Liver transplantation is major surgery in which a failing liver is replaced by a healthy one: either a whole liver from a deceased donor or part of a liver from a living, compatible relative. The liver is unusual among organs because it regenerates, so the transplanted portion grows inside the recipient while the remaining portion regrows in the living donor until each reaches a size adequate for its work. The operation is performed in specialist centres by a full team, because it involves removing the diseased liver and reconnecting veins, arteries and the bile duct with great precision. Transplantation is considered when the liver can no longer perform its functions and medical treatment is no longer enough: advanced cirrhosis with complications such as fluid in the abdomen, bleeding from oesophageal varices, hepatic encephalopathy or persistent jaundice; rapid acute liver failure; chronic bile duct disease; liver tumours within defined criteria; or inherited and metabolic diseases in children such as biliary atresia. The decision is taken by a multidisciplinary committee after comprehensive testing, and it is determined by clinical assessment rather than by reading. You will not find survival percentages or promises here, because outcomes differ according to the cause and severity of failure, the state of the heart, kidneys and lungs, age, and the presence of infection or tumour. What you must know before deciding is that lifelong immunosuppression and regular structured follow-up are not details that come after surgery: they are part of the decision itself, and a patient who cannot commit to the medicines and blood tests will lose the new liver. Fever in an immunosuppressed patient is an emergency that requires immediate contact with the team or the emergency department, not a fever tablet and a wait. The limits matter too. Transplantation replaces the organ but does not remove the cause of disease: continued alcohol use, untreated viral hepatitis, or neglected obesity, diabetes and fatty liver can damage the new liver as well. It does not repair established damage in other organs, and it may be ruled out by advanced heart or lung disease, uncontrolled infection, tumour spread beyond the liver, or the absence of social support and the ability to comply. Risks include rejection, infection, bile duct complications, vessel thrombosis, drug side effects on the kidneys, blood pressure and blood sugar, and a higher chance of certain cancers with long-term immunosuppression.
Procedure steps
- 1
Multidisciplinary evaluation and prioritisation
Comprehensive tests assess liver, kidney, heart and lung function, imaging maps the liver vessels, and screening covers infections and tumours, alongside psychological, social, nutritional and dental assessment. The severity of liver failure is graded with recognised scores and the case is discussed by a committee that decides eligibility, priority and timing.
- 2
Donor selection and matching
With a deceased donor, blood group and liver size are matched and the waiting list is managed. With a living donor, the donor undergoes independent assessment covering liver volume, vascular anatomy, mental health and the freedom of the decision, and donation is refused if it poses undue risk, because donor safety is a non-negotiable condition.
- 3
Surgery: removing the diseased liver and reconnection
The operation is performed under general anaesthesia with intensive monitoring and reserved blood units. The diseased liver is removed, the new liver or graft is positioned, and the veins, hepatic artery and bile duct are joined with fine sutures, with intraoperative ultrasound confirming blood flow before the abdomen is closed over drains.
- 4
Intensive care and starting immunosuppression
Recovery begins in intensive care on a ventilator that is weaned gradually, while the function of the new liver, fluid balance, clotting and drain output are monitored. Immunosuppressants are started immediately and adjusted according to blood levels and kidney function, with prophylaxis against infection, stomach ulcers and clotting.
- 5
Permanent lifelong follow-up
Visits are frequent in the early months to check drug levels and liver and kidney function, and a biopsy may be requested when rejection is suspected. Doses are reduced gradually by medical decision rather than personal judgement, and the bile duct, vessels, blood pressure, blood sugar, bones and skin cancers are monitored lifelong with regular screening.
Before the procedure
Bring your full file: reports on the cirrhosis and its cause, serial blood tests, abdominal imaging, endoscopy and varices reports, and a list of every medicine and supplement you take. Tell the team about blood thinners, diuretics, diabetes and blood pressure medicines, and about any drug allergy. Stop alcohol and any liver-toxic substance completely, and be honest with your team, because this is clinical information rather than a moral judgement. Complete dental and gum treatment, finish the recommended vaccinations before transplantation since some cannot be given afterwards, and treat any active infection. Improve your nutrition and preserve muscle with daily activity within your capacity, because your physical condition before surgery influences recovery. Arrange a consistent caregiver, accommodation near the centre, extended leave and a fast way to contact the team, and settle financial and insurance arrangements in advance.
After the procedure
Take your immunosuppressants at the same time every day without exception, never adjust a dose or stop a medicine even when you feel completely well, and if you vomit after a dose or miss one, call the team rather than improvise. Do not start any new medicine, supplement or herbal product before asking, since some change drug levels in the blood, and avoid grapefruit. Attend every blood-test appointment even when you feel fine, because rejection can begin without symptoms. Wash your hands, avoid crowds and unwell visitors, eat no raw meat or unpasteurised products, use sun protection and check your skin regularly. Never drink alcohol, and keep weight, blood sugar and blood pressure controlled. Seek care immediately for fever or chills, yellow eyes, dark urine or pale stools, upper abdominal pain, vomiting or diarrhoea that prevents taking medication, bleeding or bruising, confusion or excessive drowsiness, swelling of the abdomen or legs, or redness and discharge from the wound.
Expected duration
The operation usually takes six to twelve hours depending on the state of the liver, adhesions and the type of donation, with additional time for anaesthesia and preparation. The stay begins with several days in intensive care, total hospital admission is typically two to four weeks, and this is followed by frequent visits for months and lifelong follow-up.
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