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Liver Transplantation

Last updated April 3, 2019

Approved by: Maulik P. Purohit MD MPH

BruceBlaus

Liver Transplantation is a procedure that involves the surgical removal of a damaged or diseased liver and replacement with a healthy liver, from a suitable and compatible donor.


Background Information:

What are the other Names for the Procedure?

  • Hepatic Transplantation
  • Transplantation of Liver

What is Liver Transplantation surgical procedure?

Liver Transplantation is a procedure that involves the surgical removal of a damaged or diseased liver and replacement with a healthy liver, from a suitable and compatible donor.

What part of the Body does the Procedure involve?

A Liver Transplantation procedure involves the damaged or diseased liver of the recipient, a liver from the donor, surrounding blood vessels and ducts connected to the liver.

Why is the Liver Transplantation surgical procedure Performed?

A Liver Transplantation procedure is performed to restore normal liver function, when the liver is damaged beyond repair, due to various causes.

What are some Alternative Choices for the Procedure?

A Liver Transplantation procedure is performed as a last resort, when no other alternative choices exist.

What are the Recent Advances in the Procedure?

Using advanced immunosuppressive medication to reduce transplant rejection is a recent advancement with respect to Liver Transplantation.

What is the Cost of performing the Liver Transplantation surgical procedure?

The cost of Liver Transplantation surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Liver Transplantation surgical procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

United Network for Organ Sharing (UNOS)
P.O. Box 2484 Richmond, VA 23218
Phone: (804) 782–4800
Patient Information: 1 (888) 894–6361
Fax: (804) 782–4817
Email: patientservices@unos.org
Website: http://www.unos.org

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://www.surgery.com/procedure/liver-transplantation (accessed on 08/25/2014)

http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/liver_transplantation_procedure_92,P07698/ (accessed on 08/25/2014)

Prior to Liver Transplantation surgical procedure:

How is the Liver Transplantation surgical procedure Performed?

  • The Liver or Hepatic Transplantation procedure is performed under general anesthesia
  • The surgeon opens the abdomen by making an incision below the ribcage on either side and extending it a little upwards in the middle, over the breast bone
  • The liver and its connections are exposed
  • The blood vessels feeding the liver are ligated and a part or whole of the diseased liver is removed
  • The liver from a donor is also removed in a similar manner
  • Next, depending on the type of transplantation that is being carried out, the surgeon may replace the liver either in part or whole. The different transplantation types are:
  • Orthotopic transplantation: The entire diseased liver is removed and replaced by a new liver from a donor
  • Reduced-size liver transplantation: After complete removal of the diseased liver, only a part of the donor liver is transplanted. This is possible, as the new liver is capable of growing in size by itself (regeneration)
  • Heterotrophic transplantation: The donor liver is attached at a new site and the diseased liver is left in place
  • The donor liver is attached to its blood supply and the liver ducts
  • The abdominal incision is closed in layers and the skin is sutured

Where is the Procedure Performed?

A Liver Transplantation procedure is usually performed in a hospital.

Who Performs the Procedure?

A general surgeon with experience and training in Liver Transplantation performs the procedure, with assistance from an anesthesiologist.

How long will the Procedure take?

The Transplantation of Liver procedure may take anywhere between 6-8 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the liver transplantation surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently take
  • Physical exam, diagnostic testing, and psychological evaluation, will be carried out as part of evaluation to determine suitability for transplantation. Once a candidate has been considered as being suitable for Liver Transplantation, he/she will be placed on a list of people awaiting such transplants
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Liver Transplantation surgical procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Liver Transplantation surgical procedure?

Before a Liver Transplantation procedure, the patient has to undergo certain tests, such as:

  • Immune-system and liver matching procedures, to check for tissue compatibility between a donor and the recipient
  • Body system studies
  • Chest x-ray
  • Blood tests
  • Ultrasound examination
  • CT/MRI examination
  • Liver biopsy

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is Liver Transplantation procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Liver Transplantation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered for a Liver Transplantation procedure

How much Blood will you lose, during the Procedure?

Significant amount of blood loss may be expected during the Liver Transplantation procedure and blood transfusion is often necessary.

What are the possible Risks and Complications during the Liver Transplantation surgical procedure?

There are general factors that increase the risk of getting complications during Transplantation of Liver surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Transplantation of Liver surgery are:

  • Excessive bleeding
  • Infection in the surgical wound
  • Anesthetic complications
  • Donor liver rejects its new host
  • Failure of new donor liver to function normally at first

What Post-Operative Care is needed at the Healthcare Facility after the Liver Transplantation surgical procedure?

  • After the Liver Transplantation surgical procedure, the patients will be sent to an area of the hospital, called a postoperative recovery area (or PACU)
  • A patient’s blood pressure, heart rate, and respiration cycle will be closely monitored. Any additional pain associated with the procedure will also be treated. Further stay and monitoring in the surgical ICU may be warranted
  • Blood tests to monitor function of the liver, kidneys, blood clotting ability, etc. may be performed regularly. Medications to prevent rejection of the donor liver by the body (immunosuppressants) shall be started
  • Individuals are usually discharged from the hospital 2-3 weeks after the surgery is performed

After the Liver Transplantation surgical procedure:

What are the possible Risks and Complications after the Liver Transplantation surgical procedure?

The possible risks and complications that may arise after Liver Transplantation are:

  • Excessive bleeding
  • Infection in the surgical wound
  • The recipient’s immune system may reject the transplanted liver
  • Donor liver rejects its new host
  • Obstruction within the bile-duct system
  • Recurrence of hepatitis B and C infections, within the new healthy donor liver

What is the Prognosis after the Surgery?

There is a slight chance that the transplanted liver may not function as it should. The individual is likely to go back on the transplant list, if the new liver fails to function or is rejected.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, abnormal swelling within the abdomen, and prolonged constipation
  • Signs of an infection
  • Jaundice (yellowing of the eyes)
  • Abnormal fluid accumulation within the abdomen, eyes, or ankles
  • Dizziness
  • Muscle aches, headaches
  • Fever, feeling sick
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Liver Transplantation surgical procedure?

At home, the following post-operative care is recommended, after a Liver Transplantation procedure:

  • Slowly resume regular/daily activities as early as possible, which aids in a faster recovery
  • Use a heat pad or warm compress to relieve pain, due to the incision
  • Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with unscented soap and re-bandage the wound again
  • Elevate legs while resting, to prevent the formation of blood clots and reduce the possibility of swelling
  • Take stool softeners to prevent constipation
  • Ensure proper personal hygiene, like regular hand-washing, eating well-cooked meals, avoiding exposure to sick people, and taking all measures necessary to avoid infections. This is because the medications following a Liver Transplant weaken the immune system, increasing the risk of infection
  • Take antibiotic medication to help combat or prevent infection
  • Complete the course of prescribed medication, under advice of the physician. A long-term use of immunosuppressant medications may be warranted
  • Take hepatitis B immunoglobulin (HBIG) or other medications, to help prevent the recurrence of hepatitis B after the procedure
  • Individuals are advised to discuss with their physician before taking any nonprescription drug medications
  • Avoid all activities that are physically strenuous for about 6 weeks, or for a period advised by your physician
  • Resume driving, only when advised by your physician

How long does it normally take to fully recover, from the Procedure?

It may take weeks to months, to completely recover from a Liver Transplantation procedure. Lifelong medications may be necessary, to prevent rejection of the donor liver.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Liver Transplantation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • An anesthesiologist
  • A pathologist
  • A general surgeon with experience in Liver Transplantation procedures

The patient is advised to inquire and confirm the type of billing, before the Liver Transplantation surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 2, 2014
Last updated: April 3, 2019