What Is a Liver Transplant and When Is It Performed?
Request Call Back
Overview
The liver is the body’s largest internal organ after the skin and is essential to life. It supports energy metabolism, detoxification, protein and lipoprotein synthesis, glycogen storage, and bile production. When the liver fails, these vital functions collapse, leading to life-threatening complications. For people with end-stage liver disease or selected liver cancers, liver transplantation can restore liver function and dramatically improve quality of life.
At MedicalPoint Hospital, our multidisciplinary transplant team—transplant surgeons, hepatologists, interventional radiologists, anesthesiologists, infectious disease experts, critical-care physicians, dietitians, psychologists and dedicated transplant coordinators—provides end-to-end care from evaluation to surgery, ICU recovery, rehabilitation and lifelong follow-up.
What Is a Liver Transplant?
A liver transplant (orthotopic liver transplantation) replaces a failing liver with a healthy whole liver from a deceased donor or a liver segment from a living donor. Because the liver can regenerate, living-donor transplantation is possible: a portion (right or left lobe, or the left lateral segment in children) is implanted into the recipient, and both donor and recipient livers grow to meet metabolic needs.
Transplantation is considered when medical therapy no longer controls the disease or its complications. Although it is a major operation with meaningful risks, for many conditions it remains the only curative option.
How Do We Determine Donor–Recipient Compatibility?
Before listing or scheduling a transplant, both recipient and donor undergo a structured evaluation to ensure safety and suitability.
Recipient evaluation (examples):
- Detailed history and physical examination; assessment of nutrition and frailty
- Laboratory tests (liver and kidney function, coagulation, infection screening, tumor markers when relevant)
- Imaging (abdominal ultrasound, contrast CT/MRI and MRCP/cholangiographic MRI as indicated)
- Cardio-pulmonary assessment (ECG, echocardiogram; additional testing if needed)
- Cancer surveillance and psychosocial readiness review
Donor evaluation (living donor):
- Blood tests, viral hepatitis panels (e.g., HBsAg/anti-HBs), HIV testing, metabolic profile
- High-resolution CT/MRI volumetry to verify adequate future liver remnant
- Cardiac and pulmonary clearance, anesthesia assessment
- Counseling to confirm understanding, voluntariness, and long-term follow-up plan
Compatibility basics:
- ABO blood group compatibility is preferred. (Rh factor is not relevant for solid organ matching.)
- Size matching matters; volumetric calculations ensure the graft is large enough for the recipient and that the donor retains a safe remnant.
In highly selected centers and scenarios, ABO-incompatible liver transplantation may be considered with specialized desensitization protocols. Availability varies.
When Is Liver Transplantation Performed? (Indications)
Liver transplantation is a cornerstone therapy for advanced liver disease and certain tumors. Typical indications include:
- Cirrhosis (of any cause) with decompensation (ascites, variceal bleeding, hepatic encephalopathy)
- Viral hepatitis–related liver disease (e.g., hepatitis B or C with advanced damage)
- Alcohol-associated liver disease (in candidates meeting program criteria)
- Cholestatic diseases such as primary sclerosing cholangitis (PSC) and other chronic cholestatic disorders
- Metabolic/genetic diseases (e.g., Wilson disease, hereditary hemochromatosis)
- Hepatocellular carcinoma (HCC) meeting accepted transplant criteria
- Budd–Chiari syndrome (hepatic venous outflow obstruction)
- Acute liver failure unresponsive to medical therapy
At MedicalPoint, timing is guided by disease severity scores and clinical status. Early referral improves safety and outcomes.
Who Is Not a Candidate? (When Transplant Is Not Performed)
Transplantation benefits many—but not all—patients. Contraindications may include:
- Active, untreatable systemic infection or sepsis
- Uncontrolled extrahepatic malignancy or advanced cancer outside accepted criteria
- Severe cardiopulmonary disease not correctable (e.g., advanced heart failure, severe pulmonary hypertension)
- Untreated substance use disorder (e.g., alcohol or illicit drugs), or inability to adhere to the post-transplant plan
- Significant multi-organ failure incompatible with recovery
- Profound, uncontrolled psychiatric illness impairing consent or adherence
Each situation is assessed individually by the MedicalPoint transplant board to balance risks and benefits.
How Is a Liver Transplant Performed?
Deceased-Donor Transplantation
After brain death is confirmed and donation authorized, the donor liver is recovered, preserved in specialized solutions, and transported to the operating theatre. The recipient’s diseased liver is removed and the donor liver is implanted, connecting the hepatic veins, portal vein, hepatic artery, and bile duct. Surgery is conducted in advanced operating rooms with real-time imaging and hemodynamic monitoring.
Living-Donor Liver Transplantation (LDLT)
In LDLT, a healthy volunteer—usually a compatible relative—donates a lobe (commonly the right lobe for adults or left lateral segment for children). Donor and recipient operations are performed in parallel to minimize graft ischemia and protect organ viability.
Advantages of living donation
- Shorter waiting time—no prolonged deceased-donor waitlist
- Thorough, scheduled evaluation of donor health, often improving planning and outcomes
- Reduced cold-ischemia time; the graft is typically implanted promptly after resection
Considerations and risks
- Living donation entails real surgical risk to the donor (though carefully minimized), and requires rigorous ethical safeguards
- Higher resource needs and cost than a standard deceased-donor procedure
- Detailed, lifelong follow-up for both donor and recipient is essential
Who Can Be a Living Liver Donor?
Living donation is strictly voluntary and follows medical, legal, and ethical standards.
Common requirements include:
- Age typically 18–65 years, with individualized assessment outside this range
- Blood group compatibility with the recipient
- No significant liver disease, advanced fatty liver, or serious systemic illness
- Acceptable body mass index and metabolic profile
- Normal or correctable cardiopulmonary and renal status
- Clear psychosocial readiness and informed consent; conflict-of-interest safeguards
In Türkiye, a family relationship (up to 4th degree) is generally required; unrelated donors may require ethics committee approval
What to Expect After Liver Transplantation
After surgery, patients recover in the Transplant ICU and then on a specialized ward. Early goals include stable circulation, adequate bile flow, graft function, pain control, nutrition, and mobilization.
Immunosuppression
To prevent rejection, patients start immunosuppressive medications (e.g., tacrolimus/calcineurin inhibitor, mycophenolate, and corticosteroids). Doses are carefully adjusted based on levels, side effects, and graft function.
Monitoring and complications
- Rejection (acute or chronic) is monitored with labs, imaging, and sometimes biopsy; most episodes are treatable when detected early.
- Biliary or vascular issues (e.g., bile leak/stricture, hepatic artery thrombosis) are screened with ultrasound and Doppler studies; minimally invasive or surgical solutions are available.
- Infections (e.g., CMV, fungal infections) are mitigated by prophylaxis, vaccination review, and early recognition.
Lifestyle and long-term care
- Nutrition: salt-aware, balanced, dietitian-guided plan to control edema and weight gain, especially while on steroids
- Activity: gradual, structured exercise program; walking is encouraged early
- Medication safety: avoid over-the-counter or herbal products without transplant team approval
- Alcohol abstinence: strongly advised; alcohol can severely damage the new liver
Follow-up: frequent visits and blood tests initially; intervals extend as stability is achieved
Organ Donation: How It Works
Deceased (cadaveric) donation forms the backbone of transplant programs worldwide. Adults with capacity can pledge to donate their organs after death according to national regulations; families are consulted after brain death is confirmed. Living donation is offered under strict protocols to prioritize donor safety and autonomy.
In Türkiye, the national waiting list—coordinated by the Ministry of Health—allocates organs based on medical urgency, compatibility and fairness. Language, religion, gender, wealth, or social status never influence allocation.
Why Choose MedicalPoint Hospital?
- Expert, Integrated Team: Dedicated hepatology and surgical teams with round-the-clock coverage, experienced ICU and infectious disease support
- Advanced Imaging & ORs: 3-D volumetry, high-definition MRI/CT, hybrid OR capabilities, and state-of-the-art monitoring
- Living and Deceased-Donor Programs: Structured donor evaluation, robust ethics framework, and coordinated dual-room workflows
- Personalized Recovery: Tailored immunosuppression, nutrition, physiotherapy, and psychological support
- Continuity of Care: Lifelong follow-up with education on warning signs, vaccination schedules, and lifestyle coaching
If you or a loved one is living with advanced liver disease or you are considering living donation, book an appointment with MedicalPoint’s Transplant Coordination Center to discuss safe, individualized options.
FAQ
Is a liver transplant the only option for cirrhosis?
Not always. Early cirrhosis can be managed medically, but decompensated disease or specific cancers may require transplantation.
Do donors and recipients have to be the same blood type?
They should be ABO-compatible. Rh factor does not matter. Selected centers may perform ABO-incompatible transplants with special protocols.
How long will I need to take medicines?
Lifelong immunosuppression is required, with careful dose adjustments over time to balance rejection prevention and side effects.
Can I return to normal life after transplant?
Many patients return to work, family, and exercise with significant improvement in quality of life—provided they adhere to medications and follow-up.
Other Conditions
Weight Loss and GLP-1 Therapy: A Modern Approach to Sustainable Weight Management
Life During and After IVF Treatment: What Patients Should Know
Prostate Cancer Treatment in Turkey
Coronary CT Angiography: Advanced Non-Invasive Imaging for Heart and Coronary Artery Health
Toxic Shock Syndrome and Tampon Use: What Women Should Know About This Rare but Serious Condition
Neurosurgery and Brain Health: Modern Approaches to Complex Neurological Conditions
Living with Allergies: Daily Management, Nutrition, and Long-Term Strategies
Hypertension Management and Lifestyle Changes
Organ Transplantation Center
The Organ Transplantation Unit operates as a department that embraces a multidisciplinary treatment approach, involving transplantation surgeons, anesthesiologists, nephrologists, and gastroenterologists.
