure did not gain widespread acceptance until the 1980s. In 1998, a total of 4,450 liver transplants were done at 124 U.S. transplant centers. In 2002, a total of 5,329 liver transplants were done at transplant centers in this country. A liver transplant is the second most common organ transplant operation done in the United States.
When is a liver transplant needed?
A liver transplant is needed when your own liver can no longer perform these important functions:
- eliminating drugs and toxic substances from your body
- making immune factors that help you resist infections
- making new body proteins.
Cirrhosis (the death of liver cells) due to hepatitis C is currently the leading cause for liver transplantation.
Each year more than 27,000 Americans die of liver diseases. Although some liver problems can be treated with medications, liver transplant is often the most effective treatment for chronic, life-threatening liver disease.
How long is the wait?
The length of time a person may wait for a liver transplant varies, depending on the availability of a compatible donor. The time may be as short as several months to a year or as long as four years. As of September 2003, there were 17,327 candidates on the national waiting list, waiting for a liver transplant.
How successful are they?
The success rates of liver transplant are improving all the time. Currently, at one year after their transplant operation, 77 percent of liver recipients still have a well-functioning transplant, and after five years, 60 percent still have a well-functioning transplant.
Liver transplant patients have about an 87 percent one-year and 77 percent three or more year survival rate, and a good quality of life after recovery.
How much do they cost?
As of 1997, the cost of a liver transplant in the United States was $314,500, including the evaluation, procurement of the liver, hospitalization, physician fees and follow-up care and medications for the first year. As of 2002, the cost of a liver transplant in the United States averaged about $250,000 for immediate hospital and doctor expenses. Necessary pre- and post-operative expenses brought the total to about $314,500.
In some cases Medicare provides coverage for liver transplants for some causes of liver failure. Talk to your transplant center to see if they are Medicare approved and you meet the criteria for a Medicare covered transplant. If you have private insurance, you should check with your insurance representative about whether your policy covers liver transplants. This may help to pay some of the costs.
The social worker or a financial counselor at your transplant center may be able to help you to access local, state or national programs that can help you with the costs of the transplant and postoperative care, including needed medications.
How do I start the process?
You start the process by speaking to your doctor about a liver transplant. If your doctor feels that a transplant would be a good treatment choice, you need to contact a transplant center. You will need to speak to the transplant coordinator at the center, who will make arrangements for you to have a medical evaluation. This will help you and your health care team decide whether a liver transplant is a good option for you.
How am I evaluated for a liver transplant?
When patients have a life-threatening liver disease, the evaluation and liver transplant itself are best undertaken while they are still healthy enough to have major surgery. The patient will need to meet with a transplant surgeon and transplant coordinator at an approved transplant center.
In addition to a medical history review and physical examination, some special tests may include:
- tests of lung function, including chest X-ray
- heart evaluation, including EKG
- ultrasound and CT scan or MRI of the liver
- blood tests including blood and tissue typing
- special X-ray tests of the liver and bile ducts, gall bladder, and pancreas
- X-ray studies of the esophagus, stomach and intestines
- evaluation of kidney function including a 24-hour urine test
- social and psychological evaluation
- eye and dental exams.
If everything goes well, you will be placed on the center’s waiting list until a suitable deceased (nonliving) donor becomes available. You will also be registered on the national computerized registry, which is maintained by the United Network for Organ Sharing (UNOS). If a living donor is available, the donor will also need to be evaluated before the surgery can be scheduled.
What are the major risks involved in the surgery?
The first risk is the possibility of acute pre-surgery complications which might cause the operation to be postponed. Once surgery has begun, there are risks that are common to all forms of major surgery. Occasionally, there may be difficulties removing the diseased liver and implanting the donor liver. For a brief period of time during the procedure, you are without any liver function at all. After surgery, there is the possibility of inadequate functioning of the new liver, post-operative bleeding, infection, and rejection of the organ.
What should I expect after the transplant operation?
Recovery time varies, depending on a number of factors, including how ill you are before the transplant, and how well you do during the surgery. As a rule, most patients spend several days in the intensive care unit and at least four weeks in the hospital. In intensive care, you are monitored very closely. After being transferred to a regular hospital room, you are usually allowed to eat, monitoring is decreased, and tests are done less frequently. To help you regain muscle strength, physical therapy is usually begun as soon as possible. Initially, anti-rejection medications are given intravenously (IV), or directly into your veins. Later, they are given by mouth. If the new liver fails, it is possible to have another transplant. However, even if the transplant does not function perfectly, you may still do very well.
What complications may occur after the transplant?
The main complications that may occur are infection and rejection. In order to prevent rejection, it is important to take your medications faithfully, exactly as ordered by your doctor. The symptoms of rejection that liver transplant patients need to watch for may include fatigue and jaundice, or yellowing of your skin.
If you have any of these, speak to your transplant team right away. You will be followed regularly at the transplant center. Sometimes, early symptoms of rejection are hard to notice, but they can be detected in your blood work and treated. Most liver transplant patients may have a rejection episode during the first few months, requiring a return to the hospital for additional treatment.
The medications you need to take to prevent rejection lower your body’s immune defenses, and this increases the chance you may have an infection. This risk is higher right after your transplant because the doses of your medications are higher. During this time, it is important to avoid large crowds and people who are sick, especially with contagious diseases such as colds or flu. You should wash your hands often. After a while, the doses of your medications will be reduced, and the chance of getting infections will be less.
Do the anti-rejection medications have side effects?
Yes. These medications have many potential side effects. All of them can increase your chances of getting infections (see last question). Other side effects depend on the specific medications you are taking. It is important to learn the side effects each of your medications may cause and understand what to do if you get any of them. Some side effects are more serious and require an immediate call to your transplant team and quick adjustments in your medications. Other side effects may be more of a bother, but not life-threatening, and they can be dealt with at your next clinic visit. Ask your transplant team how to recognize the side effects of your medications, and what you can do to help minimize side effects.
How can I cope with fears of rejection and other concerns?
Although transplantation gives you a new lease on life with added freedom and increased energy and productivity, it is normal to experience some stress after the transplant.
This may include fear of rejecting the transplant, concerns about returning to work or other activities and feelings of isolation. Some strategies that may help you cope with these and other challenges include:
- join a local support group for transplant recipients
- learn as much as possible about your medical care and individual progress
- find personal quiet time to think about your feelings and concerns and the adjustments you need to make
- get to know the members of your transplant team, and sit down with them to discuss the issues that concern you most.
Can I return to work and other activities after the transplant?
It is hoped that you may return to your previous employment, start a new job or work part-time. However, if this is not possible, there are many other types of fulfilling and productive activities you can explore. These may include continuing your education, pursuing hobbies, volunteering, starting an exercise program, traveling or just spending quality time with family and friends. If returning to work is an option for you, you may want to ask the transplant social worker at your center for information about the rehabilitation services provided through your state’s Department of Vocational Rehabilitation.
Other sources of help and information
If you have questions or problems, you should speak with your doctor or other members of the health care team at your transplant center. For further information you may contact:
American Liver Foundation:
National Kidney Foundation
National Transplant Assistance Fund
(if you are a veteran and received your transplant at a VA hospital)
Insurance for High Risk Individuals
National Foundation for Transplants
(American Medical Support Flight Team)
The Children’s Organ Transplant Association
You may also be interested in the following NKF publications. Copies are available by contacting your local NKF Affiliate, or by calling the national toll-free number: 1-800-622-9010.
- From Illness to Wellness: Life after Transplantation
- Optimal Drug Use: Be a Team Player
- The Organ and Tissue Donor Program
- Nutrition and Transplantation
- How to Write to Donor Families
- Transplant Chronicles—a quarterly newsletter for transplant recipients and their families.
You may also be interested in learning more about NKF's transAction Council. The Council provides recipients and their families with information and programs in education, fitness and research designed to improve their quality of life. Membership in the Council is free and open to all individuals who have received a life-saving or life-enhancing organ transplant, their families and friends. For more information about the benefits of membership and to receive a membership form, call or write the National Kidney Foundation.
United Network for Organ Sharing, accessed January 2004.
The American Liver Foundation, 2003.
OPTN, September 2003.
Battelle Institute/ Seattle Research Center, 2002.
Children’s Organ Transplant Association.
If you would like more information, please contact us.
© 2014 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.