Liver transplantation: procedures, steps and survival

In a liver transplant, a diseased liver is replaced with a healthy liver from a living or deceased donor. Recovery can take up to 1 year and 5-year survival rates can be as high as 75%.

A person will work with a multidisciplinary medical team throughout the transplant process. This team evaluates a person’s suitability for a transplant, finds a suitable donor, and helps the person navigate the surgery and recovery.

This article explains how a liver transplant works, what a person can expect after surgery, and what a person’s outlook is after a liver transplant.

A liver transplant is a type of surgery in which a surgeon removes a person’s damaged liver and replaces it with a healthy liver from another person, the donor.

A donor may be alive or recently deceased. Living donors donate only a portion of their liver—a “graft.” If the donor is deceased, a surgeon can use the entire liver for the transplant.

Both adults and children can have a liver transplant, and the goal of the surgery is to prolong a person’s life. Receiving a liver transplant can extend a person’s life by 15 years.

According to the Health Resources and Services Administration (HRSA), surgeons performed 9,236 liver transplants in 2021.

The HRSA also states that the liver is one of the most commonly transplanted organs and that the number of liver transplants has set new records every year for the past 9 years.

Learn more about how organ transplants work.

The two types of liver transplantation are deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT).

DDLT is more often as LDLT. LDLT used to be reserved for pediatric cases, but the increasing demand for liver transplants means doctors are now using LDLT in adults as well.

In DDLT, a surgeon removes the recipient’s liver and replaces it with a healthy liver from a deceased donor. The surgeon then connects the veins and arteries and reconstructs the bile duct.

In LDLT, a surgeon may use multiple parts of the liver, including:

  • left lateral sector
  • left lobe
  • right lobe

In some cases, a surgeon transplants two left lobes from two donors into one recipient. This is called a dual graft.

People may be eligible for a liver transplant if their liver is failing after an injury or a period of illness.


A number of conditions can because Liver disorders, including:

  • Cirrhosis: Cirrhosis is scarring of the liver, often as a result of alcohol abuse or hepatitis.
  • Alcohol-related liver disease: This condition can occur when a person consumes alcohol excessively, which damages their liver. People with alcoholic liver disease must stop drinking alcohol and receive psychological care for 6 months before receiving a liver transplant.
  • Acute liver necrosis: This is the death of liver tissue, possibly as a result of acute infection or drug side effects.
  • biliary atresia: This is a rare congenital liver and bile duct disease that affects newborns. It’s the most common Reason for liver transplants in children.
  • Hepatitis: Hepatitis is a viral infection that affects the liver. Medical professionals categorize hepatitis into five strains: A, B, C, D, and E. Some strains cause short-term infections, while others cause chronic infections.
  • Autoimmune hepatitis: In this condition, a person’s immune system targets their liver, causing cirrhosis and liver failure.
  • liver cancer: People with a type of cancer called hepatocellular carcinoma may be eligible for a liver transplant if they meet certain criteria, such as: B. if their tumor is less than 5 centimeters (cm) in diameter or if they have multiple tumors less than 3 cm in diameter.
  • Acute liver failure: A person can develop acute liver failure if they take too much acetaminophen. Other causes of this rare condition include blocked blood vessels, genetic disorders, autoimmune disorders, and reactions to medications.


A person must work with a doctor to find out if they are a candidate for a liver transplant. Generally, a doctor will only recommend a liver transplant after ruling out all other treatment options and when they think the person is healthy enough for the procedure.

If a person is a candidate for a liver transplant, a doctor will refer them to a transplant center. A transplant team will examine the person using a range of tests and exams, including blood and urine tests, imaging tests, and tests to evaluate heart, lung, and kidney function.

A transplant team may include:

Once a transplant team approves a person’s evaluation and recommends the person for a liver transplant, they will place the person on a national deceased donor waiting list.

According to that National Institute of Diabetes and Digestive and Kidney Diseasesa person in the United States can be on the waiting list for anywhere from less than 30 days to more than 5 years.

A person’s position on the waiting list depends on a variety of eligibility criteria, including their test results and how badly they need a new liver.

Physicians position people on the waitlist using the Model for End-Stage Liver Disease (MELD) grading system. A person’s score estimates their risk of dying within 90 days if they do not receive a transplant.

If a person has a willing living donor, the transplant team will assess whether the potential donor is a good match, taking into account the donor’s blood type and whether the recipient and potential donor are of similar body sizes. A donor must be between the ages of 18 and 60 and have an emotional connection to the recipient. A living donor can be a family member, spouse or friend.

The liver transplant procedure involves three main steps: preparation, surgery, and recovery.


The preparation phase differs depending on whether the donor is alive or deceased.

For a deceased donor, the transplant coordinator calls the recipient as soon as the transplant team finds a matching liver. The recipient must go to the hospital immediately.

If the donor is living, the medical team will plan the operation 4-6 weeks in advance.

The recipient’s transplant coordinator will tell them what to do to prepare.


If the liver is from a deceased donor, the surgical procedure begins when the liver arrives at the hospital.

If the liver is from a living donor, the medical team plans the procedures in advance, and the recipient and donor are operated on at the same time.

Before the operation, the transplant recipient is given general anesthesia. That means they sleep during the operation.

To replace the liver, a surgeon cuts through the recipient’s abdomen and toward their chest. They then remove the damaged liver and insert the new one, connecting it to the recipient’s blood vessels and bile ducts, which connect the liver to the small intestine. The surgeon then closes the wound with staples or sutures.


After the surgery, the medical team takes the recipient to the intensive care unit (ICU). Living donors also spend a day in the intensive care unit.

Medical specialists and nurses closely monitor recipients and donors.

Medical professionals will perform blood tests and medical tests to check the recipient’s heart, lungs, and kidney function. The recipient also begins taking immunosuppressive medications to prevent their immune system from damaging the new liver. They must take this drug for the rest of their lives.

The medical team will encourage the recipient to get out of bed and sit in a chair and walk short distances, if able, the day after surgery.

The transplant team works with both the recipient and the donor so they know how to take care of themselves after they leave the hospital.

A liver transplant can take up to 12 hours and sometimes longer.

Recipients must expect to remain hospitalized 2 weekswhile donors can go home after 1 week.

The length of time a person stays in hospital depends on how quickly they recover.

Recovery begins in the hospital. The transplant team teaches the transplant recipient how to take care of themselves before they are discharged. This includes instructions on:

  • medical aftercare
  • Things to do to take care of your new liver
  • potential problems they may have with their new liver

According to the UK’s National Health Service (NHS), some people may take a year or more to fully recover, but most people are able to return to their usual activities within a few months.

According to the American Liver Foundation, the 5-year survival rate for liver transplants is 75%, and liver transplant survival rates continue to improve.

For the best chance of a successful outcome, a person who has had a liver transplant should:

  • take part in all medical examinations
  • Take your medication as directed by your doctor
  • Be alert to symptoms of organ rejection and infection and tell your doctor immediately if they occur
  • Avoid people with contagious diseases like cold or flu
  • Eat a healthy diet and exercise regularly
  • Avoid alcohol and tobacco

Learn more about liver transplant survival rates.

In a liver transplant, a person’s damaged liver is replaced with a healthy liver from a donor. Donors can be living or deceased. Living donors donate part of their liver, and deceased donors donate the entire liver.

A liver transplant can treat a variety of health conditions, including cirrhosis, alcoholic liver disease, and hepatitis. Surgery can have a 75% survival rate, and survival rates are improving.

A person will first work with a transplant team to determine if they are a candidate for a liver transplant, and then throughout their surgery and recovery if they decide to have a transplant.

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