Before the operation
Once a liver donor is found for you, your transplant team will contact you. This can be at any time, day or night and you’ll need to go to the transplant centre straight away. Take care on your journey so you arrive safely. You may be able to take someone with you to the transplant centre for support but this will depend on your hospital’s infection control guidelines. Ask them what the current guidelines are when you get the call.
When you get the call, the transplant coordinator will tell you to make your way to hospital, usually the liver transplant ward. When you get there you’ll meet the nurses and doctors who will be taking you through your liver transplant.
Your transplant coordinator will tell you if you need to stop eating and drinking. This will depend on the timings of your operation but your stomach will need to be empty for the surgery.
Tests before your operation
It’s important to let your doctors and nurses know if there’s been any change to your health since your liver transplant assessment, so they have all the information they need to safely do your operation.
You’ll have a number of tests to check that you’re well enough for surgery, which may include:
- blood tests to check your overall health, including how well your liver and kidneys are working
- blood pressure
- temperature check
- electrocardiogram (ECG)
- chest X-ray
- a sample of any fluid in your tummy (ascites) to check for bacteria
You’ll meet an anaesthetist too who will check you’re well enough to have a general anaesthetic. A general anaesthetic is a combination of medicines to make you unconscious, relax your muscles and stop you feeling pain.
You’ll also meet your surgeon who will go through the operation with you again and give you information about the benefits and the risks.
Tests on the donor liver
Your surgeon will assess the donor liver to make sure it’s the right size, quality and fit for you. They’ll look at everything from the blood vessels to the bile ducts, to check everything is ok and it’s safe to use.
The decision to go ahead or not
Your operation can only go ahead once your surgeon and anaesthetist are satisfied that you’re well enough to have the operation, and that the donor liver is right for you.
Sometimes, after your test results have come back and the liver has been assessed, the operation may not be able to go ahead. Possible reasons include the following.
- Your tests show that you have a new health problem, or your health has got worse since your liver transplant assessment. This may make the operation too risky for you.
- There may be a problem with your donor’s health that wasn’t known when you accepted the liver.
- Your surgeon decided that the donated liver isn’t right for you. It may not be in good enough condition, for example, or the wrong size for you.
Questions to ask your assessor
If this happens, have some questions ready to ask your transplant team about what it means for you.
- What did the test show and why does it matter?
- What’s next – can I get treatment for the health condition the test showed?
- Will I go back on the waiting list – if so, when?
- Why is the donor liver not suitable for me?
How to cope with false calls
Its normal to have one or more false calls before you have a liver transplant. It can naturally feel devastating to be told your operation can’t go ahead.
This can mean different things to different people. Talk to your transplant team to make sure you understand what this will mean for you. It can help to talk to someone who understands. Call our nurses or sign up to a Support Group session. Or have a look at our looking after your mental health page for more information and useful links.
The operation
A liver transplant operation usually takes about 5 to 8 hours but it can take longer. You’ll have a general anaesthetic so you’ll be asleep and won’t feel any pain. Your anaesthetist will help to prepare you for the operation. If you have any questions about the anaesthetic and how you’ll feel afterwards, ask them.
Once you’re asleep, your surgeon will make a large cut in your tummy (abdomen) and up towards your chest. The cut will either be like a hockey stick, or an upside-down Y. They’ll then remove your liver and put the donor liver in its place.
This may be a whole liver, a reduced liver or a split liver. A reduced liver is when only a part of the liver is used. And a split liver is when either a right or left lobe is used. Both will grow over time to a full-sized liver. They’ll attach your blood vessels and bile ducts to the donor liver.
Your surgeon may put two drainage tubes in just before they close your wound. These will drain blood and fluid from around your liver.
Once your surgeon has finished, they’ll close the cut with stitches or clips.
” I walked with the anaesthetist and transplant coordinator to a tiny holding room just outside the operating theatre to confirm my signature of consent. Then I walked into theatre and thought: “Right, that’s it then.”
I woke up in feeling groggy and sore. There were tubes, but they didn’t feel uncomfortable and nothing was hurting really badly – perhaps my mind just didn’t connect with having pain as I was just so relieved to have come through the surgery.”
Risks of liver transplants
There are some potential risks of liver transplant that you’ll need to understand before you can sign a consent form to have the operation. These can happen during the operation or immediately after. There are some things to look out for when you get home too.
Risks during the operation
Although very rare, it’s possible that you may have bleeding during your operation (a haemorrhage) that your surgeon cannot stop, and this could be fatal. Your surgical team will do all they can to help you, and you may need to have blood transfusions. Ask your surgeon what your risk of bleeding is.
Risks immediately after the operation
- It’s possible that the new liver won’t function after it’s been transplanted to you. If this happens, you’ll be put on a ‘super urgent’ waiting list to have another transplant.
- A blood may clot may form in the artery going to your liver, which is called hepatic artery thrombosis. Again, you may be put on the super urgent waiting list for another transplant, or you may be able to have an operation to treat it.
Later complications
- An infection – a common viral infection after a liver transplant is cytomegalovirus (CMV).
- Your body rejecting the new liver.
- Problems with your blood vessels and bile duct.
These are just some of the potential risks. Your surgeon will give you more detailed information about the benefits and the risks of liver transplant.
After your operation
When you wake up
When you wake up, you’ll be in the intensive care unit (ICU or ITU), where you’ll recover until you’re well enough to go to a hospital ward. This is usually a few days but may be less. Doctors and nurses will monitor your health regularly. They’ll check your blood pressure and temperature, for example, and you’ll have some blood tests to check how you’re doing.
As the anaesthetic wears off you’ll start to feel some pain. You probably won’t be able to move much after your operation as you’ll feel sore, and you might feel bloated too.
Your transplant team will give you some strong painkiller medicines through a drip to help control your pain at first. As you recover, you may be able to take these as tablets. It’s important to let your doctors and nurses know if the painkillers are working for you.
You may have some tubes coming out from your body when you wake up, which can include the following:
- A breathing tube attached to a machine that helps you breathe (a ventilator). Your transplant team will remove this once you’re awake and can breathe on your own. Your throat may be sore from this.
- A tube in your neck to give you fluid and medicines – this will be removed when you’re able to drink fluid on your own.
- A tube coming out of your nose – this will be removed as soon as you are able to eat and drink.
- A tube to help you pee (a catheter) – this will be removed when you’re able to go to the toilet.
- A small tube in your arm – you can receive fluids and medicines through this until you’re able to drink.
- Tubes (drains coming out of your tummy) – your surgeon will remove these within a few days of your operation.
Recovering from a liver transplant
As you recover from your operation, your transplant team will encourage you to eat and drink. After a day or two, you should be able to sit up in bed and start walking (with help from nurses and physiotherapists).
It’s important to get moving to keep your blood flowing so you don’t get clots. It will also help your bowels to get going again so you can go to the toilet.
Remember to let your transplant team know if your medicines are controlling your pain. This will help you to get moving again.
Tests
You may have some daily tests to monitor your progress. These may include:
- blood tests to check things like how your liver and kidneys are working
- an ultrasound test soon after your surgery to check your liver is working as it should be
- a liver biopsy (small sample of tissue) – you won’t need to have an operation again, your doctor can take the sample with a needle using a local anaesthetic so you won’t feel any pain
Depending on what your personal circumstances and needs are, as well as nurses and doctors, while you’re in hospital you may see a:
- physiotherapist – they’ll help you with some breathing exercises at first, before they help you to get moving and to eventually make sure you’re mobile enough to go home
- psychologist, if you feel that you need support with your mental health
- a transplant coordinator
- pharmacist
- social worker
- dietician
They’ll all work with you closely to plan and prepare for you to leave hospital.
Medicines
You’ll need to take medicines after your operation to lower your immune system and reduce the chance of your body rejecting your new liver. These are called immunosuppressants.
Your transplant doctors or liver pharmacist will tell you which types of immunosuppressant you’ll take and give you detailed information about how to take them. They may give you some side-effects, such as headaches and tremors but it depends on which medicine you take. Your team will let you know how to manage these, and if you need to take a different dose or type of medicine.
It’s very important to follow their instructions and to take your medicines as prescribed, and not forget to take them, as this will keep your liver healthy. Speak to your liver pharmacist if you think you might struggle with this, as there are various things they can do to help.
You will need to understand how to take your medicines before you can go home. And you’ll usually need to take immunosuppressants for the rest of your life.
Leaving hospital
You’ll usually be able to go home after a week or two but it will depend on how you recover. Your transplant team will make sure that you are strong enough to go home. Your doctors will need to be confident that you can take all the medicines you will need after a liver transplant, and your physiotherapist will need to make sure you are mobile enough to go home.
They’ll also need to make sure that you understand how to take care of yourself at home and what problems to look out for so you can get the care you need. For example, what to do if you get an infection.
Your transplant team will give you a range of information including:
- Your diet – what you can eat and drink.
- When you can exercise and how to lose weight if you need to (once you have recovered).
- Any ongoing support to stop smoking and drinking alcohol.
- When you can go back to work.
- When you can drive.
Tip: Ask whoever is driving you home to bring you a pillow or cushion. Pop this between the seatbelt and your tummy to protect your wound while going over bumps.
Preparing to go home
Here are some things to consider when you prepare to go home.
- Do you have support at home? If you need some extra help at home, for example help with cleaning and looking after your wound, tell your transplant team as they may be able to help you arrange this.
- Pets and other caring responsibilities. It can be challenging to look after others while you’re recovering so it may be a good idea to get some support.
- Eat well. Get food delivered, or ask family or friends to help out for a bit.
- Do you have transport set up as you’ll need to go back to the hospital for regular check-ups? You probably won’t be able to drive yourself for a few months so if you don’t have friends or family who can take you, arrange some hospital transport.
Your aftercare
You’ll have regular appointments at the liver transplant centre. To start with, these will probably be about once a week for the first 2 or 3 months. You’ll then go less often as you recover – every few months to once a year.
Your transplant doctors will check how your liver is working at these appointments and if you have any complications of your surgery. Complications after surgery can include:
- An infection – a common viral infection after a liver transplant is cytomegalovirus (CMV).
- Your body rejecting the new liver.
- Problems with your blood vessels and bile ducts.
Ask your transplant team to go through all the possible complications of liver transplant surgery with you, and what to look out for.
Tests after a liver transplant
You’ll have a number of checks at the clinic. These may include questions or tests on the following:
- Immunosuppressant medicines. A specialist pharmacist will talk to you and your family at your appointments, to see how you’re coping taking immunosuppressants, and if you need help to manage them.
- Liver tests. You may have blood tests to check for infections, or an ultrasound to look at your new liver.
- Tests of your heart function. Your doctors can prescribe medicines if you need them. They’ll also check your blood pressure.
- Measurements of your height and weight. Your transplant team will provide support to help you lose weight if you need to. Your transplant is more likely to be a success for longer if you keep to a healthy weight.
- If you’re struggling to stop smoking for good, your transplant team will ask you about how they can help.
These are just some of the tests, ask your transplant coordinator for a full list.
What happens if your body rejects your new liver
If your body rejects your liver, your immune system starts to attack it because it realises your new liver came from a different person. So it sees it as something that it isn’t supposed to be there. Rejection isn’t all or nothing, if your body starts to reject your new liver this can often be stopped. So it’s important to tell your transplant team if you think this is happening.
Your transplant doctors will prescribe immunosuppressant medicines for you that aim to stop your body rejecting your new liver, but sometimes it can still happen. The risk is greatest just after your transplant operation (acute rejection), but less often it can happen months (or years) later (chronic rejection). The most important things you can do to help prevent this are to take the right dose of your medicines at the right time every day and to make sure you attend your clinic appointments, even if you’re feeling well.
You may get some symptoms if your body acutely rejects your liver, such as a fever, extreme tiredness and your eyes and skin may look yellow (jaundice). Your tummy may feel tender too. Ask your transplant team what else to look out for.
Your transplant team will need to take a biopsy of your liver. A biopsy is a small sample of tissue. Your doctor can take the sample with a needle using a local anaesthetic so you won’t feel any pain.
If it’s confirmed that your body is rejecting your liver, your doctors will give you some stronger immunosuppressant medicines. This usually stops your immune system attacking your new liver.
- Why did this happen?
- Is there anything I can do to prevent it happening again?
- Will I need more check-ups?
- How will I know my body is accepting my new liver?