About liver transplant surgery

In the months, weeks, and days leading up to liver transplant surgery, it's a good idea to become familiar with what to expect afterward. The highlights below can help set expectations.

Before surgery

When it comes to liver transplant surgery, there are typically two approaches. Although these surgeries are very different, they both take up to 10 hours to complete. It's important to keep in mind, however, that the length of surgery can be different for every patient. That makes it important to talk to your treatment team about what you can expect for your particular situation.

Liver surgery approaches:

  • Orthotopic — here, the recipient's liver is replaced with the donor liver.
  • Heterotopic — In heterotopic liver transplantation, the recipient's liver is left in place and a donor liver is sewn into an ectopic site. Your physician can explain why this approach may better suit your needs.

How to prepare for surgery:

  • Your liver transplant team will get you ready for your surgery in the operating room or holding area.
  • Anesthesia is administered to help you sleep.
  • Once you are asleep and all prep work is complete, the surgeon will begin the operation to remove the diseased liver.

During surgery

Liver surgery begins by replacing the diseased liver with the new healthy donor liver. Because liver surgery is a major procedure, several tubes will need to be placed in your body to help you carry out certain functions during the operation and for a few days afterward.

During the removal of your liver, one of the other surgeons will check and prepare the new liver for the transplant. Once prepared, the new liver will be put in place:

  • The blood vessels will be sewn together, and the bile duct of the donor liver will be sewn to the bile duct of the recipient.
  • The abdomen will be closed using special stitches, some of which will dissolve over time.
  • Afterward, you are taken directly to the intensive care unit, where the staff will monitor your vital signs very closely.

After surgery

The period immediately after liver transplant surgery is a very critical time for you. Your transplant team will monitor you very closely. As your condition begins to stabilize, you and your family will be taught about medications, diet, and other important issues. Most people can go home after a full week to a week and a half after their transplant, and can return to their normal, active lives within a few months.

Watching for a liver rejection

It is important to remember that transplantation is a serious surgery with inherent risks. One of the more common complications of transplantation is rejection. However, thanks to anti-rejection medications, rejection episodes are less common and can usually be managed.

Though such medications help prevent rejection, suppression of the immune system also makes transplant recipients more likely to get infections.

  • Talk to your transplant team immediately if you experience any of the following signs or symptoms:
  • Fever over 100°F (38°C)
  • Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
  • Coughing up yellow or green mucus
  • A dry cough that lasts for more than 1 week
  • Severe diarrhea
  • A burning feeling when you urinate
  • Vaginal discharge or itching
  • A wound that oozes fluid, does not heal, or feels warm
  • Swelling, warmth, redness, pain, or tenderness of an arm or leg
  • Pain or tenderness over your transplant site
  • Change in pulse rate
  • Yellow color to the skin or eyes
  • Light-colored or blackened stools

As you know, liver rejection is serious. That makes taking your anti-rejection medication directly as prescribed serious as well. Make sure you take the same anti-rejection medicine each time, unless your doctor tells you otherwise.

Watching for a liver transplant infection

The medications you take to prevent liver rejection work by slowing down your body's immune system. While they help to prevent rejection of your new liver transplant, they also lower your body's ability to fight infections.

To help lower the risk for infection, you may be prescribed preventive medications. Because your risk for infection will go down over time, your transplant team may decide to lower the amount or dose of preventive medications that you require.

  • Here are some things you can do to help further reduce your risk of infection:
  • Scrub your hands often, especially before eating and after using the bathroom or touching animals.
  • Keep fingernails short and always use clean nail clippers.
  • Wear gloves when gardening to avoid bacteria in plants and soil.
  • Practice good oral hygiene to prevent mouth sores.
  • Avoid raw or partially cooked foods and unwashed fruits and vegetables.
  • Avoid take-out and deli foods (foods sitting at room temperature can develop bacteria).
  • Notify a member of your transplant team if you have been around anyone with a contagious illness (flu, chicken pox, etc.)

Infections can become very serious and can even lead to death if left untreated.

  • Contact your transplant team right away if you have any of the following symptoms:
  • Fever over 100°F (38°C)
  • Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
  • Coughing up yellow or green mucus
  • A dry cough that lasts for more than 1 week
  • Severe diarrhea
  • A burning feeling when you urinate
  • Vaginal discharge or itching
  • A wound that oozes fluid, does not heal, or feels warm
  • Swelling, warmth, redness, pain, or tenderness of an arm or leg