Living Donor Liver Transplantation

A living donor liver transplantation is a surgery that removes a diseased or malfunctioning liver and replaces it with a portion of a healthy liver from a living donor. Due to the liver’s unique ability to regenerate, the partial livers of both the donor and recipient soon grow into complete organs.

Key Facts

  • Unlike traditional liver transplantation surgery, which uses livers from deceased donors, living donor liver transplantation uses partial livers from living donors.
  • Living donors must meet various mental and physical requirements, have a blood type compatible with the recipient, and have an altruistic motive to donate.
  • This type of surgery offers numerous benefits over traditional liver transplantation, such as shorter waiting times, faster recovery, and improved outcomes.

Purpose

Like traditional liver transplantations, living donor liver transplantations are performed in people who have liver conditions that cannot be cured any other way. However, because living donor liver surgery involves the transplantation of only a portion of a liver, rather than an entire liver, patients with severe liver disease, active infections, or a history of alcohol or substance abuse are usually not eligible. 

Living donor liver transplantation was developed due to the shortage of available deceased donor livers, particularly for children. By transplanting a partial liver to someone with a diseased or malfunctioning liver, living donor liver transplantation can dramatically reduce the wait for a new liver. This has the added benefit of helping recipients avoid the health complications that can come from long waiting times.

In fact, living donor liver transplantation offers several benefits over traditional liver transplantation:

  • Shorter Waits: Typically, living donors are a family member or loved one of the recipient. This means there is no need to remain on a waiting list.
  • Faster Recovery: Living donor recipients experience shorter hospital stays and are less likely to require blood transfusions or dialysis after their surgery.
  • Improved Outcomes: Recipients of living donor livers have an average 5 percent better long-term survival rate than recipients of deceased donor livers.

Procedure

A living donor liver transplantation is a complex and serious operation for both the recipient and the donor. The following is the general process both will undergo when getting this procedure.

Evaluation

Before surgery, the recipient and the donor will both need to be evaluated in order to determine if they are physically and mentally able to undergo a liver transplantation. For the recipient, this process is identical to the evaluation for a traditional transplantation. The evaluation process for donors will include the following:

  • Blood Tests: Determines whether their blood is compatible with the recipient’s blood, as well as whether their liver, kidney, and thyroids are functioning properly. Also screens for transmittable viruses, such as hepatitis and HIV. 
  • Physical Exam: If their blood types are compatible, then a physician will examine them to determine their general level of health.
  • Magnetic Resonance Imaging (MRI): Creates a detailed picture of the donor’s internal organs so that surgeons have an anatomical “road map” during surgery.
  • Diagnostic Tests: These will include a CAT scan of their abdomen and a chest x-ray.
  • Screening Tests: If required, these may include an echocardiogram (EKG), pulmonary function test, and an exercise stress test.
  • Additional Consultations: Donors will also meet with a psychiatrist to assess their mental health and a social worker, who will discuss the donation process with them and their family.

It typically takes two to four weeks to complete the donor evaluation process. However, in rare emergency situations, it can be completed in as little as 48 hours. For more information on the evaluation process, call 1-877-LIVER MD (1-877-548-3763).

Surgery

Living donor liver transplantation surgery involves the removal of a portion of the donor liver, the removal of the recipient’s diseased or malfunctioning liver, and the implantation of the donor’s partial liver. Successfully implanting the donor liver requires the surgeon to reestablish all of the liver’s vital veins, arteries, and bile duct connections. In general, it takes about four to six hours to remove the donor liver, then another six to 12 hours to implant it into the recipient.

The following is the general step-by-step process of a living donor liver transplantation:

  1. Preparation: Both the recipient and the donor are given a final physical examination and are prepared for surgery.
  2. Anesthesia: Just before surgery, both the recipient and the donor will be given general anesthesia. This will put them into a deep sleep for the entirety of the operation.
  3. Incision: The surgeon will begin by making a long incision across the donor’s abdomen to gain access to the liver. If the recipient is a child, then a smaller laparoscopic incision will be made.
  4. Removal: The surgeon will remove a portion of the liver they have previously identified as adequate for the recipient. This portion may make up anywhere from 25 to 65 percent of the liver.
  5. Closure: After controlling bleeding, the surgeon will close the incision and the donor will be taken to recovery.
  6. Incision: Much as they did for the donor, the surgeon makes a long incision across the recipient’s abdomen to gain access to their liver.
  7. Removal: All existing connections are severed from the diseased liver. The surgeon removes the liver from the recipient.
  8. Implantation: The partial donor liver is implanted inside the recipient. This involves attaching it to their body’s veins, arteries, and bile ducts.
  9. Closure: When all bleeding is controlled, the surgeon sews the incision closed.

The following are some of the types of doctors that may be involved in a living donor liver transplantation:

  • Anesthesiologist: A specialist in administering sedatives and anesthetics.
  • Hepatologist: A specialist in the liver, pancreas, and gallbladder.
  • Radiologist: A specialist in imaging organs.
  • Transplant Surgeon: A specialist in removing and implanting organs.

Alternatives

Currently, few alternatives to liver transplantation exist. While some medications and therapies may be able to delay liver failure or alleviate symptoms, liver transplantation is usually the only viable way to cure end-stage liver disease. 

If a patient is not eligible for a living donor liver transplantation, their only alternative may be a traditional liver transplantation.

Risks and Complications 

As with any major surgery, living donor liver transplantations come with risks, including possible complications. For donors, these include:

  • Bile duct leakage
  • Bleeding
  • Blood clots
  • Hernia
  • Infection
  • Nausea

For recipients, the risks are similar to those of a traditional liver transplantation. These include:

  • Bile duct leakage or shrinkage
  • Bleeding
  • Blood clots
  • Failure of donated liver
  • Infection
  • Mental confusion or seizures
  • Rejection of donated liver

However, because the donated liver comes from a living donor, serious complications occur at a lower rate. In fact, research has shown that the majority of complications that occur during living donor liver transplantations are due to the relative technical complexity of the procedure and are offset when performed by experienced surgeons. 

What to Expect Afterwards

After a living donor liver transplantation, most people experience excellent outcomes. However, it can take several months until the livers of both the donor and recipient grow back to a normal size. All recipients will also likely have to take some form of medication for the rest of their lives. 

Recovery

After their surgery, the donor will typically remain in the hospital for four to seven days. Most donors are fully recovered after three to six weeks. However, each donor’s recovery time will depend on their age and overall health, among other factors.

The recipient will remain in the hospital for about seven days after their surgery. Most recipients are fully recovered after three to six months. However, this will depend on the severity of their condition, their age, and their general health.

Medications

Donors and recipients will have to take a variety of medications after their surgery. In general, these medications can be divided into three categories:

  • Anti-Rejection: Also called immunosuppressants, these medications weaken the immune system of the recipient so that it does not reject the new liver.
  • Anti-Infective: Because the immunosuppressants weakens their immune systems, recipients will need to take anti-infective medicine to protect against infection.
  • Miscellaneous: Additional medications may include ones to treat the side effects of the immunosuppressants, alleviate pain, or help with other medical conditions.

Immediately after surgery, recipients will take a combination of these medications. As they heal, the dosage amounts and number of medications will be reduced. By six months, it is normal for them to only be taking one or two medications. Immunosuppressants will likely have to be taken for the rest of their lives so that their bodies don’t reject their donor liver. If this medication is not taken as prescribed, organ failure may result. 

Donors will likely need to remain on pain medication for several weeks after their surgery. They may also need to take anti-infective medication as well.

Survival Rates

According to data compiled by the Organ Procurement and Transplantation Network (OPTN), the national survival rate for living donor transplants performed between 2008 and 2015 was:

  • 92 percent one year after surgery
  • 88 percent three years after surgery
  • 84 percent five years after surgery

For more information, read the FAQ for living donor liver transplantation surgery.

Next Steps

Columbia has long been a leading in living donor liver transplantations. Our doctors pioneered the development of this procedure in the 1980s and have since helped produce vital innovations that have helped make it safer and less invasive. As a result, we are now one of the largest and most successful living donor liver transplantation programs in the country. Learn more about our program on the Living Donor Liver Transplantation Program page

Call us at (877) LIVER MD/ (877) 548-3763 or use our online form to schedule an appointment.

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