What is a Liver Transplant, How is it Done? and Who is it For?

A liver transplant is a life-saving treatment option when the liver cannot continue its functions. The need for a transplant usually arises in cases of acute (sudden onset) or chronic (slowly progressing) liver failure.
Main conditions requiring transplant:
•    Acute liver failure: Develops in a short time as a result of mushroom poisoning, toxic effects of some drugs, or viral infections and may require an emergency transplant.
•    Chronic liver failure: Usually develops due to cirrhosis, Hepatitis B and C, bile duct diseases, genetic and metabolic disorders (e.g., Wilson's disease, hemochromatosis), or excessive alcohol use.
•    Liver tumors: Some types of cancer originating in the liver itself or spreading from another organ may require a transplant.
In these diseases, the liver becomes unable to regenerate itself and loses its functions. In this case, a liver transplant is the only way to extend the patient's life expectancy and improve their quality of life.
 

Chronic end-stage liver disease is an advanced stage liver failure condition where the liver tissue is permanently damaged and can no longer perform its functions. It usually occurs due to causes such as cirrhosis, autoimmune hepatitis, biliary atresia, primary sclerosing cholangitis, or metabolic liver diseases.

At this stage, healthy liver cells are replaced by scar (fibrotic) tissue, and the organ's regeneration capacity decreases. Patients may experience serious symptoms such as jaundice, fluid accumulation in the abdomen (ascites), variceal bleeding, clotting disorders, and encephalopathy (confusion).

Since it is not possible for the liver to regain its functions in this condition, liver transplant becomes the only treatment option.
 

The main situations where a liver transplant cannot be performed are:

•    Active alcohol or substance use
•    Advanced stage heart or lung disease
•    HIV infection or uncontrolled systemic infections
•    Cancer that has spread outside the liver (metastasis)
•    Severe psychiatric disorders or treatment non-compliance
•    Massive brain edema or multiple organ failure
•    Severe pulmonary hypertension (high lung pressure)

In these situations, the patient's general condition cannot withstand a liver transplant, so underlying diseases must first be brought under control. If suitable conditions are provided, the transplant can be re-evaluated.
 

The duration of a liver transplant surgery varies depending on whether the transplant is from a living donor or a cadaver. Living donor liver transplant usually takes 8-16 hours, while the donor surgery takes 4-6 hours. If organ incompatibility or an unexpected situation arises during the surgery, the procedure may be postponed or canceled.

Both the recipient and the donor are evaluated in detail before a liver transplant. Blood group compatibility is the first condition. The donor's liver must be of normal structure and sufficient size. Additionally, there should be no psychiatric illness, infectious disease, or any condition that would risk the surgery. Most importantly, the donor must give the decision completely of their own free will.

After all necessary tests are completed, the results are evaluated by a multidisciplinary team. This team includes surgeons, doctors, radiologists, anesthesiologists, psychiatrists, nurse coordinators, and relevant consultant physicians. The decision is never made individually; it is always determined by team decision and with the donor's health prioritized.

No, a cirrhotic liver cannot regenerate itself. Cirrhosis is a disease where the liver tissue is permanently damaged and healthy cells are replaced by scar (fibrotic) tissue. At this stage, the liver's regeneration capacity is completely lost.

•    The donor must make the donation of their own free will.
•    The donor must be over 18 years of age.
•    The donor must be a relative up to the 4th degree.
•    The donor and recipient's blood groups must match.*
•    The donor's liver structure and function and other systems must be normal.
•    The donor's liver anatomy must be suitable for both the recipient and themselves.
•    The suitability of the conditions above and other technical points is determined by our transplant team during the pre-transplant donor evaluation, which usually lasts 2-3 days.
 

Yes, to be a liver donor, one must be over 18 years old and under 60 years old. This age range covers the period when the liver's regeneration capacity and post-operative recovery process are most optimal.

No, the donor does not necessarily have to be a relative. However, in our country, primarily relatives up to the 4th degree can be donors. For individuals without a kinship bond to be donors, the situation must be evaluated and approved by the Ministry of Health Ethics Committee.

No, tissue compatibility is not required in liver transplant. What is essential in these surgeries is blood group compatibility and the organ size being suitable for the recipient. Tissue compatibility is not a determining factor in liver transplants.

The MELD score (Model for End-Stage Liver Disease) is a scoring system that shows the severity of liver failure. This score is calculated from the results of laboratory tests such as bilirubin, INR (clotting value), and creatinine. As the score increases, it is understood that the disease is progressing and the need for transplant is increasing.

Usually, those with a MELD score of 10 and above are considered liver transplant candidates. Patients with a score of 15 and above can be placed on the national cadaver waiting list. This system helps determine how urgent the disease is and ensures a fair ranking in organ distribution.
 

No, diabetics (diabetes patients) cannot be liver donors.
Because diabetes can negatively affect liver, kidney, and vascular health and increase the risk of post-operative complications.
 

No, individuals carrying Hepatitis B or C cannot be liver donors.
These infections can lead to permanent damage in the liver and risk of transmission, constituting an absolute obstacle for donation.
 

Living donor liver transplant allows for a transplant to be performed quickly without going on a waiting list.
Since the number of cadaver donors is low in our country, this method allows patients to get a transplant chance before their condition worsens and increases the success rate.
 

No, living donors do not carry a long-term risk of liver disease.

The liver is the only organ that can regenerate itself, and the removed portion reaches its original size in approximately 3 months. In healthy individuals, no long-term functional loss or disease risk is expected.
 

Usually, 25% to 60% of the donor's liver is taken.

This ratio can vary depending on the age, weight of the recipient and donor, and the anatomical structure of the liver. In pediatric patients, often a small part of the left lobe (25%) is taken, while in adult patients, the right half (60%) or left half (40%) of the liver is transplanted.
 

Comprehensive tests are performed on the liver donor candidate to evaluate both their general health status and the suitability of the liver for transplant.
These examinations include:
•    Blood and urine tests
•    Liver function tests
•    Tumor markers
•    Viral hepatitis (A, B, C) and AIDS tests
•    Chest X-ray and heart ECG (echocardiography if needed)
•    Abdominal ultrasonography
•    Computed tomography (CT) for liver volume measurement
•    MR cholangiography to examine the bile ducts
•    Cardiology, psychiatry, chest diseases, and (for female donors) gynecology consultations
If deemed necessary, additional tests and branch evaluations are also performed.
 

The evaluation process begins with blood group determination and biochemical tests and continues with radiological imaging, specialty consultations, and any additional investigations required by these assessments.

The aim of this process is to establish that the liver disease is severe enough to warrant transplantation and that the other organ systems are sufficiently healthy to tolerate the surgical procedure.
 

Liver transplant candidates who are deemed suitable following multidisciplinary committee evaluation are registered on the Ministry of Health’s deceased-donor waiting list.

Patients without a living donor await a liver from donors with confirmed brain death.

Priority on the waiting list is determined based on criteria such as blood group compatibility, tissue matching, medical urgency, and the MELD score. As the MELD score increases, both the patient’s priority on the list and the likelihood of transplantation increase.

For liver transplantation, if a transplant indication has been established by your treating physician and the transplant center, you should apply to the nearest or a transplant center of your choice that you can access.

If you are found to be suitable following the evaluations performed there, you will be registered on the deceased-donor waiting list.

When selecting a transplant center, data such as the center’s annual transplant volume, success rates, and the frequency of postoperative complications should be carefully reviewed. In addition, the presence of an experienced surgical team and a well-established multidisciplinary infrastructure is of great importance for the safety and success of the transplantation process.

The first three months are the most critical period.
Continue the care practices you learned in the hospital at home with the same level of discipline. Mood fluctuations are normal; family support is important. If you have any questions or concerns, you may contact your transplant team at any time.

T-tube / Biliary drainage care

• Clean the area around the T-tube with antiseptic soap; avoid sudden or forceful movements that may strain the tube.
• Notify your transplant team immediately if any of the following occur: redness, warmth, discharge, suture separation, or a visible change in the length of the tube.

(If present) Biliary stent care

• Clean the area around the stent with antiseptic soap; avoid vigorous movements.
• Inform your team if redness, warmth, discharge, suture separation, or a change in stent length is observed.

Temperature monitoring

• Measure your temperature if you experience chills, fatigue, or a general feeling of unwellness.
• Contact your transplant team if your temperature exceeds 38°C and persists for more than 24 hours.
• Fever, chills, or fatigue may be early signs of infection or organ rejection; notify your physician immediately.
• Do not take any medication without your doctor’s approval.

Blood pressure and pulse

• Measure your blood pressure and pulse regularly as instructed by the nurse.
• Report abnormal values to your physician.

Medication adherence and regular follow-up

• Take your immunosuppressive medications every day at the same time without interruption.
• If you miss a dose, do not attempt to compensate on your own; inform your physician.
• Always consult your doctor before using over-the-counter medications, herbal products, or vitamins.
• Do not miss follow-up visits or blood tests; medication levels are adjusted under medical supervision.
• These medications are required for many years or lifelong in most patients; never change the dose without consulting your physician.

Vaccinations

• Live or attenuated vaccines are not recommended.
• Inactivated vaccines (e.g., tetanus) may be administered with physician approval.
• Always inform your transplant team before receiving any vaccination.

Sexual activity and contraception

• You may gradually resume sexual activity when you feel well and if your physician considers it appropriate.
• Some immunosuppressive medications may reduce the effectiveness of oral contraceptives; consult a gynecologist to determine appropriate contraceptive methods.

Travel (vacation)

• Check the healthcare conditions at your destination and carry an adequate supply of medications.
• Avoid consuming unsafe food or water.
• Discuss your travel plans with your physician in advance.

Alcohol

• Avoid completely. Even small amounts can cause serious damage to the transplanted liver.

Smoking

• Stop smoking completely. Smoking increases the risk of infection, cancer, cardiovascular disease, and impaired wound healing.

Signs of rejection

• Contact your physician immediately if you experience fatigue, jaundice, dark-colored urine, abdominal pain, or fever.
• These symptoms may be early signs of liver rejection.

Psychological support

• Emotional changes and anxiety are normal after transplantation.
• Seek psychological support if needed; support groups may be beneficial.

Surgical wound care

• Keep the wound clean using antiseptic soap.
• Contact your physician immediately if you notice redness, swelling, or discharge.

Oral and dental care

• After each meal, brush with a soft toothbrush and use an antiseptic mouthwash; clean dentures thoroughly.
• Have a dental check-up every 6 months.
• Regardless of how much time has passed since your liver transplant, antibiotic prophylaxis is required starting 24 hours before any dental procedure and continuing until 48 hours after the procedure.
  This is called prophylactic treatment, and your physician will instruct you on when and how to take the antibiotic.
• Avoid unnecessary dental procedures during the first 6 months after surgery, unless advised otherwise by your physician.

General personal hygiene

• Prefer showers over baths; use liquid soap.
• Change hand and face towels daily; clean nails using a nail brush.
• During menstruation, change pads/tampons frequently; avoid vaginal disinfectants (mild soap and water are sufficient).

Skin and hair care

• Corticosteroids may cause acne; gently wash affected areas with a mild antibacterial soap three times daily without scrubbing.
• Consult a dermatologist for severe or infected acne.
• Hair may become more fragile with permanent dyes or bleaching agents; moisturizing products are recommended.

Excessive hair growth

• Some immunosuppressive medications (especially cyclosporine) may cause increased hair growth.
• Depilatory creams, bleaching, waxing, or electrolysis may be considered.
• Do not discontinue medication; consult your physician if the condition is severe.

Sun protection

• Avoid sun exposure between 10:00 a.m. and 3:00 p.m.; wear a hat, long sleeves, and lightweight trousers.
• Use sunscreen with at least SPF 15; reapply after sweating or swimming.
• Avoid tanning beds.
• Consult a dermatologist for any mole that changes in color or shape.

Nutrition and fluid balance

• Maintain a balanced, hygienic, and protein-adequate diet.
• Avoid raw meat or eggs and unpasteurized dairy products.
• Drink 2–2.5 liters of water daily; limit salt intake due to the risk of edema associated with corticosteroids.
• Consult a dietitian in cases of excessive weight gain or loss of appetite.

Additional hygiene recommendations:
Weigh yourself daily; wash and peel fruits and vegetables thoroughly; peel and cook soil-grown vegetables well (use a pressure cooker if necessary); avoid moldy or unpasteurized foods.

Infection prevention

• Avoid crowded places and contact with sick individuals; ventilate your home regularly.
• Maintain strict hand hygiene after contact with pets.
• Clean any cuts or scratches with antiseptic solution.

Pets, plants, and soil

• Avoid cleaning animal waste or litter; use gloves if unavoidable.
• Cats and birds may carry certain infections; follow your physician’s recommendations.
• Avoid gardening or soil contact during the first year; afterward, use gloves.

Physical activity

• Avoid heavy lifting and sudden movements during the first weeks.
• Begin walking with your physician’s approval and gradually increase activity (swimming and cycling may be appropriate).
• Take breaks when fatigued; stop exercise and consult your physician if pain or shortness of breath occurs.
• Regular sleep and stress management support recovery.

Maintaining an ideal body weight after transplantation is important. Your nutrition plan should be individualized according to your personal needs under the supervision of your physician and dietitian.

To help balance your weight and blood glucose levels, your diet should include:

• Fresh fruits and vegetables
• Whole grains and whole-grain bread varieties
• Low-fat milk and dairy products or other sources of calcium
• Lean meat, fish, poultry, or plant-based protein sources

Avoid fatty foods and excessive protein intake. Choose boiling, baking, or grilling instead of frying.

Weigh yourself daily; sudden weight gain may indicate fluid retention.

Avoid sugary foods. Instead of cakes, biscuits, and snacks, consume fresh fruit or low-calorie vegetables.

Consume approximately 2 liters of fluids per day.
Water is the best choice; low-fat pasteurized milk, natural fruit juices, and herbal teas are also appropriate.

Wash and peel fruits and vegetables thoroughly. Pay special attention to hygiene when consuming raw produce.

Peel soil-grown vegetables such as potatoes and boil them in boiling water.
Pressure cooking or steaming helps minimize vitamin loss.

Consume milk, yogurt, and cheese in fresh, pasteurized forms.
Avoid cheeses made from unpasteurized milk or mold-ripened products.

Limit salt intake. In patients receiving corticosteroid therapy, excessive salt may increase the risk of edema and hypertension.

Purchase fats and dairy products in small quantities to maintain freshness and avoid consumption of spoiled foods.

Alcohol must be strictly avoided. The transplanted liver is more sensitive to the harmful effects of alcohol.

Consult your dietitian in cases of excessive weight gain or loss of appetite; your nutrition plan may need to be adjusted accordingly.

One of the side effects of the medications used after liver transplantation is an increase in blood glucose levels.
In some patients this condition is temporary, while in others it may become permanent (diabetes mellitus).
Therefore, patients who experience elevated blood sugar levels should avoid excessive weight gain and adhere to a regular, balanced diet.

Points to consider

• Age, weight gain, and a family history of diabetes may contribute to elevated blood glucose levels.
• Reduction of corticosteroid therapy and adherence to regular nutritional habits help improve glycemic control.
• When necessary, oral antidiabetic medications or insulin therapy may be initiated.
• Regular follow-up at a diabetes clinic should be maintained.

The body’s immune system recognizes its own cells; however, it perceives an organ transplanted from another individual as foreign and mounts a defensive response against it. This immune reaction directed against the transplanted organ is called tissue rejection (rejection).

After liver transplantation, immunosuppressive medications are administered to prevent rejection. These drugs inhibit the immune system from damaging the new liver. Despite this, mild rejection may occasionally occur; however, when detected early and treated promptly, it is usually well controlled and liver function returns to normal.

Yes. Patients who undergo liver transplantation, like recipients of other solid organ transplants, are required to use immunosuppressive medications for life.

These medications prevent the body from recognizing the transplanted liver as foreign and mounting an immune-mediated rejection response.

Patient follow-up schedule

• The first follow-up visit is performed 2 days after discharge.
• During the first 3 months, outpatient clinic visits should be scheduled once weekly.
• After the 6th month, follow-up visits every 3 weeks may be sufficient, depending on the patient’s clinical condition.
• During these visits, blood tests, liver function tests, and immunosuppressive drug levels are evaluated.

Donor follow-up

• The follow-up period for liver donors is shorter.
• The first follow-up visit is performed 1 week after discharge.
• Subsequent evaluations with blood tests are carried out at the 3rd and 6th months.
• If all results are within normal limits, no further follow-up is required for the don

The primary goal of liver transplantation is to enable the patient to regain a healthy and functional life.

As long as medical recommendations are followed, returning to social activities and professional life is possible.

After liver transplantation, the 1-year survival rate is approximately 90–95%, the 5-year survival rate is around 75%, and the 10-year and longer survival rate is approximately 60%.

In general, following a successful liver transplantation performed by an experienced team, about 75% of patients have a life expectancy exceeding five years. In addition, factors such as the patient’s overall health status, the presence of comorbid conditions, and individual patient-related factors may lead to variations in survival outcomes.

One or two intravenous lines may be placed to administer medications or fluids.
One of these lines is used for pain control. In addition, a urinary catheter is inserted into the bladder to monitor kidney function.

One or two small drainage tubes are placed in the abdomen. The intravenous lines and the urinary catheter are usually removed within 3–4 days, while the abdominal drainage tubes are removed within 6–7 days.

The length of hospital stay for liver donors typically ranges from 7 to 10 days.

The surgical incision is usually a large J-shaped incision or a “Mercedes-type” incisio

The risk of mortality associated with living liver donor surgery is below 0.5% and is considered very low.

Rare complications may include bile leakage and bleeding, which may require additional surgical intervention or blood transfusion when necessary.

As with other surgical procedures, temporary side effects such as wound infection, gas pain, constipation, and anesthesia-related nausea may also occur.

Due to the liver’s regenerative capacity, the portion removed from the donor generally regenerates and returns to near-normal volume within approximately 6 weeks.

Yes. In liver donors, particularly during right lobe hepatectomy, the gallbladder is removed.

The removed gallbladder is not transplanted to the recipient; it is sent for pathological examination. The gallbladder is not a vital organ for either the donor or the recipient, and its removal does not result in any long-term deficiency.

Yes. After surgery, you should remain in close proximity to the transplant center for 2–3 weeks. This is important to ensure that you can return to the center promptly in case of any complications.

For patients traveling from out of town, it is recommended that a relative accompany the patient as a caregiver.

In most cases, the surgical incision heals within a short period, and its appearance gradually becomes less noticeable. However, it does not disappear completely, and a faint scar usually remains.

If the wound becomes infected, the scar may become wider and more prominent.

Yes. There are no restrictions on having children for male donors. For female donors, it is recommended to wait at least one year before becoming pregnant.

Liver transplantation in children is a life-saving treatment for liver diseases that cannot be managed with medical therapy. However, it is a high-risk procedure that requires lifelong medication use and regular follow-up. For a successful outcome, appropriate patient selection, accurate timing, and surgery performed by an experienced multidisciplinary team are of critical importance.

Indications for transplantation

Acute liver failure: A sudden-onset condition, most commonly related to viral infections, certain medications, or toxins.

Chronic liver failure: Develops due to conditions such as biliary atresia, Wilson disease, familial progressive cholestasis, and alpha-1 antitrypsin deficiency.

Metabolic diseases: Transplantation may also be performed for therapeutic purposes in certain genetic or metabolic disorders.

Pre-transplant evaluation

Children undergo comprehensive assessment for infectious diseases, cardiac, pulmonary, renal, and neurological status. Nutritional status and vaccination history are evaluated, and deficiencies are corrected.
Voluntary donor candidates are assessed through blood tests and imaging studies; health status, age (18–60 years), voluntariness, and suitability criteria are carefully evaluated.

Post-transplant course

After surgery, the child typically remains in the intensive care unit for approximately 1 week, followed by 2–8 weeks of inpatient ward care. After discharge, regular blood tests and outpatient clinic follow-up are mandatory to ensure long-term success and optimal quality of life.

No. Once you have donated a portion of your liver, it is not possible to donate again.

It is recommended not to plan international travel for at least 4 weeks, preferably 8–12 weeks, after liver transplantation.

If you need to return home and there is a physician in your city capable of post-transplant follow-up, you may travel 2–4 weeks after surgery provided you feel well. However, if there is any suspicion of a complication, you may be called back to the transplant center for evaluation and treatment.

In general, after the 12th week, patients can safely travel to their desired destinations.

Yes. Disability retirement is possible after liver transplantation.