Adult Liver Transplant Surgery

What is a liver transplant?

A liver transplant is a surgery during which doctors remove your sick or injured liver and replace it with a healthy liver from a donor. Most often, the liver is from a deceased organ donor. Sometimes, a portion of the liver of a healthy living donor can be used for transplantation.
 

Who needs a liver transplant?

You cannot live without a liver. If your liver damaged to a point that it doesn’t work properly, in other words if you have liver failure, a liver transplant can help you to become healthy again and save your life.

Most common cause for chronic liver failure is cirrhosis. This is a condition where healthy liver tissue is over time replaced by more and more scar tissue. This makes that the liver stop functioning properly.

Many different conditions can cause the liver to become cirrhotic:

• Excessive and longstanding use of alcohol.
• Hepatitis B and Hepatitis C virus infection.
• Fatty liver disease.
• Certain genetic diseases such as Hemochromatosis (too much iron buildup in the liver) Wilson’s disease (too much copper buildup in the liver), etc.
• Certain diseases of the bile ducts such as Primary Sclerosing Cholangitis (PSC) and Primary Biliary Cholangitis (PBC).
• Autoimmune hepatitis - A disease where the immune system attacks the liver.

There are other conditions where a liver transplant can be the treatment of choice:

• Acute liver failure: a condition where an often previously healthy liver can be damaged quickly (in days to weeks). Different conditions can cause acute liver failure such as certain viral infections like hepatitis A or B, certain drugs such as acetaminophen, or toxins such as certain poisonous mushrooms.
• Certain liver cancers.
   

Sometimes transplant may not be beneficial or is too risky.  This includes the following common scenarios:

• Acute or chronic infection that is not under control
• Untreatable heart or lung disease
• Cancer elsewhere in the body, outside the liver
• Ongoing alcohol or drug use
• Inability to follow a treatment plan
   

Liver Transplant Evaluation

If your provider believes you would benefit from a liver transplant, they will refer you for a liver transplant evaluation.

You will be invited to meet with one of our liver transplant nurse coordinators who’ll educate you about liver transplantation and provide more details about the process, and answer any questions you may have.

During the evaluation process you will meet the transplant team including the hepatologist (liver specialist), a transplant surgeon, an infectious disease specialist, a transplant psychiatrist, nutritionist, social worker, financial specialist.

You will also undergo a thorough medical history, physical exam, and a number of tests including lab work, imaging of your abdomen and chest (CT scan and or MRI), stress test, endoscopy and other necessary tests.

Once you have met the team and all the tests are done, the transplant team will carefully review all the results and let you know if they believe you would benefit from a liver transplant. If the team believes a liver transplant is beneficial for you —and you agree to move forward—your name will be placed on the national waiting list for a deceased donor liver. At any time during the evaluation process or prior to transplant surgery you may decide—for any reason—that you no longer wish to be considered for a liver transplant, or you can refuse the transplant when offered.  
 

Waiting for a donor organ

Many patients are on the national waiting list. The sickest patients get the highest priority and patients often have to wait a long time before they can receive a liver transplant.

We understand that waiting for a donor organ can be extremely stressful. We have support networks in place, including a monthly pre- and post-transplant support group to help you and your family navigate the transplant process.

These and other resources are available to you and your family at any time during the evaluation, wait listing, transplant and post-transplant period.
 

When a donated organ becomes available

Once a deceased donor liver becomes available for you, you’ll receive a phone call from the UMass Memorial transplant coordinator asking you to come to the hospital, often within hours, where a member of the transplant team will meet you and admit you to the hospital.
 

What surgery involves

Before the actual surgery you’ll meet with your transplant surgeon and anesthesiologist who will discuss the procedure, risks and benefits and answer all of your questions.

Liver transplant is a major surgery and takes several hours. There are three main components to the surgery: removal of your diseased liver, preparation of the healthy donor liver and implantation of the new liver.
 

After surgery

Immediately after surgery, you’ll be taken to the intensive care unit where you’ll stay for a few days, then you will move to a regular hospital room on a general surgical floor.

• If all goes well you can expect to be discharged from the hospital 10 to 14 days after surgery; the length of your hospital stay also depends on how sick you were before surgery.
• Your recovery period at home can take 8 to 12 weeks. It is not safe to drive for 4 to 6 weeks after surgery.
• Most liver transplant recipients are able to return to their regular activities within 12 weeks, and to their most demanding activities in 3 to 4 months.
• To protect your new liver from rejection, you will have to take antirejection (immunosuppressive) medications for the rest of your life.  
   

If you have received a portion of a liver from a living donor, it’s important to know that the transplanted portion in your body and the portion left behind in your donor regenerate quickly, reaching normal size within just a few months.
 

Ongoing follow-up care

A team of UMass Memorial doctors, including a liver specialist, will be involved in your post-transplant care, which will include doctor visits and lab work on a periodic basis.