The liver is the body's largest internal organ (approximately three pounds in adults). It is located below the diaphragm on the right side of the abdomen.
The liver performs many complex functions in the body, including the following:
Liver transplantation is considered when the liver no longer functions adequately (liver failure). Two possible causes of liver failure are an acute (sudden) failure from infection or complications from certain medications.
Long-term liver failure is more common and can be a result of the following conditions:
Candidates for liver transplant are evaluated by specialists from several fields to determine if transplantation is appropriate. The evaluation includes a review of the patient’s medical, surgical, and psycho-social history, and a variety of tests.
Many healthcare facilities offer an interdisciplinary approach to evaluate and select candidates for liver transplantation. This interdisciplinary healthcare team may include the following:
You will need to bring all of your medical records, X-rays, liver biopsy slides, operative reports, and a list of medications to your pre-evaluation. To complement and update previous tests, some or all of the following studies are usually performed during your evaluation:
If these tests reveal specific problems, the medical team may order additional tests.
If you become an active liver transplant candidate, your name will be placed on a national waiting list. Patients are listed according to blood type, body size, and the model of end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) score.
Your transplant team will determine if a particular donor organ is a suitable match for you. As patients become more ill, their scores may increase and their priority for transplant increases, allowing for the sickest patients to be transplanted first. A small group of patients who are critically ill from acute liver disease have the highest priority on the waiting list.
It is impossible to predict how long a patient will wait for a liver to become available. Your transplant coordinator is always available to discuss where you are on the waiting list.
There are two types of liver transplantation options: living donor and cadaveric.
Living donor liver transplants are an option for some patients with end-stage liver disease. In this procedure, a segment of liver is removed from a healthy living donor and implanted into a recipient. Both the donor and recipient liver segments will grow to an adequate size in a few weeks.
The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to make sure there is as little risk as possible. Blood type and body size are important factors in determining who is an appropriate donor.
Recipients for the living donor transplantation must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
In cadaveric liver transplantation, the donor may be a victim of a cerebral vascular accident or head injury, such as spontaneous bleeding into the head. There are two types of cadaveric donors, both involving patients who have suffered irreversible brain injury:
The identity of a cadaveric donor and circumstances surrounding the person's death are kept confidential. It is considered an anonymous “gift.”
Hospitals will evaluate all potential donors for evidence of liver disease, alcohol or drug abuse, cancer, or infection. Donors will also have serology testing and testing for other infections. If this screening does not reveal problems with the liver, donors and recipients are matched according to blood type and body size. Age, race, and sex are not considered.
The transplant team will discuss your transplantation options with you at the time of your pre-transplant evaluation, or you can contact the transplant team for more information.
When an organ has been identified for you, a transplant coordinator will call you. Do not eat or drink anything once you have been called to the hospital. The transplant coordinator will let you know of any additional instructions.
When you arrive at the hospital, you will have additional blood tests, an electrocardiogram, and a chest X-ray before the operation. You also may meet with the anesthesiologist and a surgical resident. If the donor liver is found to be acceptable, you will proceed with the transplant. If not, you will be sent home to continue waiting.
Liver transplants usually take from six to 12 hours. During the operation, surgeons will remove your liver and replace it with the donor liver.
Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes will help your body carry out certain functions during the operation and for a few days afterward.
Two of the most common complications after liver transplantation are rejection and infection:
After the transplant, you will take anti-rejection medications called immunosuppressants. These medications slow or suppress your immune system to prevent it from rejecting your new liver. They may include:
You must take one or a combination of these drugs exactly as prescribed for the rest of your life.
The average hospital stay after liver transplantation is 10 to 14 days. Some patients may be discharged in less than one week, while others may be in the hospital much longer, depending on complications that may arise. You need to be prepared for both possibilities.
To provide a smooth transition from hospital to home, the nursing staff and your transplant coordinator will begin to prepare you for discharge shortly after you are transferred from the intensive care unit to the regular nursing floor. You will be given a discharge manual, which reviews much of what you will need to know before you go home.
You will be an important participant in your healthcare. Before your discharge, you will learn:
Readmission to the hospital after discharge is not uncommon, especially within the first year after transplantation. The admission is usually for treatment of a rejection episode, infection, or other complication.
Your first return appointment will generally be scheduled about one to two weeks after you are discharged from the hospital. During this visit, you will see the transplant surgeon and transplant coordinator. If needed, a social worker or a member of the psychiatric team can also be available.
Additional appointments are scheduled for every two to four weeks until three months after the transplant (as directed by the transplant surgeon). Generally, patients are then scheduled to return for follow-up at 6 and 9 months.
All patients are scheduled to return to the transplant clinic on the first anniversary of their transplant, and then every year after that.
Your primary care doctor should be notified when you receive your transplant and when you are discharged. Though most problems related to the transplant will need to be taken care of at the transplant hospital, your primary care doctor will remain an important part of your medical care.
Learn more about the Living Liver Donor program from Cleveland Clinic's Transplant Center.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 03/29/2019