Typically, surgeons will only perform a liver transplant when all other treatment options have been ruled out. Nevertheless, liver transplants are the second most common type of transplant surgery after kidney transplants, with more than 157,000 carried out in the United States since 1988.
The chance to be transplanted at two years from listing was 65% and the risk of death was 17%. Patients with metabolic liver disease had the highest chance of undergoing liver transplantation.
Liver transplant survival rates
In general, about 75% of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 75 will live for five years and 25 will die within five years.
Transplants. In 2020, despite the COVID-19 pandemic, 8906 liver transplants were performed in the United States, more than in any previous year (Figure LI 60, Figure LI 61). Adults represented 94.4% of liver transplant recipients, with 7979 deceased donor and 425 living donor liver transplants.
An ideal liver comes from a healthy young person who has died. Ideal livers are more likely to work well and less likely to transmit cancer or infection. In the United States, roughly a third of all liver transplants come from ideal donors. This means it's impossible for every patient to get an ideal liver.
Waiting for a liver transplant
Donor livers are scarce and waiting for a suitable liver may take many months or even several years. During this time, the cancer may continue to grow. As a result, most people have tumour ablation or TACE to control the cancer while they wait for a donor liver to become available.
The waiting period for a deceased donor transplant can range from less than 30 days to more than 5 years. How long you will wait depends on how badly you need a new liver.
The long-term outlook for a liver transplant is generally good. More than 9 out of every 10 people are still alive after 1 year, around 8 in every 10 people live at least 5 years, and many people live for up to 20 years or more.
Many may live for up to 20 years or more after the transplant. A study says 90% of people with transplant survive for at least 1 year, and 70% of people may live for at least 5 years after transplant.
Although mortality has traditionally been estimated at 1 in 250 for living donation, a more recent survey found a 1 in 1,000 chance of death among liver donors at experienced centers, and a morbidity rate of approximately 30%.
There is pain after liver transplant surgery, however it is generally not as severe as with other abdominal surgeries. This is because nerves are severed during the initial abdominal incision causing numbness of the skin around the abdomen. These nerves regenerate over the following six months and sensation returns.
A transplanted liver may be more sensitive to damage by chemicals, including alcohol. The transplantation team recommends that recipients avoid overuse of alcoholic beverages after transplantation.
The 1-, 5- and 10-year graft survival rates of liver transplant recipients who were younger than 65 years were 82.1%, 67.8% and 52.6%, respectively; for recipients who were 65 years or older they were 77.5%, 59.7% and 41.2%, respectively.
People needing liver or heart transplants often need to wait nine or more months. Recipients are assessed for compatibility to the donor (not just blood type, but for six different tissue antigen subtypes as well as general body size – e.g. putting an adult heart into a small child is not possible).
Currently, approximately 260 liver transplants (224 in adults and 39 in children) occur annually in Australia and New Zealand (see Fig. 1). The annual rates of LT per 1 million of population are approximately 9.3 for Australia and 10.1 for New Zealand.
Dr Hodgkinson said it was extremely gratifying to know patient time on the waitlist had been reduced and that five-year survival rates continued to improve in Australia. “Historically, liver transplants have had a 90% survival rate after five years, but now our five-year survival rate has improved to 96%.”
Overall, infections are the most frequent cause of mortality in males and females, though they are significantly higher in females. In our cohort, the main causes of mortality within the first year after transplantation were infections and surgical complications in both sexes.
The duration of liver transplant surgery depends on how complex your case is. On average, the surgery can take between 6-12 hours.
You can't live without a working liver. If your liver stops working properly, you may need a transplant. A liver transplant may be recommended if you have end-stage liver disease (chronic liver failure). This is a serious, life-threatening liver disease.
Potential liver donors must not have any serious medical conditions, such as liver disease, diabetes, heart disease or cancer. To become a live liver donor, you must: Be a willing adult between age 18 and 60. Be prepared to commit to the pre-donation evaluation process, surgery and recovery.
Your liver can keep working even if part of it is damaged or removed. But if it starts to shut down completely—a condition known as liver failure—you can survive for only a day or 2 unless you get emergency treatment.
If your MELD or PELD score is very high, you will have very high priority for a transplant. MELD scores range from 6 (least sick) to 40 (most sick). PELD scores may range lower or higher than MELD scores. Your score may go up or down over time as your liver disease either worsens or improves.
Traditionally, being liver transplant candidate requires “six months of abstinence” from alcohol. However, the so-called “six-month rule” may not save some of life especially in severe ALHep patients.
Living liver donors donate part of their liver to someone with liver failure. Liver failure may be caused by a number of conditions, including liver cancer, hepatitis or cirrhosis. Donating part of your liver is possible because the liver – unlike other organs – has the remarkable ability to regenerate.
Organ donation process
There are around 1,800 Australians waitlisted for a transplant and around 14,000 additional people on dialysis – some of whom may need a kidney transplant.