Liver transplantation or hepatic transplantation is the replacement of a
diseased liver with the healthy
liver
The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...
from another person (
allograft
Allotransplant (''allo-'' meaning "other" in Ancient Greek, Greek) is the Organ transplant, transplantation of cell (biology), cells, Biological tissue, tissues, or Organ (anatomy), organs to a recipient from a genetically non-identical donor of ...
). Liver transplantation is a treatment option for
end-stage liver disease and
acute liver failure, although availability of donor organs is a major limitation. Liver transplantation is highly regulated, and only performed at designated transplant medical centers by highly trained transplant physicians. Favorable outcomes require careful screening for eligible recipients, as well as a well-calibrated live or deceased donor match.
Medical uses
Liver transplantation is a potential treatment for acute or chronic conditions which cause irreversible and severe ("end-stage") liver dysfunction.
Since the procedure carries relatively high risks, is resource-intensive, and requires major life modifications after surgery, it is reserved for dire circumstances.
Judging the appropriateness/effectiveness of liver transplant on case-by-case basis is critically important (''see
Contraindications''), as outcomes are highly variable.
Allocation
Scoring systems are widely used to determine recipient benefit, and hence to more fairly allocate organs for transplantation.
MELD
In the US, the Model for End Stage Liver Disease (
MELD score) for adults and the Pediatric End Stage Liver Disease (PELD score) for children younger than 12 years old are clinical scoring tools that take various clinical criteria into consideration and are used to assess the need for a liver transplant.
Higher scores for each clinical scoring tool indicates a higher severity of liver disease, and thus a greater need for a liver transplant.
In those with chronic liver disease, a decompensating event such as
hepatic encephalopathy
Hepatic encephalopathy (HE) is an altered level of consciousness as a result of liver failure. Its onset may be gradual or sudden. Other symptoms may include movement problems, changes in mood, or changes in personality. In the advanced stag ...
,
variceal bleeding,
ascites, or
spontaneous bacterial peritonitis may also signal a new need for a liver transplant.
Transplant Benefit Score
The Transplant Benefit Score is an algorithmic
medical scoring system used for making liver transplant waiting list decisions for the
National Liver Offering Scheme in the
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
.
In 2023, an investigation by the ''
Financial Times
The ''Financial Times'' (''FT'') is a British daily newspaper printed in broadsheet and also published digitally that focuses on business and economic Current affairs (news format), current affairs. Based in London, the paper is owned by a Jap ...
'' stated that the scoring system might result in younger patients not getting transplants under certain circumstances.
A publication in ''
The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication.
The journal publishes ...
'' also showed that the TBS algorithm generated implausible results in some circumstances.
Contraindications
Although liver transplantation is the most effective treatment for many forms of end-stage liver disease, the tremendous limitation in allograft (donor) availability and widely variable post-surgical outcomes make case selection critically important. Assessment of a person's transplant eligibility is made by a multi-disciplinary team that includes surgeons, medical doctors, psychologists and other providers.
The first step in evaluation is to determine whether the patient has irreversible liver-based disease which will be cured by getting a new liver.
Thus, those with diseases which are primarily based outside the liver or have spread beyond the liver are generally considered poor candidates. Some examples include:
* someone with advanced liver cancer, with known/likely spread beyond the liver. Or those with cancer of any type, if the cancer cannot be treated successfully without rendering them unsuitable for transplant (other than skin cancers).
* active illicit substance use
* anatomic abnormalities that prevent liver transplantation
* severe heart/lung disease, whether it is primary heart/lung disease, or brought on by the liver disease (unless the team thinks they can still proceed)
*
HIV/AIDS
The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...
, especially if it is not well-managed (some persons with HIV/AIDS that have very low or undetectable viral loads could still be eligible)
Importantly, many contraindications to liver transplantation are considered reversible; a person initially deemed "transplant-ineligible" may later become a favorable candidate if the circumstances change.
Some examples include:
* partial treatment of liver cancer, such that risk of spread beyond liver is decreased (for those with primary liver cancer or secondary spread to the liver, the medical team will likely rely heavily on the opinion of the patient's primary provider, the oncologist, and the radiologist)
* cessation of substance use (time period of abstinence is variable)
* improvement in heart function, e.g. by
percutaneous coronary intervention
Percutaneous coronary intervention (PCI) is a minimally invasive non-surgical procedure used to treat stenosis, narrowing of the coronary artery, coronary arteries of the heart found in coronary artery disease. The procedure is used to place and ...
or
bypass surgery
* treated HIV infection (''see
Special populations'')
Other conditions, including hemodynamic instability requiring
vasopressor support, large liver cancers or those with invasion to blood vessels, intrahepatic
cholangiocarcinoma,
frailty, fulminant liver failure with suspected brain injury, alcohol use disorder with recent alcohol consumption, cigarette smoking, inadequate social support, and nonadherence to medical management may disqualify someone from liver transplantation, however these cases are usually evaluated by the multi-disciplinary transplant team on an individual basis.
Risks/complications
Graft rejection
After a liver transplantation, immune-mediated rejection (also known as rejection) of the allograft may happen at any time. Rejection may present with lab findings: elevated AST, ALT, GGT; abnormal liver function values such as prothrombin time, ammonia level, bilirubin level, albumin concentration; and abnormal blood glucose. Physical findings may include encephalopathy, jaundice, bruising and bleeding tendency. Other nonspecific presentation may include malaise, anorexia, muscle ache, low fever, slight increase in white blood count and graft-site tenderness.
Three types of graft rejection may occur: hyperacute rejection, acute rejection, and chronic rejection.
* Hyperacute rejection is caused by preformed anti-donor antibodies. It is characterized by the binding of these antibodies to antigens on vascular endothelial cells.
Complement activation
The complement system, also known as complement cascade, is a part of the humoral, innate immune system and enhances (complements) the ability of antibodies and phagocytic cells to clear microbes and damaged cells from an organism, promote infla ...
is involved and the effect is usually profound. Hyperacute rejection happens within minutes to hours after the transplant procedure.
* Acute rejection is mediated by
T cell
T cells (also known as T lymphocytes) are an important part of the immune system and play a central role in the adaptive immune response. T cells can be distinguished from other lymphocytes by the presence of a T-cell receptor (TCR) on their cell ...
s (versus
B-cell-mediated hyperacute rejection). It involves direct
cytotoxicity
Cytotoxicity is the quality of being toxic to cells. Examples of toxic agents are toxic metals, toxic chemicals, microbe neurotoxins, radiation particles and even specific neurotransmitters when the system is out of balance. Also some types of d ...
and
cytokine
Cytokines () are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling.
Cytokines are produced by a broad range of cells, including immune cells like macrophages, B cell, B lymphocytes, T cell, T lymphocytes ...
mediated pathways. Acute rejection is the most common and the primary target of immunosuppressive agents. Acute rejection is usually seen within days or weeks of the transplant.
* Chronic rejection is the presence of any sign and symptom of rejection after one year. The cause of chronic rejection is still unknown, but an acute rejection is a strong predictor of chronic rejections.
Biliary complications
Biliary complications include biliary stenosis, biliary leak, and ischemic cholangiopathy. The risk of ischemic cholangiopathy increases with longer durations of cold ischemia time, which is the time that the organ does not receive blood flow (after death/removal until graft placement).
Biliary complications are routinely treated with Endoscopic Retrograde Cholangiopancreatography (
ERCP), percutaneous drainage, or sometimes re-operation.
Vascular complications
Vascular complications include
thrombosis
Thrombosis () is the formation of a Thrombus, blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fib ...
,
stenosis
Stenosis () is the abnormal narrowing of a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture).
''Stricture'' as a term is usually used when narrowing ...
, pseudoaneurysm, and rupture of the hepatic artery.
Venous complications occur less often compared with arterial complications, and include thrombosis or stenosis of the portal vein, hepatic vein, or ''
vena cava
In anatomy, the ''venae cavae'' (; ''vena cava'' ; ) are two large veins ( great vessels) that return deoxygenated blood from the body into the heart. In humans they are the superior vena cava and the inferior vena cava, and both empty into t ...
''.
Technique
Before transplantation, liver-support therapy might be indicated (bridging-to-transplantation). Artificial liver support like
liver dialysis or bioartificial liver support concepts are currently under preclinical and clinical evaluation. Virtually all liver transplants are done in an orthotopic fashion; that is, the native liver is removed and the new liver is placed in the same anatomic location.
The transplant operation can be conceptualized as consisting of the hepatectomy (liver removal) phase, the anhepatic (no liver) phase, and the postimplantation phase. The operation is done through a large incision in the upper abdomen. The hepatectomy involves division of all ligamentous attachments to the liver, as well as the common bile duct, hepatic artery, all three
hepatic veins and portal vein. Usually, the retrohepatic portion of the inferior vena cava is removed along with the liver, although an alternative technique preserves the recipient's vena cava ("piggyback" technique).
The donor's blood in the liver will be replaced by an ice-cold organ storage solution, such as UW (
Viaspan) or
HTK, until the allograft liver is implanted. Implantation involves anastomoses (connections) of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new liver, the biliary (bile duct) anastomosis is constructed, either to the recipient's own bile duct or to the small intestine. The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation and the experience of the surgeon.
The large majority of liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients. A major advance in pediatric liver transplantation was the development of reduced size liver transplantation, in which a portion of an adult liver is used for an infant or small child. Further developments in this area included split liver transplantation, in which one liver is used for transplants for two recipients, and living donor liver transplantation, in which a portion of a healthy person's liver is removed and used as the allograft. Living donor liver transplantation for pediatric recipients involves removal of approximately 20% of the liver (
Couinaud segments 2 and 3).
Further advance in liver transplant involves only resection of the lobe of the liver involved in tumors and the tumor-free lobe remains within the recipient. This speeds up the recovery and the patient stay in the hospital quickly shortens to within 5–7 days.
Radiofrequency ablation of the liver tumor can be used as a bridge while awaiting liver transplantation.
Cooling
Between removal from donor and transplantation into the recipient, the allograft liver is stored in a temperature-cooled preservation solution. The reduced temperature slows down the process of deterioration from normal metabolic processes, and the storage solution itself is designed to counteract the unwanted effects of cold ischemia. Although "static" cold storage method has long been standard technique, various dynamic preservation methods are under investigation. For example, systems which use a machine to pump blood through the explanted liver (after it is harvested from the body) during a transfer have met some success (''see
Research section for more'').
Living donor transplantation
Living donor liver transplantation (LDLT) has emerged in recent decades as a critical
surgical option for patients with end stage liver disease, such as
cirrhosis
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, chronic liver failure or chronic hepatic failure and end-stage liver disease, is a chronic condition of the liver in which the normal functioning tissue, or parenchyma, is replaced ...
and/or
hepatocellular carcinoma often attributable to one or more of the following: long-term
alcohol use disorder, long-term untreated
hepatitis C
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection period, people often have mild or no symptoms. Early symptoms can include ...
infection, long-term untreated
hepatitis B
Hepatitis B is an infectious disease caused by the '' hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. ...
infection. The concept of LDLT is based on (1) the remarkable regenerative capacities of the human liver and (2) the widespread shortage of
cadaver
A cadaver, often known as a corpse, is a Death, dead human body. Cadavers are used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue (biology), tissue to ...
ic livers for patients awaiting
transplant. In LDLT, a piece of healthy liver is surgically removed from a living person and transplanted into a recipient, immediately after the recipient's diseased liver has been entirely removed.
Historically, LDLT began with terminal pediatric patients, whose parents were motivated to risk donating a portion of their compatible healthy livers to replace their children's failing ones. The first report of successful LDLT was by
Silvano Raia at the
University of São Paulo
The Universidade de São Paulo (, USP) is a public research university in the Brazilian state of São Paulo, and the largest public university in Brazil.
The university was founded on 25 January 1934, regrouping already existing schools in ...
Faculty of Medicine in July 1989.
It was followed by
Christoph Broelsch at the
University of Chicago Medical Center in November 1989, when two-year-old Alyssa Smith received a portion of her mother's liver. Surgeons eventually realized that adult-to-adult LDLT was also possible, and now the practice is common in a few reputable medical institutes. It is considered more technically demanding than even standard, cadaveric donor liver transplantation, and also poses the ethical problems underlying the indication of a major surgical operation (
hemihepatectomy or related procedure) on a healthy human being. In various case series, the risk of complications in the donor is around 10%, and very occasionally a second operation is needed. Common problems are
biliary fistula,
gastric stasis and
infection
An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...
s; they are more common after removal of the right lobe of the liver. Death after LDLT has been reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to decrease further as surgeons gain more experience in this procedure. Since the law was changed to permit altruistic non-directed living organ donations in the UK in 2006, the first altruistic living liver donation took place in Britain in December 2012.
In a typical adult recipient LDLT, 55 to 70% of the liver (the right lobe) is removed from a healthy living donor. The donor's liver will regenerate approaching 100% function within 4–6 weeks, and will almost reach full volumetric size with recapitulation of the normal structure soon thereafter. It may be possible to remove up to 70% of the liver from a healthy living donor without harm in most cases. The transplanted portion will reach full function and the appropriate size in the recipient as well, although it will take longer than for the donor.
Living donors are faced with risks and/or complications after the surgery. Blood clots and biliary problems have the possibility of arising in the donor post-op, but these issues are remedied fairly easily. Although death is a risk that a living donor must be willing to accept prior to the surgery, the mortality rate of living donors in the United States is low. The LDLT donor's immune system does diminish as a result of the liver regenerating, so certain foods which would normally cause an upset stomach could cause serious illness.
Donor requirements

Any member of the family, parent, sibling, child, spouse or a volunteer can donate their liver. The criteria
[Living Donor Liver Transplantation FAQ - Columbia University Dept of Surgery](_blank)
Retrieved on 2018-06-10.
, Retrieved on 2018-06-10.
for a liver donation include:
* Being in good health
* Having a
blood type
A blood type (also known as a blood group) is based on the presence and absence of antibody, antibodies and Heredity, inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycop ...
that matches or is compatible with the recipient's,
although some centres now perform blood group incompatible transplants with special immunosuppression protocols.
* Having a charitable desire of donation without financial motivation
* Being between 20 and 60 years old
(18 to 60 years old in some places
)
* Have an important personal relationship with the recipient
* Being of similar or larger size than the recipient
* Before one becomes a living donor, the donor must undergo testing to ensure that the individual is physically fit, in excellent health, and not having uncontrolled high blood pressure, liver disease, diabetes or heart disease.
Sometimes CT scans or MRIs are done to image the liver. In most cases, the work up is done in 2–3 weeks.
Complications
Living donor surgery is done at a major center. Very few individuals require any
blood transfusions during or after surgery. All potential donors should know there is a 0.5 to 1.0 percent chance of death. Other risks of donating a liver include bleeding, infection, painful incision, possibility of
blood clots
A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulati ...
and a prolonged recovery.
[Liver Transplant](_blank)
Retrieved on 2010-01-20. The vast majority of donors enjoy complete and full recovery within 2–3 months.
[Post Operative Care](_blank)
Retrieved on 2021-05-05.
Pediatric transplantation

In children, living liver donor transplantation has become very accepted. The accessibility of adult parents who want to donate a piece of the liver for their children/infants has reduced the number of children who would have otherwise died waiting for a transplant. Having a parent as a donor also has made it a lot easier for children – because both patients are in the same hospital and can help boost each other's morale.
National Digestive Diseases Information Clearinghouse (NDDIC), Retrieved on 2010-01-20.
Benefits
There are several advantages of living liver donor transplantation over cadaveric donor transplantation, including:
* Transplant can be done on an elective basis because the donor is readily available
* There are fewer possibilities for complications and death than there would be while waiting for a cadaveric organ donor
* Because of donor shortages,
UNOS has placed limits on cadaveric organ allocation to foreigners who seek medical help in the USA. With the availability of living donor transplantation, this will now allow foreigners a new opportunity to seek medical care in the USA.
Screening for donors
Living donor transplantation is a multidisciplinary approach. All living liver donors undergo medical evaluation. Every hospital which performs transplants has dedicated nurses that provide specific information about the procedure and answer questions that families may have. During the evaluation process, confidentiality is assured on the potential donor. Every effort is made to ensure that organ donation is not made by coercion from other family members. The transplant team provides both the donor and family thorough counseling and support which continues until full recovery is made.
[Liver Donor: All you need to know](_blank)
Retrieved on 2010-01-20.
All donors are assessed medically to ensure that they can undergo the surgery. Blood type of the donor and recipient must be compatible but not always identical. Other things assessed prior to surgery include the anatomy of the donor liver. However, even with mild variations in
blood vessels
Blood vessels are the tubular structures of a circulatory system that transport blood throughout many animals’ bodies. Blood vessels transport blood cells, nutrients, and oxygen to most of the tissues of a body. They also take waste an ...
and
bile duct
A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. The bile duct is separated into three main parts: the fundus (superior), the body (middle), and the neck (inferior).
Bile is requ ...
, surgeons today are able to perform transplantation without problems. The most important criterion for a living liver donor is to be in excellent health.
[Liver Transplant Program And Center for Liver Disease](_blank)
, University of Southern California Department of Surgery, Retrieved on 2010-01-20.
Post-transplant immunosuppression
Like most other allografts, a liver transplant will be
rejected by the recipient unless
immunosuppressive drugs are used. The immunosuppressive regimens for all solid organ transplants are fairly similar, and a variety of agents are now available. Most liver transplant recipients receive
corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...
s plus a calcineurin inhibitor such as
tacrolimus
Tacrolimus, sold under the brand name Prograf among others, is an immunosuppressive drug. After Allotransplantation, allogenic organ transplant, the risk of organ Transplant rejection, rejection is moderate. To lower the risk of organ rejectio ...
or
ciclosporin
Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken Oral administration, orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease, nephr ...
, (also spelled cyclosporine and cyclosporin) plus a purine antagonist such as
mycophenolate mofetil. Clinical outcome is better with tacrolimus than with ciclosporin during the first year of liver transplantation. If the patient has a co-morbidity such as active hepatitis B, high doses of hepatitis B immunoglubins are administered in liver transplant patients.
Due to both the pharmacological immunosuppression and the immunosuppression of underlying liver disease, vaccinations against vaccination-preventable diseases are highly recommended before and after liver transplantation. Multiple doses of COVID-19 vaccine lead to a continuous increase in antibody response. Predictors of a weaker antibody response are chronic kidney disease and metabolic etiology for liver transplantation. Vaccine hesitancy in transplant recipients is less than in the general population. Vaccinations are preferably administered to the recipient before the transplant, as post-transplant immunosuppression leads to reduced vaccine effectiveness.
Liver transplantation is unique in that the risk of chronic rejection also decreases over time, although the great majority of recipients need to take immunosuppressive medication for the rest of their lives. It is possible to be slowly taken off anti rejection medication but only in certain cases. It is theorized that the liver may play a yet-unknown role in the maturation of certain cells pertaining to the
immune system
The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as Tumor immunology, cancer cells, Parasitic worm, parasitic ...
. There is at least one study by
Thomas E. Starzl's team at the
University of Pittsburgh
The University of Pittsburgh (Pitt) is a Commonwealth System of Higher Education, state-related research university in Pittsburgh, Pennsylvania, United States. The university is composed of seventeen undergraduate and graduate schools and colle ...
which consisted of
bone marrow
Bone marrow is a semi-solid biological tissue, tissue found within the Spongy bone, spongy (also known as cancellous) portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production (or haematopoiesis). It i ...
biopsies taken from such patients which demonstrate genotypic
chimerism in the bone marrow of liver transplant recipients.
Recovery and outcomes
The prognosis following liver transplant is variable, depending on overall health, technical success of the surgery, and the underlying disease process affecting the liver. There is no exact model to predict survival rates; those with transplant have a 58% chance of surviving 15 years. Failure of the new liver (primary nonfunction in liver transplantation or PNF) occurs in 10% to 15% of all cases. These percentages are contributed to by many complications. Early graft failure is probably due to preexisting disease of the donated organ. Others include technical flaws during surgery such as revascularization that may lead to a nonfunctioning graft.
History
As with many experimental models used in early surgical research, the first attempts at liver transplantation were performed on dogs. The earliest published reports of canine liver transplantations were performed in 1954 by Vittorio Staudacher at Ospedale Maggiore Policlinico in Milan, Italy. This initial attempt varied significantly from contemporary techniques; for example, Staudacher reported "arterialization" of the donor portal vein via the recipient hepatic artery, and use of cholecystostomy for biliary drainage.
The first attempted
human
Humans (''Homo sapiens'') or modern humans are the most common and widespread species of primate, and the last surviving species of the genus ''Homo''. They are Hominidae, great apes characterized by their Prehistory of nakedness and clothing ...
liver transplant was performed in 1963 by
Thomas Starzl, although the pediatric patient died intraoperatively due to uncontrolled bleeding.
Multiple subsequent attempts by various surgeons remained unsuccessful until 1967, when Starzl transplanted a 19-month-old girl with
hepatoblastoma who was able to survive for over one year before dying of metastatic disease.
Despite the development of viable surgical techniques, liver transplantation remained experimental through the 1970s, with one year patient survival in the vicinity of 25%. The introduction of
ciclosporin
Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken Oral administration, orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease, nephr ...
by Sir
Roy Calne, Professor of Surgery Cambridge, markedly improved patient outcomes, and the 1980s saw recognition of liver transplantation as a standard clinical treatment for both adult and pediatric patients with appropriate indications. Liver transplantation is now performed at over one hundred centers in the US, as well as numerous centres in Europe and elsewhere.
The limited supply of
liver
The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...
allograft
Allotransplant (''allo-'' meaning "other" in Ancient Greek, Greek) is the Organ transplant, transplantation of cell (biology), cells, Biological tissue, tissues, or Organ (anatomy), organs to a recipient from a genetically non-identical donor of ...
s from non-living donors relative to the number of potential recipients spurred the development of
living donor liver transplantation. The first altruistic living liver donation in Britain was performed in December 2012 in St James University Hospital Leeds.
Society and culture
Famous liver transplant recipients
See also:
:Liver transplant recipients and
List of organ transplant donors and recipients
*
Eric Abidal (born 1979), French footballer (
Olympique Lyonnais,
FC Barcelona
Futbol Club Barcelona (), commonly known as FC Barcelona and colloquially as Barça (), is a professional Football club (association football), football club based in Barcelona, Catalonia, Spain, that competes in La Liga, the top flight of ...
),
transplant in 2012 (survival: 13 years)
*
Gregg Allman
Gregory LeNoir Allman (December 8, 1947 – May 27, 2017) was an American musician, singer and songwriter. He was known for performing in the Allman Brothers Band. Allman grew up with an interest in rhythm and blues music, and the Allman B ...
(1947–2017), American musician (
The Allman Brothers Band
The Allman Brothers Band was an American rock music, rock band formed in Jacksonville, Florida, in 1969. Its founding members were brothers Duane Allman (slide guitar, lead guitar) and Gregg Allman (vocals, keyboards), as well as Dickey Betts ( ...
),
transplant in 2010 (survival: 7 years)
*
George Best
George Best (22 May 1946 – 25 November 2005) was a Northern Irish professional association football, footballer who played as a winger (association football), winger, spending most of his club career at Manchester United F.C., Manchester Un ...
(1946–2005), Northern-Irish footballer (
Manchester United
Manchester United Football Club, commonly referred to as Man United (often stylised as Man Utd) or simply United, is a professional association football, football club based in Old Trafford (area), Old Trafford, Greater Manchester, Engl ...
),
transplant in 2002 (survival: 3 years)
*
David Bird (1959–2014), American journalist (''
The Wall Street Journal
''The Wall Street Journal'' (''WSJ''), also referred to simply as the ''Journal,'' is an American newspaper based in New York City. The newspaper provides extensive coverage of news, especially business and finance. It operates on a subscriptio ...
''),
transplant in 2004 (survival: 10 years)
*
Jack Bruce (1943–2014), Scottish musician (
Cream
Cream is a dairy product composed of the higher-fat layer skimmed from the top of milk before homogenization. In un-homogenized milk, the fat, which is less dense, eventually rises to the top. In the industrial production of cream, this proces ...
),
transplant in 2003 (survival: 11 years)
*
Frank Bough (1933–2020), English television presenter,
transplant in 2001 (survival: 19 years)
*
Robert P. Casey (1932–2000), American politician (
42nd Governor of Pennsylvania),
transplant in 1993 (survival: 7 years)
*
David Crosby
David Van Cortlandt Crosby (August 14, 1941 – January 18, 2023) was an American singer, songwriter, and guitarist. He first found fame as a member of the Byrds, with whom he helped pioneer the genres of folk rock and psychedelic music, psych ...
(1941–2023), American musician (
The Byrds
The Byrds () were an American Rock music, rock band formed in Los Angeles, California, in 1964. The band underwent multiple lineup changes throughout its existence, with frontman Roger McGuinn (known as Jim McGuinn until mid-1967) being the so ...
,
Crosby Stills, Nash (& Young)),
transplant in 1994 (survival: 28 years)
*
Gerald Durrell
Gerald Malcolm Durrell Order of the British Empire, OBE (7 January 1925 – 30 January 1995) was a British naturalist, writer, zookeeper, conservation movement, conservationist, and television presenter. He was born in Jamshedpur in British Ind ...
(1925–1995), British zookeeper (
Durrell Wildlife Park),
transplant in 1994 (survival <1 year)
*
Vaughn Eshelman (1969–2018), American Major League Baseball pitcher (
Boston Red Sox
The Boston Red Sox are an American professional baseball team based in Boston. The Red Sox compete in Major League Baseball (MLB) as a member club of the American League (AL) American League East, East Division. Founded in as one of the Ameri ...
),
transplant in 2018 (survival <6 months)
*
Shelley Fabares (born 1944), American actress (''
The Donna Reed Show'', ''
Coach'') and singer ("
Johnny Angel"),
transplant in 2000 (survival: 25 years)
*
Freddy Fender (1937–2006), American musician ("
Before the Next Teardrop Falls," "
Wasted Days and Wasted Nights"),
transplant in 2004 (survival: 2 years)
*
"Superstar" Billy Graham (1943–2023), American wrestler (
WWF),
transplant in 2002 (survival: 20 years)
*
Larry Hagman
Larry Martin Hagman (September 21, 1931 – November 23, 2012) was an American actor, best known for playing ruthless oil baron J. R. Ewing in the 1978–1991 primetime television soap opera ''Dallas'', and the handsome astronaut Major Anthon ...
(1931–2012), American actor (''
Dallas
Dallas () is a city in the U.S. state of Texas and the most populous city in the Dallas–Fort Worth metroplex, the List of Texas metropolitan areas, most populous metropolitan area in Texas and the Metropolitan statistical area, fourth-most ...
'', ''
Harry and Tonto'', ''
Nixon'', ''
Primary Colors''),
transplant in 1995 (survival: 17 years)
*
Dahlan Iskan (born 1951), Indonesian minister,
transplant in 1987 (survival: 38 years)
*
Steve Jobs
Steven Paul Jobs (February 24, 1955 – October 5, 2011) was an American businessman, inventor, and investor best known for co-founding the technology company Apple Inc. Jobs was also the founder of NeXT and chairman and majority shareholder o ...
(1955–2011), American businessman (
Apple Inc.
Apple Inc. is an American multinational corporation and technology company headquartered in Cupertino, California, in Silicon Valley. It is best known for its consumer electronics, software, and services. Founded in 1976 as Apple Comput ...
),
transplant in 2009 (survival: 2 years)
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Chris Klug (born 1972), American snowboarder,
transplant in 2000 (survival: 25 years)
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Evel Knievel
Robert Craig Knievel (October 17, 1938November 30, 2007), known professionally as Evel Knievel (), was an American stunt performer and entertainer. Throughout his career, he attempted List of Evel Knievel career jumps, more than 75 ramp-to-ra ...
(1938–2007), American stunt performer,
transplant in 1999 (survival: 8 years)
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Chris LeDoux (1948–2005), American musician and rodeo champion,
transplant in 2000 (survival: 5 years)
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Kyung Won Lee (born 1928-2025), Korean-American journalist,
transplant in 1992 (survival: 33 years)
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Phil Lesh (1940–2024), American musician (
Grateful Dead
The Grateful Dead was an American rock music, rock band formed in Palo Alto, California, in 1965. Known for their eclectic style that fused elements of rock, blues, jazz, Folk music, folk, country music, country, bluegrass music, bluegrass, roc ...
),
transplant in 1998 (survival: 16 years)
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Linda Lovelace (1949–2002), American pornographic actress (''
Deep Throat''),
transplant in 1987 (survival: 15 years)
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Mickey Mantle (1931–1995), American baseball player (
New York Yankees
The New York Yankees are an American professional baseball team based in the Boroughs of New York City, New York City borough of the Bronx. The Yankees compete in Major League Baseball (MLB) as a member club of the American League (AL) Am ...
),
transplant in 1995 (survival: <1 year)
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Mike MacDonald (1954–2018), Canadian comedian and actor (''
Mr. Nice Guy''),
transplant in 2013 (survival: 5 years)
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Jim Nabors (1930–2017), American actor (''
The Andy Griffith Show''),
transplant in 1994 (survival: 23 years)
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John Phillips (1935–2001), American musician (
The Mamas & the Papas),
transplant in 1992 (survival: 9 years)
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James Redford (1962–2020), American documentary filmmaker and environmentalist,
transplant in 1993 (survival: 27 years)
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Lou Reed
Lewis Allan Reed (March 2, 1942October 27, 2013) was an American musician and songwriter. He was the guitarist, singer, and principal songwriter for the rock band the Velvet Underground and had a solo career that spanned five decades. Althoug ...
(1942–2013), American musician (
The Velvet Underground
The Velvet Underground were an American Rock music, rock band formed in New York City in 1964. Its classic lineup consisted of singer and guitarist Lou Reed, Welsh multi-instrumentalist John Cale, guitarist Sterling Morrison, and percussionis ...
),
transplant in 2013 (survival: <1 year)
*
Sam Rivers (born 1977), American bassist (
Limp Bizkit
Limp Bizkit is an American nu metal band from Jacksonville, Florida. Its lineup consists of lead vocalist Fred Durst, drummer John Otto (drummer), John Otto, guitarist Wes Borland, turntablist DJ Lethal and bassist Sam Rivers (bassist), Sam ...
),
transplant in 2015 (survival: 10 years)
*
U. Srinivas (1969–2014), Indian musician,
transplant in 2014 (survival: <1 year)
*
Mike IX Williams (1968), American vocalist and songwriter (
Eyehategod),
transplant in 2016 (survival: 9 years)
Research directions
Cooling
There is increasing interest in improving methods for allograft preservation following organ harvesting. The standard "static cold storage" technique relies on flushing a liver with a preservation solution and then placing it in static cold storage at a decreased temperature (usually 4 degrees Celsius) to slow down anaerobic metabolic breakdown.
An alternative method involves machine perfusion, in which oxygenated, preservation solutions are continually pumped through the liver prior to transplantation. This is currently being investigated with cold (hypothermic), body temperature (normothermic), and under body temperature (subnormothermic) preservation solutions. Hypothermic machine perfusion has been used successfully at Columbia University and at the University of Zurich. A randomized controlled clinical trial comparing normothermic machine preservation with conventional cold storage showed less donor liver injury, less discarded donor livers (due to suboptimal condition), better early function, and longer preservation times compared with static cold stored livers. Graft survival and patient survival after transplant were similar with both approaches. Machine perfusion prior to transplant is associated with decreased tissue re-perfusion ischemic injury (a process in which liver cells are damaged as a statically stored liver is re-perfused after transplant) as well as a decreased risk of intrahepatic biliary strictures.
A 2014 study showed that the liver preservation time could be significantly extended using a supercooling technique, which preserves the liver at subzero temperatures (-6 °C)
Normothermic Regional Perfusion
Donation after circulatory death (DCD) has become an increasingly important source of organs for transplantation, with categories ranging from uncontrolled to controlled DCD () donors. Despite its growing use, DCD organs generally suffer from warm ischemia injuries, leading to fewer and lower-quality organs compared to those from donation after brain death (DBD).
To mitigate these issues, there has been a rising interest in normothermic regional perfusion (NRP), a technique that temporarily restores oxygenated blood flow to organs after death, thereby improving their viability prior to recovery.
NRP works by reversing the detrimental effects of warm ischemia on cellular energy substrates and antioxidants, thereby reconditioning the organs before transplantation. This technique, often facilitated by extracorporeal membrane oxygenation (ECMO) technology, allows for organ assessment and optimization, reducing the risk of graft failure.
NRP can be established either abdominally or thoracoabdominally, depending on the intended organs for transplantation, with specific techniques and monitoring protocols in place to ensure optimal outcomes.
Clinical outcomes of NRP in DCD organ transplantation have shown promising results, particularly in kidney and liver transplantation, with lower rates of complications and improved graft survival compared to traditional preservation methods.
Through the utilization of NRP,
Dr. Fondevila et al. at
Hospital Universitario La Paz have achieved successful transplantation of livers that have undergone extensive warm ischemic periods of up to 2.5 hours prior to recovery. This has resulted in biliary complication and graft survival rates comparable to those observed in controlled DCD livers that have experienced significantly less warm ischemia.
While ethical considerations remain, especially regarding the use of NRP in controlled DCD scenarios, ongoing research aims to address these concerns and expand the application of NRP to other organ types, ultimately increasing the availability of viable organs for transplantation and improving outcomes for patients with end-stage organ disease
Herpesvirus 6 Reactivation
A study published in ''The Journal of Infectious Diseases'' in 2024 investigated the reactivation of inherited chromosomally integrated human herpesvirus 6 (iciHHV-6B) in a liver transplant recipient and its impact on the graft. The research, conducted by Hannolainen et al., utilized hybrid capture sequencing and various molecular techniques to analyze the viral sequences and host immune response. The findings demonstrated active replication of iciHHV-6B within the graft tissue and significant immune activation, suggesting the pathological impact of viral reactivation on transplant outcomes. The study highlights the importance of monitoring iciHHV-6 reactivation in liver transplant recipients.
Special populations
Alcohol dependence
The high incidence of liver transplants given to those with alcoholic
cirrhosis
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, chronic liver failure or chronic hepatic failure and end-stage liver disease, is a chronic condition of the liver in which the normal functioning tissue, or parenchyma, is replaced ...
has led to a recurring controversy regarding the eligibility of such patients for liver transplant. The controversy stems from the view of
alcoholism
Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...
as a self-inflicted disease and the perception that those with alcohol-induced damage are depriving other patients who could be considered more deserving. It is an important part of the selection process to differentiate transplant candidates who have alcohol use disorder as opposed to those who were susceptible to non-dependent alcohol use. The latter who gain control of alcohol use have a good prognosis following transplantation. Once a diagnosis of alcoholism has been established, however, it is necessary to assess the likelihood of future sobriety.
HIV
Historically, HIV was considered an absolute contraindication to liver transplantation. This was in part due to concern that the infection would be worsened by the immunosuppressive medication which is required after transplantation.
However, with the advent of highly active antiretroviral therapy (HAART), people with HIV have much improved prognosis. HIV controlled with HAART is no longer a contraindication to liver transplantation.
Uncontrolled HIV disease (AIDS) remains an absolute contraindication.
Medical cannabis
Medical criteria for transplant often require "lack of substance abuse". The changing status of cannabis has resulted in many patients who never abused any substancemerely used oneeither being turned down for transplants, forced to stop a useful medicine suggested by their doctors, or both.
For example, in 2011,
Cedars-Sinai Medical Center
Cedars-Sinai Medical Center is a non-profit, Tertiary referral hospital, tertiary, 915-bed teaching hospital and multi-specialty academic health science centre, academic health science center located in Los Angeles, California. Part of the Cedars ...
denied a liver transplant to
medical cannabis
Medical cannabis, medicinal cannabis or medical marijuana (MMJ) refers to cannabis products and cannabinoid molecules that are prescribed by physicians for their patients. The use of cannabis as medicine has a long history, but has not ...
patient Norman Smith. They removed Mr. Smith from a transplant waiting list for "non-compliance of our substance abuse contract", despite his own oncologist at Cedars-Sinai having recommended that he use the cannabis for his pain and chemotherapy. Dr. Steven D. Colquhoun, director of the Liver Transplant Program, said that the hospital "must consider issues of substance abuse seriously", but the transplant center did not seriously consider whether Mr. Smith was "using" cannabis versus "abusing" it. In 2012, Cedars-Sinai denied a liver transplant to a second patient, Toni Trujillo, after her Cedars-Sinai doctors knew and approved of her legal use of medical cannabis. In both cases, the patients acceded to the hospital's demand and stopped using cannabis, despite its therapeutic benefits for them, but were both sent back to the bottom of the transplant list. Smith's death inspired
Americans for Safe Access
Americans for Safe Access (ASA), is a Washington, D.C., based advocacy organization working to ensure safe and legal access to medical Cannabis (drug), cannabis
References
{{authority control
Drug policy organizations based in the Uni ...
to lobby for the California Medical Cannabis Organ Transplant Act (AB 258), which was enacted in July 2015 to protect future patients from dying at the hands of medical establishments prejudiced against the legal use of medical cannabis.
References
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Further reading
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External links
UNOS: United Network of Organ Sharing, U.S.American Liver FoundationHistory of pediatric liver transplantation!--do we need a separate listing for pediatric liver transplantation?-->
Liver Donation Surgery and RecoveryFacts about Liver TransplantationChildren's Liver Disease FoundationThe Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Living Donor Right Lobe Liver Transplant video (recipient)The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Living Donor Left Lateral Lobe Liver Transplant video (donor)The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Living Donor Right Posterior Sectionectomy (Segments 6/7) Liver Transplant video (donor)
{{DEFAULTSORT:Liver Transplantation
Accessory digestive gland surgery
Hepatology
Organ transplantation