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Liver Transplant - Procedure, Surgery, Problems and Recovery

Medically Reviewed by
Dr. K R Vasudevan
Liver Transplant

Treatment Duration

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8 Hours

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12 Hours

Treatment Cost

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15,00,000

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32,00,000

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Liver Transplant
Medically Reviewed by Dr. K R Vasudevan Written by Sangeeta Sharma

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The liver is not only the second largest organ in the human body but also the most important. Liver transplantation is a permanent treatment for end-stage liver disease. 

The Government of India passed the Human Organs Transplant Act (HOTA) in 1994, where the first attempt at a deceased donor liver transplant (DDLT) was made in Chennai in 1996 at the Apollo Hospital.

Read more about the procedure, its benefits, cost, etc.

Surgery Name Liver Transplant / Liver Transplantation
Diseases Treated Acute liver failure, Chronic liver failure, Biliary atresia, Cirrhosis, Alcoholic liver disease, Bile duct cancer, Primary liver cancer
Benefits of the Surgery Better quality of life, Quick recovery, Higher short-term survival rate
Treated By Hepatologist and Gastrointestinal surgeon

You can check Liver Transplant Cost here.

What is a liver transplant?

A liver transplant is a surgical procedure wherein a damaged liver is replaced with a healthy one from a donor. It offers a life-saving option for individuals with cirrhosis and end-stage liver disease (ESLD).

The liver can be donated by two types of donors:

  1. Living Donor Liver Transplantation: This procedure involves replacing a diseased or damaged liver with a portion of a healthy liver from a living donor. Living donors can be spouses, parents, siblings, grandparents, children, or friends of the recipient. A healthy donor can donate 60% of the organ.

  2. Deceased Donor Liver Transplantation: Also known as cadaver liver transplantation, this method removes a healthy liver from a recently deceased individual. It is then transplanted into a patient with liver damage.

Anatomy and Physiology of a Liver

The liver is situated in the upper right of the abdomen, beneath the diaphragm, and above the right kidney and small intestine. 

It has a reddish-brown appearance and weighs approximately 1.3 to 1.5 kilograms. The liver comprises two main lobes: the right and left lobes, each housing thousands of smaller lobules. These lobules are connected by specialised tubes called bile ducts, which transport bile produced by the liver to the small intestine, facilitating digestion.

Over 500 vital functions are performed by the organ, such as regulating metabolism, synthesising proteins, and producing bile for digestion. Additionally, it stores nutrients and releases them as required to maintain proper bodily function.

Who needs a Liver Transplant?

A transplant becomes necessary when the liver fails to function properly, whether suddenly (acute) or over time (chronic). Despite medical treatments, some liver issues cannot be fully resolved.

Potential candidates for liver transplants undergo a detailed evaluation process. Approximately 80% of liver transplants are due to severe liver damage, known as decompensated cirrhosis.

Various conditions necessitate a transplant. It includes:

  1. Viral Hepatitis: Chronic infections like hepatitis B or C can severely damage the liver. This, in turn, leads to the need for a transplant when the liver can no longer function adequately.

  2. Non-alcoholic Fatty Liver Disease (NAFLD): This condition involves fat buildup in the liver without alcohol consumption. If it progresses to advanced stages, causing inflammation and scarring, a transplant may be needed.

  3. Alcoholic Fatty Liver: Long-term, excessive alcohol consumption can cause liver disease, progressing from fatty liver to inflammation and cirrhosis. Currently, alcohol-related liver disease is the leading cause of liver transplants. If the liver damage is irreversible, a transplant is often recommended.

  4. Acute Liver Failure: This sudden, severe liver dysfunction can result from drug toxicity or viral infections, making up about 5-6% of liver transplants. In these cases, a liver transplant is urgently needed to save the patient's life, as without it, the mortality risk is 100% due to liver failure or complications like infections and multiple organ failure.

  5. Liver Cancer: In India, many liver cancer cases occur in people with existing liver conditions. A liver transplant is considered when the cancer is advanced or unresponsive to other treatments.

Benefits of Liver Transplant

The liver transplant success rate is over 90%. The survival rate after a year of transplant is 93%, and 83% after five years. The chances of a successful transplant and long-term survival depend on the personal health condition.

For patients who are healthy for the surgery, this procedure is often the most effective treatment for liver failure. The main advantages of a successful liver transplant include:

  1. Extended Lifespan: Most liver transplant recipients experience a significant increase in life expectancy. The new liver restores essential bodily functions that were compromised by liver failure.

  2. Improved Quality of Life: Patients enjoy a much higher quality of life after the transplant. Symptoms like chronic fatigue, jaundice, and abdominal pain often diminish, allowing for a more comfortable and active life.

  3. Reduced Risk of Mortality from Liver Disease: The likelihood of passing from liver disease decreases substantially post-transplant, as the new liver can effectively perform the necessary metabolic and detoxifying functions.

  4. Increased Energy Levels: Many recipients report having more energy after the transplant. This boost in vitality enables them to engage in activities they previously found exhausting or impossible.

  5. Return to Normal Activities: Patients are more likely to resume regular activities, including work, travel, and hobbies. The ability to partake in everyday tasks and enjoy leisure activities contributes to a sense of normalcy and well-being.

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Protocol Before and After Liver Transplant

The liver transplant process comprises three primary stages. These are:

  1. Evaluation: Patients undergo a thorough assessment to determine their eligibility for the transplant procedure.

  2. Waiting List Placement: If deemed suitable, individuals must wait for a suitable donor liver to become available, which can take several months.

  3. Transplant Surgery: Upon the availability of a donor's liver, patients are admitted to a transplant centre for the surgical procedure.

Before Liver Transplant

Before proceeding with a liver transplant, patients undergo a comprehensive diagnosis and consultation with a transplant surgeon to determine the necessity of the procedure.

After diagnosis, the surgeon carefully evaluates the patient's condition and advises a liver transplant if it is deemed essential. For individuals with alcohol-related issues, it's crucial to seek psychological and psychiatric support beforehand.

This precaution ensures a minimum of six months of alcohol abstinence, aiming to prevent relapses that could result in removal from the liver transplant waiting list.

Parameters

Pre-requisites

Pre-op Assessment (Physical)

  1. Blood tests

  2. Imaging studies (X-rays, ultrasound, MRI) 

  3. Pulmonary fitness test

  4. Cardiac test

  5. Social and psychological evaluation to determine if the patient is fit for surgery and can take the stress of surgery

  6. Comprehensive heart and lung tests and liver biopsy

  7. Women may undergo mammograms, Pap tests and general gynaecological examinations

Risk Evaluation

  1. Allergies

  2. Benefits of the procedure

  3. Potential Risks based on the patient's condition

Anaesthesia Selection

General

Fasting

4-8 hours before surgery

Others

Stopping supplements and other blood thinning medicines


After Liver Transplant

On the day of the surgery, the patient can expect to go through the following required preparations:

Parameters

Pre-requisites on the Day of Liver Transplant Surgery

Consent

Mandatory

Surgical Preparation

  1. Hospital gown

  2. Briefing of procedure

  3. Removing all accessories like wallet, belts, jewellery, etc

Physical Evaluation

Vitals check-up (Blood pressure, heart rate, oxygen saturation, etc.)

IV Line

Yes, for administering pain medications

Anaesthesia Administration

General anaesthesia

Liver Transplant Procedure

The surgery lasts 8 to 12 hours while the patient is under general anesthesia. In the case of a living donor, the transplant is simultaneous. 

The procedure involves several steps:

  1. Anesthesia Administration: In the operating room, the patient is given general anaesthesia to ensure they are unconscious and pain-free during the surgery.

  2. Incision and Access: Surgeons make an incision in the abdomen to access the liver. It is carefully done to reduce the trauma and ensure a smoother transplant.

  3. Liver Removal and Transplant: The diseased liver is removed to make space for the healthy donor liver. This step requires great precision to avoid damaging nearby tissues. The donor's liver is connected to the blood vessels and bile ducts, ensuring proper blood flow and bile function.

  4. Closure of Incision: After the transplant, the surgical team closes the incision with sutures.

  5. Postoperative Monitoring: The patient is moved to a recovery area where they are closely watched for any signs of complications, allowing immediate intervention if necessary.

Expectation After Liver Transplant

After a liver transplant, patients usually stay in the hospital for 2-4 weeks, depending on their health before the surgery and how quickly they recover. The following are the recovery expectations:

Recovery in Hospital

For donors, life usually returns to normal without needing long-term medications or special diets. After a liver transplant, recipients can expect the following in the hospital:

  1. Vital Signs Monitoring: Healthcare staff will closely monitor vital signs like heart rate, blood pressure, and oxygen levels to ensure a smooth recovery.

  2. Pain Management: Effective pain relief methods will keep the patient comfortable and improve their overall well-being during the initial recovery period.

  3. Immunosuppressants: The patient will begin taking medications to prevent their body from rejecting the new liver. These doses are adjusted over time, and some may be reduced eventually. 

At-home Recovery

Patients are given a detailed discharge summary that includes instructions for tests, medication schedules and charts for monitoring their health.

Ensure the home is thoroughly cleaned with disinfectants. Stay close to the hospital with easy access to transportation, minimal stairs, and a clean living environment.

Limit visitors for the first few weeks, avoid contact with sick individuals, and report any signs of illness. Patients should wear masks for the first three months and avoid crowded places. 

For a smooth recovery at home after a liver transplant, follow these guidelines:

  1. Medication Adherence: Take all prescribed medications, especially immunosuppressants, as directed to ensure a successful recovery. Over time, the need for these medications may decrease, but at least one immunosuppressant is usually required for life.

  2. Diet and Nutrition: Follow a high-protein diet to aid wound healing and liver regeneration. Prepare and eat food hygienically, focusing on fresh fruits and vegetables and a balanced, low-fat, high-protein diet.

  3. Foods to Avoid: Stay away from fried or greasy foods, leftovers, raw eggs, or undercooked items.

  4. Activity and Exercise: Gradually increase walking and routine activities. Regular exercise helps improve energy levels and muscle strength.

  5. Rest and Avoiding Heavy Lifting: Ensure you get plenty of rest and sleep. Avoid lifting weights over 5 kg, including babies, and avoid abdominal exercises.

First Follow-up Appointment

Consistent follow-ups and hospital visits are essential for a successful liver transplant. Both donors and recipients to maintain health and address any concerns promptly:

For Donors

  1. Donors should have follow-up appointments every 5-7 days during the first month after the transplant.

  2. After the first month, donors need follow-up tests and reviews at three months and one-year post-transplant.

For Recipients

  1. Frequent Follow-ups Initially: Recipients will have frequent follow-ups initially, according to a schedule provided at discharge.

  2. Reduced Frequency Over Time: As the recipient's condition stabilises, follow-up visits will become less frequent, which can be every 3-6 months.

Risks and Complications of Liver Transplant

Liver transplant surgery is a complex procedure that carries certain risks and complications. These include:

  1. Bleeding: Like any major procedure, there is a risk of bleeding during the surgery.

  2. Infections and Bile Duct Complications: After the transplant, infections and complications related to the bile duct are common and require close monitoring and management.

  3. Organ Rejection: The risk of rejection is highest during the initial six months following a transplant. After this period, the immune system is less likely to identify the new liver as foreign. Chronic rejection occurs in 2 out of 100 patients. 

  4. Possible Liver Dysfunction: There is a risk that the transplanted liver may not function properly, which may necessitate further medical interventions or, in rare cases, re-transplantation.

Risks of Delayed Liver Transplant

Delaying a liver transplant surgery can worsen the underlying liver disease, accelerating its progression and causing more severe symptoms and complications. The following can happen if the transplant is not done in time:

  1. Impaired Liver Function: The liver may become so damaged that it cannot perform its normal functions effectively.

  2. End-stage Liver Damage: It can lead to end-stage liver damage or failure, which progresses through stages of inflammation, fibrosis, and cirrhosis.

  3. Spread of Liver Cancer: If cancer is present, it may spread to other organs, potentially leading to fatal consequences.

Liver Transplant Cost in India

The liver transplant cost in India depends on various factors like the health condition of the patient. The cost breakdown is as follows:

  1. Surgeon's Fees: Pricing is influenced by the expertise and reputation of specialists, particularly transplant surgeons.

  2. Hospital Location: Costs may vary based on the facility's geographic location, with urban areas or high-cost regions charging more.

  3. Types of Liver Transplant Surgery: Pre-transplant tests play a significant role in pricing and are crucial for evaluating overall health. The final bill includes donor medical exams for living donor transplants. The cost of different types are:

Type

Price

Living Donor Liver Transplant (LDLT)

₹15,00,000 to ₹20,00,000

Deceased Donor Liver Transplant (DDLT)

₹20,00,000 to ₹25,00,000


ABO-incompatible Liver Transplant

₹25,00,000 to ₹30,00,000

Type of Technique

Surgical methods also influence costs due to aftercare needs, equipment, and expertise required. It includes:

Type of Technique

Expense

Orthotopic Liver Transplant

₹15,00,000 to ₹25,00,000

Laparoscopic Liver Transplant

₹17,00,000 to ₹25,00,000

Robotic Liver Transplant

₹20,00,000 to ₹30,00,000

Medications

These also include expenses of immunosuppressive drugs and other prescriptions needed pre-and post-surgery.

Takeaway

Liver transplantation is the most successful treatment option for individuals dealing with severe liver failure. The success rate is over 95%, providing patients with a promising route to restored health and well-being.

HexaHealth is dedicated to providing high-quality and accessible liver transplant surgeries in India. Feel free to contact us for information regarding the procedure, costs, and post-operative recovery. We're here to offer comprehensive assistance and guidance throughout the process.

Suggested Reads

Alcoholic Fatty Liver Grade 2
Diet chart for Fatty Liver
Yoga for Fatty Liver
Liver Cancer Treatment

Frequently Asked Questions (FAQ)

A liver transplant replaces a failing liver with a healthy one from a donor, who can be living or deceased. It's done when the liver stops functioning normally, and other treatments don't help.


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In India, a liver transplant can cost between INR 15-35 lakhs, depending on the hospital and the patient's medical needs. The exact amount varies based on specific circumstances. Contact HexaHealth to know the accurate price based on your requirements.

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The success rate of liver transplants is over 90%. After one year, the survival rate is 93% and 83% after five years.

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A liver transplant is considered when the liver can no longer function properly. These indications can be

  1. End-stage liver disease

  2. Liver failure 

  3. Liver cancers

  4. Biliary atresia

  5. Alpha-1 antitrypsin deficiency

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The criteria for a donor and recipient can differ slightly. The considerations can include:

  1. Severe liver disease not responding to other treatments.

  2. Good general health without other serious medical conditions.

  3. Age considerations, with younger patients, preferred due to lower complication risks.

  4. Commitment to a lifestyle free from alcohol and drugs.

  5. Availability of a suitable donor liver.

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In liver transplant surgery, the surgeon removes the diseased liver and replaces it with a healthy liver from a donor. The donor's liver is connected to the patient's blood vessels and bile ducts to restore normal liver function. The procedure is done under general anaesthesia and takes 8-10 hours.

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It is important to adhere to the guidelines given by the doctor to have a successful transplant. The pre and post-op care includes:

Before a liver transplant

  1. Extensive medical evaluations and tests

  2. Meeting with a transplant team for assessments

  3. Lifestyle changes, including quitting alcohol and drugs

  4. Waiting period for a suitable donor liver

After a liver transplant

  1. Hospital stay for recovery and monitoring

  2. Regular follow-up visits and blood tests

  3. Lifelong immunosuppressant medications to prevent rejection

  4. Adopting a healthy lifestyle to support the new liver

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A liver donation is voluntary. The following are the criteria for liver donation:

  1. Deceased donors who have opted for organ donation

  2. Living donors, often family members or close friends

  3. Age requirement: Donors must be willing adults aged 18 to 60

  4. Preparedness for the evaluation process, surgery, and recovery

  5. Good physical and psychological health are necessary

  6. Blood type compatibility with the recipient

  7. Liver and kidney function must be healthy

  8. BMI should be less than 32

  9. Alcohol abstinence until fully recovered

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A liver transplant scar appears as a long, horizontal line across the upper abdomen. Over time, it may fade and become less noticeable.

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In November 1998, the first successful liver transplant in India was done on an 18-month-old child diagnosed with biliary atresia. The child's father made history as India's first living-related donor for the procedure.

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On average, recipients of liver transplants live for more than ten years, with many surviving up to 20 years or longer. 90% of transplant recipients survive for at least one-year post-surgery.

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Liver surgeons in India are highly skilled and deliver excellent care. Notable liver transplant surgeons in India include:

  1. Dr Sanjay Goja

  2. Dr K R Vasudevan

  3. Dr Giriraj Singh Bora

  4. Dr Neeraj Goyal

  5. Dr Vivek Vij

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Life after a liver transplant often involves regular medical check-ups and medication to prevent rejection. Many recipients enjoy improved health and can return to their usual activities with careful management.

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After a liver transplant, recovery includes a hospital stay for monitoring and managing complications. Once home, patients need regular check-ups and medications to prevent organ rejection.

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The liver can be donated by a deceased or a living person. The approaches to the transplant can be:

  1. Orthotopic transplant: Replacing the diseased liver with a whole healthy liver from a deceased donor.

  2. Split liver transplant: A deceased donor's liver is divided and transplanted into two recipients.

  3. Auxiliary liver transplant: Part of a healthy liver is added to the patient's liver, allowing the diseased liver to regenerate.

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Liver transplant surgery is generally safe. It has a success rate of over 90%. However, it carries some risks like any major surgery. For individuals with severe liver disease who are unresponsive to other treatments, the benefits of a liver transplant usually outweigh the risks.

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Not all patients experience complications. The most common complications of liver transplant surgery include 

  1. Bleeding

  2. Organ Rejection

  3. Infections

  4. Issues with bile ducts

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Liver transplant failure occurs when the transplanted liver malfunctions or is rejected by the body. It can lead to severe complications like liver failure. Additional treatments, such as a repeat transplant or supportive measures, may be necessary, and in some cases, failure can be fatal.

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Up to 30 out of 100 liver transplant recipients may experience rejection, with the highest risk occurring in the first six months post-transplant. Chronic rejection occurs in around 2 out of every 100 patients.

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Yes, all health insurance plans cover liver transplant surgery. Our team facilitates paperwork on your behalf, ensuring smooth approval and a cashless facility. Contact HexaHealth for a simple cashless, and hassle-free experience.

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References

All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.


  1. Moon DB, Lee SG. Liver transplantation. Gut Liver. 2009 Sep;3(3):145-65. doi: 10.5009/gnl.2009.3.3.145. Epub 2009 Sep 30. PMID: 20431740; PMCID: PMC2852711.link
  2. Soin AS, Kakodkar R. Living donor liver transplantation in India. Trop Gastroenterol. 2007 Jul-Sep;28(3):96-8. PMID: 18383995.link
  3. Nagral S, Nanavati A, Nagral A. Liver Transplantation in India: At the Crossroads. J Clin Exp Hepatol. 2015 Dec;5(4):329-40. doi: 10.1016/j.jceh.2015.11.001. Epub 2015 Nov 12. PMID: 26900275; PMCID: PMC4723645.link
  4. Humar A. Adult living donor transplants-which portion of the liver to use? Liver Transpl [Internet]. 2003;9(6):634–6.link
  5. Rivera W. An introduction for donors and recipients. American Liver Foundation. 2022 [cited 2023 Dec 5].link
  6. Living donor liver transplant. Organ transplantation - NHS Blood and Transplant. [cited 2023 Dec 5].link
  7. Shroff S. Legal and ethical aspects of organ donation and transplantation. Indian J Urol. 2009 Jul;25(3):348-55. doi: 10.4103/0970-1591.56203. PMID: 19881131; PMCID: PMC2779960.link
  8. Choudhary NS, Bhangui P, Soin AS. Liver Transplant Outcomes in India. Clin Liver Dis (Hoboken). 2022 Jan 24;19(1):32-35. doi: 10.1002/cld.1166. PMID: 35106148; PMCID: PMC8785916.link
  9. Living donor liver transplant. Uofmhealth.org. [cited 2023 Dec 5].link
  10. Nadalin S, Bockhorn M, Malagó M, Valentin-Gamazo C, Frilling A, Broelsch CE. Living donor liver transplantation. HPB (Oxford). 2006;8(1):10-21. doi: 10.1080/13651820500465626. PMID: 18333233; PMCID: PMC2131378.link
  11. Shah SA, Levy GA, Adcock LD, Gallagher G, Grant DR. Adult-to-adult living donor liver transplantation. Can J Gastroenterol. 2006 May;20(5):339-43. doi: 10.1155/2006/320530. PMID: 16691300; PMCID: PMC2659892.link
  12. Organ transplantation in India. Organindia.org. 2014 [cited 2023 Dec 5].link

Last Updated on: 30 May 2024

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.

Reviewer

Dr. K R Vasudevan

Dr. K R Vasudevan

MBBS, MS General Surgery, DNB Surgical Gastroenterology

25 Years Experience

Dr K R Vasudevan is a well-known Gastrointestinal Surgeon currently associated with Jaypee Hospital in Noida. He has 25 years of experience in Liver Transplant Surgery and worked as an expert in Liver Transplant and Surgical Ga...View More

Author

Sangeeta Sharma

Sangeeta Sharma

BSc. Biochemistry I MSc. Biochemistry (Oxford College Bangalore)

6 Years Experience

She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More

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