Liver Transplantation
Liver transplantation is surgery to replace a diseased liver with a healthy one. The healthy liver comes from either a deceased or living donor. You may need a liver transplant if you have liver failure or liver cancer.
Your liver performs many critical functions that keep you alive. If it becomes severely damaged, you’ll need a replacement to survive. If you meet the medical criteria for a liver transplant, you’ll be added to a U.S. national waiting list.
The wait can be long. There are far more people on the list than there are donor livers available. Each year, some people die or become too sick to have surgery while waiting for a transplant.
But surgery success rates are high. About 90% of people who have a liver transplant survive the surgery and recovery process, which can take up to 12 months. The current five-year survival rate is about 73%.
Preparations for a heart transplant often begin weeks or months before you receive a donor heart.
Liver transplantation is typically a last resort when your liver can no longer support your body. This may be because your liver is failing (losing its function) or because it has cancer that needs to be removed.
Conditions that may qualify you for a liver transplant include:
- Acute liver failure (when your liver becomes very sick very fast)
- Chronic liver failure (when cirrhosis gradually stops your liver from working)
- Primary liver cancer (like cholangiocarcinoma or hepatocellular carcinoma)
- Metastatic cancer that’s spread to your liver (like colorectal cancer)
Your healthcare provider must also determine that you’re well enough to have organ transplant surgery and likely to recover. Certain medical conditions may make the procedure too risky.
Conditions that may disqualify you from having a liver transplant include:
- Cancer that’s outside your liver (unless it’s been successfully treated)
- Congestive heart failure
- Dementia
- Infections that medications can’t manage and that a liver transplant can’t cure
- Severe lung diseases
- Severe pulmonary hypertension
- Severe, unmanaged mental health disorders with psychosis
- Substance use disorders
If your healthcare provider recommends a liver transplant for you, they’ll refer you to a transplant hospital. A multidisciplinary team will evaluate you to determine if you’re a candidate.
Each transplant hospital has its own criteria for accepting transplant candidates. If they accept you, they’ll put you on the national waiting list maintained by United Network for Organ Sharing (UNOS).
To be a match for a donor liver, you’ll need to:
- Have a compatible blood type. This helps prevent your body from rejecting the new liver.
- Be about the same height and weight as the donor. This is to make sure their liver fits your body. (Children are an exception to this rule. They only need a small portion of an adult liver.)
- Be in the same geographical region. This is to ensure the donor liver can get to you in time.
- Have the most immediate need for it. UNOS will rank your need according to your condition.
If you have acute liver failure with immediate need for a liver transplant, you’ll go to the top of the waiting list. Most people on the list have chronic liver disease, which tends to progress more slowly.
In those cases, UNOS uses a scoring system called MELD (Model for End-Stage Liver Disease) or PELD (Pediatric End-Stage Liver Disease). These scores are based on your blood test results to determine your place on the waiting list.
When a donor liver becomes available, your transplant coordinator will contact you and ask you to come to the hospital right away. Surgery will begin as soon as possible after both you and the liver have arrived.
While you wait, you’ll have standard screening tests to make sure you’re ready for the operation. You’ll also meet with your surgeon and anesthesiologist to go over the plan and prepare for surgery.
Liver transplantation is a major operation that can take up to 12 hours. You’ll receive general anesthesia, so you’ll be asleep through the procedure. You’ll also have several tubes in place to support your body throughout the surgery.
You’ll have:
- An IV in a vein of your arm or hand to deliver fluids and medicine
- An IV in a vein of your neck or thigh to draw blood and check your blood pressure
- A breathing tube connected to a mechanical ventilator
- Drainage tubes in your abdomen to remove fluid and blood
- A nasogastric tube to empty your stomach
- A catheter in your bladder to drain your pee
During the operation, your surgeon will:
- Make one long incision across your abdomen to access your liver.
- Carefully separate your liver from the ligament that connects to your abdominal wall.
- Place a clamp on your bile ducts and the blood vessels that connect to your liver.
- Remove your liver and gallbladder.
- Put the new liver in its place and attach it to your blood vessels and bile ducts.
- Close your incision and move you to a recovery room.
If you have end-stage liver disease or liver cancer, a liver transplant is your best hope of survival. It can extend your life and significantly improve your quality of life.
Like any major surgery, liver transplantation comes with risks. These range from minor complications to serious ones that may affect your recovery or long-term health.
Complications from the procedure itself can include:
- Bile leak: Bile may leak from the new connection between your bile duct and the donor’s bile duct into your abdominal cavity.
- Blood clots in the new liver: This rare complication requires immediate treatment.
- Hemorrhage: Livers tend to bleed heavily, and liver disease can make bleeding worse. You may need blood transfusions or additional surgery to control bleeding.
- Infection: Any surgery carries a risk of infection, but that risk increases after organ transplantation. Anti-rejection medications weaken your immune system, which makes infections more likely.
Complications after the procedure can include:
- Liver failure after transplantation: About 5% of donor livers don’t function properly after surgery. If this happens, you’ll need another transplant as soon as possible.
- Organ rejection: This happens when your immune system attacks the donor liver. About 5% of people have ongoing rejection episodes despite taking medication. Over time, this can lead to liver failure.
You’ll likely stay in the intensive care unit (ICU) for several days after your surgery. During this time, you’ll receive fluids and nutrition through an IV until your body is ready to handle liquids and solid food. You’ll also receive pain medication as needed.
Your healthcare team will monitor you closely and check for any signs of complications. They’ll take blood samples to see how well your new liver is working and may need to manage things like:
- Blood sugar levels
- Blood volume
- Electrolyte levels
- Fluid levels
When your vital signs are stable and your new liver is functioning well, you’ll move out of the ICU to a regular hospital room. You’ll continue recovering there for another one to three weeks.
Before you go home, your care team will teach you how to:
- Care for your surgical wound
- Take your medications correctly
- Check your blood pressure and pulse
- Watch for signs of infection
- Know when to contact them
In general, contact your care team right away if you experience:
- Abdominal pain
- Chest pain
- Fatigue
- Fever
- Decreased output of pee
- Severe headache
- Shortness of breath
- Vomiting
- Yellowing of your eyes or skin
Most people can return to work within three months and return to all other activities within six to 12 months. As you continue to recover at home, you’ll have frequent follow-up visits with your healthcare team.
The scar from open liver surgery is typically six to 12 inches long. It may run horizontally across your abdomen or be shaped like a “V.” The scar may appear red or brown and raised above the skin. In some cases, it fades over time; in others, it may remain visible.
Liver transplantation is a major operation that can take up to 12 hours. You’ll receive general anesthesia, so you’ll be asleep through the procedure. You’ll also have several tubes in place to support your body throughout the surgery.
You’ll have:
- An IV in a vein of your arm or hand to deliver fluids and medicine
- An IV in a vein of your neck or thigh to draw blood and check your blood pressure
- A breathing tube connected to a mechanical ventilator
- Drainage tubes in your abdomen to remove fluid and blood
- A nasogastric tube to empty your stomach
- A catheter in your bladder to drain your pee
During the operation, your surgeon will:
- Make one long incision across your abdomen to access your liver.
- Carefully separate your liver from the ligament that connects to your abdominal wall.
- Place a clamp on your bile ducts and the blood vessels that connect to your liver.
- Remove your liver and gallbladder.
- Put the new liver in its place and attach it to your blood vessels and bile ducts.
- Close your incision and move you to a recovery room.
After an organ transplant, you’ll need to take immunosuppressant medications for the rest of your life. You’ll usually start with a higher dose and then taper to a lower maintenance dose over time.
Immunosuppressants can cause side effects, so your healthcare team will monitor you closely with regular blood tests and adjust your medications as needed.
Common immunosuppressants include:
- Corticosteroids (methylprednisolone, prednisone)
- Monoclonal antibodies (basiliximab, daclizumab)
- Calcineurin inhibitors (cyclosporine, tacrolimus)
- Inosine monophosphate dehydrogenase (IMDH) inhibitors (mycophenolate mofetil, azathioprine)
- Mechanistic target of rapamycin (mTOR) inhibitors (sirolimus, everolimus)
These medications work by suppressing your immune system to prevent it from attacking your new liver. But this also means your body will be more vulnerable to everyday infections and certain diseases.
Possible side effects of immunosuppressants include:
- High blood sugar and Type 2 diabetes, especially if you already have metabolic syndrome
- Hypertension (high blood pressure)
- Increased risk of infections and certain cancers
- Kidney disease or kidney failure, especially if you had prior kidney damage
About 90% of people survive at least one year after liver transplantation, and nearly 65% are still alive after 10 years. Some people live for decades. However, many factors can affect your personal life expectancy, including:
- Your age and overall health at the time of surgery
- Any preexisting medical conditions
- Complications or side effects after liver transplantation
- The condition that caused you to need a transplant in the first place
Your healthcare provider is the best person to ask about your life expectancy and expected quality of life after liver transplantation. They know your medical history and current medical status.
You can take care of your new liver and your overall health by:
- Considering some lifestyle changes: Avoid alcohol completely, as it can be very harmful to your new liver. If you smoke, work with your provider to quit. Consider meeting with a dietitian to develop a liver-friendly eating plan. Try to add light physical activity to your daily routine.
- Protecting yourself from infections: Stay away from people who are sick and avoid crowded places when possible. If you need to be in a crowd, wear a mask. Wash your hands often and ask your provider which vaccines are safe and recommended for you.
- Taking your medications as prescribed: Don’t skip doses. If you forget to take your medicine, tell your provider. Always check with your care team before taking any new medications or supplements — some can interfere with your transplant medications.
Heart transplant surgery is an open-heart procedure that takes several hours. If you’ve had previous heart surgeries, the surgery is more complicated and will take longer.
You’ll receive medication that causes you to sleep (general anesthetic) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.
Your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart.
Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly.
You’ll be given medication to help with pain control after the surgery. You’ll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you’ll also receive fluids and medications through intravenous (IV) tubes.
You’ll initially stay in the intensive care unit (ICU) for a few days, then be moved to a regular hospital room. You’re likely to remain in the hospital for a week or two. The amount of time spent in the ICU and in the hospital varies from person to person.
After you leave the hospital, your transplant team will monitor you. Due to the frequency and intensity of the monitoring, many people stay close to the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and travel is easier.
You’ll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It’s important to let your transplant team know if you notice any signs or symptoms of rejection or infection.
To determine whether your body is rejecting the new heart, you’ll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time.
During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. The doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab.
You’ll need to make several long-term adjustments after you have had your heart transplant. These include:
Taking immunosuppressants. These medications decrease the activity of your immune system to prevent it from attacking your donated heart. You’ll take some of these medications for the rest of your life.
Because immunosuppressants render your body more vulnerable to infection, your doctor might also prescribe antibacterial, antiviral and antifungal medications. Some drugs could worsen — or raise your risk of developing — conditions such as high blood pressure, high cholesterol, cancer or diabetes.
Over time, as the risk of rejection decreases, the doses and number of anti-rejection drugs can be reduced.
Managing medications and a lifelong care plan. After a heart transplant, taking all your medications as your doctor instructs and following a lifelong care plan are vital.
A daily routine for taking your medications may be helpful. Keep a list of all your medications with you at all times for medical appointments and in case you need emergency care. Check with your doctor before you use any nonprescription medicines, vitamins, supplements or herbal products.
Your doctor might give you instructions regarding your lifestyle. Recommendations may include wearing sunscreen, exercising, eating a healthy diet and being careful to lower your risk of infection. You doctor may also recommend that you not use tobacco products or recreational drugs and limit alcohol use.
Follow all of your doctor’s instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have signs or symptoms of complications.
- Cardiac rehabilitation. This program incorporates exercise and education to help you improve your health and recover after a heart transplant. Cardiac rehabilitation can help you regain your strength and improve your quality of life. You may start it before you leave the hospital.
References
- American College of Gastroenterology. Liver Transplantation (https://gi.org/topics/liver-transplantation/). Updated 7/2023. Accessed 11/26/2025.
- American Liver Foundation. Liver Transplant (https://liverfoundation.org/for-patients/about-the-liver/liver-transplant/). Updated 3/22/2024. Accessed 11/26/2025.
- Medscape. Liver Transplantation (https://emedicine.medscape.com/article/431783-overview). Accessed 11/26/2025.
- Merk Manual Professional Version. Liver Transplantation (https://www.merckmanuals.com/professional/immunology-allergic-disorders/transplantation/liver-transplantation). Updated 8/2022. Accessed 11/26/2025.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (U.S.). Liver Transplant (https://www.niddk.nih.gov/health-information/liver-disease/liver-transplant). Updated 3/2017. Accessed 11/26/2025.
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