Liver Transplantation and Life After Transplant
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Overview
The liver sits in the right upper abdomen, protected by the rib cage, and performs hundreds of vital tasks: regulating energy supply, supporting immunity, clearing medicines and toxins from the blood, producing bile for digestion, synthesizing proteins and lipoproteins, and storing vitamins such as vitamin A. Although the liver has a remarkable capacity to regenerate, chronic damage—most commonly from alcohol misuse, viral hepatitis, fatty liver disease, or autoimmune/cholestatic disorders—can lead to irreversible liver failure. In carefully selected people, a liver transplant (karaciğer nakli) can be life-saving.
At MedicalPoint Hospital, our multidisciplinary transplant team (hepatology, transplant surgery, anesthesia/critical care, interventional radiology, infectious diseases, nutrition, psychology, and transplant coordination) provides end-to-end, evidence-based care—before, during, and long after surgery.
What Is a Liver Transplant?
A liver transplant replaces a diseased liver with a healthy liver from a deceased donor or a portion of liver from a living donor. Because the liver can regrow, living-donor liver transplantation (LDLT) is possible: a lobe (right or left) or the left lateral segment (often for children) is transplanted into the recipient, and both donor and recipient livers enlarge to meet metabolic demands.
Transplantation is considered when medical therapy no longer controls complications of end-stage liver disease or acute liver failure, and when expected benefits outweigh the risks.
Who Can Receive a Liver Transplant? (Eligibility)
Referral to a transplant center begins with a comprehensive evaluation of medical, surgical, and psychosocial suitability. There is no absolute upper age limit, but outcomes depend on overall health and frailty.
Core recipient requirements typically include:
- Advanced liver disease (e.g., decompensated cirrhosis with ascites, variceal bleeding, or hepatic encephalopathy) or acute liver failure not improving with medical therapy
- Adequate cardiopulmonary reserve and nutrition status for major surgery
- Infection control: active serious infections must be treated before listing
- Substance abstinence: for alcohol-related disease, documented abstinence (commonly ≥6 months, center-specific) and participation in support programs
- Willingness and ability to adhere to long-term follow-up and immunosuppressive therapy
At MedicalPoint Hospital, candidacy is determined through transparent, shared decision-making with the patient and family.
Donor Options and Matching
Deceased donor (cadaveric) transplantation: The entire liver is recovered after confirmed brain death and consent, preserved in a special solution, and transplanted urgently.
Living donor transplantation: A healthy volunteer—usually a relative—donates a size-matched liver segment. Donor safety is paramount; we perform detailed medical testing, imaging (CT/MRI volumetry), and psychosocial assessment to ensure voluntariness and long-term wellbeing.
Compatibility basics:
- ABO blood group compatibility is preferred; Rh factor (positive/negative) is not relevant in solid-organ matching.
- Size matching matters—calculations ensure the graft is large enough for the recipient while leaving a safe future liver remnant for the donor.
- In select scenarios and specialized centers, ABO-incompatible transplantation may be considered with desensitization protocols; availability varies.
How Do We Confirm Donor–Recipient Suitability?
Both donors and recipients undergo structured testing. Examples include:
- Blood tests (liver/kidney function, coagulation, complete blood count)
- Viral screening (HBsAg/anti-HBs, anti-HCV, HIV, others)
- Cancer screening and tumor markers as indicated
- Cardiac and lung evaluation (ECG, echocardiography)
- Imaging of the liver and bile ducts (ultrasound, contrast CT/MRI, MRCP)
- Urinalysis and additional tests tailored to individual risk
This evaluation confirms medical safety, rules out active infection, and verifies anatomical suitability for surgery.
When Is a Liver Transplant Performed? (Common Indications)
- Cirrhosis of any cause with decompensation (alcohol-associated disease, viral hepatitis B or C, non-alcoholic steatohepatitis)
- Cholestatic and autoimmune diseases (e.g., primary sclerosing cholangitis)
- Metabolic/genetic conditions (e.g., Wilson disease, hereditary hemochromatosis)
- Budd–Chiari syndrome (hepatic venous outflow obstruction)
- Acute liver failure from drugs, toxins, or severe hepatitis
- Selected liver cancers (e.g., hepatocellular carcinoma) that meet transplant criteria
Each case is reviewed by MedicalPoint’s Transplant Board to determine timing and priority.
Who Is Not a Candidate? (Contraindications)
Transplantation may not proceed in the presence of:
- Uncontrolled sepsis or untreatable systemic infection
- Advanced extrahepatic cancer or disease outside accepted criteria
- Severe heart or lung disease not correctable (e.g., marked pulmonary hypertension)
- Active substance use disorder or inability to adhere to care
Profound, untreated psychiatric illness affecting consent/adherence
How Is the Surgery Performed?
Deceased-donor transplant: The recipient’s diseased liver is removed. Surgeons connect the donor liver to the hepatic veins, portal vein, hepatic artery, and bile duct.
Living-donor transplant: Donor and recipient operations run in parallel to minimize cold ischemia time. The donated lobe is implanted, and blood flow/bile drainage are restored.
Surgery duration varies (often several hours) and depends on prior operations, anatomy, and clinical complexity. After the operation, patients are closely monitored in the Transplant ICU.
Why living donation can help:
- Shorter waiting time—less risk of deterioration while on the list
- Scheduled, thorough donor work-up
- Typically shorter cold ischemia (organ spends less time outside the body)
Considerations:
Living donation carries real surgical risk for the donor (though rare, complications can occur); ethical safeguards and lifelong follow-up are standard.
Life After Liver Transplant: What to Expect
Hospital recovery: Initial ICU care focuses on circulation, pain control, graft function, and early mobilization. Most patients transition to the transplant ward within days, barring complications.
Immunosuppression: To prevent rejection, patients take tailored combinations of medicines such as tacrolimus (or cyclosporine), mycophenolate, and corticosteroids. Doses are adjusted using blood levels and liver tests.
Monitoring & potential complications:
- Rejection (acute or chronic): usually detected by lab changes or symptoms (fever, jaundice, abdominal pain) and managed with medication adjustments
- Biliary issues (leak or stricture) and vascular problems (e.g., hepatic artery thrombosis): evaluated by Doppler ultrasound, MRCP, or angiography
- Infections (e.g., CMV, fungal infections): managed with prophylaxis, vaccination review, and early treatment
Metabolic effects of medicines: hypertension, diabetes, weight gain, bone loss—addressed through medication optimization, nutrition, and exercise
Practical Guidance for a Healthy Life After Transplant
1) Keep every follow-up. Regular clinic visits and blood tests are essential—especially in the first year.
2) Take medicines exactly as prescribed. Never stop or change doses without your transplant team.
3) Eat smart. Follow a dietitian-guided, balanced plan; limit salt to control fluid retention; ensure safe food handling to reduce infection risk.
4) Move safely. Start with gentle activity and progress as advised; brisk walking supports heart and bone health.
5) Avoid alcohol and unproven supplements. Alcohol can quickly injure the new liver; many “herbal” products interact with immunosuppressants.
6) Vaccinations. Inactivated vaccines (e.g., influenza, pneumococcal, hepatitis B) are recommended on the transplant team’s schedule; live vaccines depend on immune status and timing.
7) Infection prevention. Hand hygiene, dental care, and prompt attention to fevers or new symptoms.
8) Mental wellbeing. Counseling and peer support can ease adjustment and improve long-term outcomes.
Red flags after transplant: fever, chills, jaundice, dark urine, pale stools, abdominal pain/swelling, confusion, sudden weight gain, or a significant rise in blood pressure—contact MedicalPoint immediately.
Donation, Ethics, and the Waiting List
Organ donation is voluntary. After brain death is confirmed, organs from deceased donors are allocated fairly via the national waiting list according to medical urgency, compatibility, and time on the list—never by wealth, gender, language, or religion. Living donation follows strict legal and ethical protocols; in Türkiye, donation up to 4th-degree relatives is typical, and unrelated donation requires ethics committee approval.
Why Choose MedicalPoint Hospital?
- Comprehensive Transplant Program: Living- and deceased-donor liver transplantation with coordinated dual-theatre workflows
- Advanced Imaging & ORs: 3-D CT/MRI volumetry, MRCP, hybrid OR capability, state-of-the-art monitoring
- Infection & Rejection Expertise: Protocol-driven prophylaxis and surveillance, rapid access to interventional radiology and endoscopy
- Patient-Centred Recovery: Personalized immunosuppression, dietetics, physiotherapy, and psychological support
- Lifelong Partnership: Structured education, tele-follow-up options, and clear pathways for pregnancy planning, travel, and vaccinations
FAQ
Do the donor and recipient need the same blood type?
They should be ABO-compatible; Rh factor does not matter. Selected centers may consider ABO-incompatible liver transplants with special preparation.
How long will I need medicines?
Lifelong immunosuppression is required, with doses generally reduced over time under close supervision.
Can donors return to normal life?
Most healthy donors gradually return to work and daily routines within weeks to months, following individualized recovery plans.
Is every liver cancer suitable for transplant?
No. Transplant is offered only when cancer meets established criteria (to optimize outcomes and prevent recurrence).
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Organ Transplantation
Organ transplantation involves the replacement of a severely malfunctioning organ, which cannot be effectively treated through medical means, with a new organ sourced from either living donors or deceased donors diagnosed with brain death. This form of treatment is employed to address the patient’s condition.
