Liver Transplant: Who Qualifies, Surgery, Recovery and Survival
Updated: 7 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer: What is a liver transplant?
A liver transplant is major surgery that replaces a diseased liver with a healthy whole or partial liver from a deceased or living donor. It is usually a last resort for liver failure or liver cancer. About 90% of people survive at least one year, and about 73% are alive after five years. [1]
What the research says
Living-donor livers are linked to better survival in adults. A pooled analysis of 19 studies comparing 4,571 living-donor and 66,826 deceased-donor transplants found 13% lower 5-year mortality with a living donor (HR 0.87), shorter waits and less rejection, but about twice the risk of bile duct problems (OR 2.14). (Barbetta et al., American Journal of Transplantation, 2021) [2]
About 1 in 5 people return to alcohol after a transplant for alcohol-related liver disease. Across 92 studies with more than 8,000 patients, 22% drank again and 14% returned to heavy drinking over about 4 years. Psychiatric conditions (OR 3.46) and less than 6 months of abstinence before transplant (OR 2.76) were the strongest risk factors. (Chuncharunee et al., BMC Gastroenterology, 2019) [3]
Key takeaways
A liver transplant is considered when the liver can no longer keep the body alive, most often because of acute or chronic liver failure or liver cancer. [1]
Candidates go on a national waiting list and are matched by blood type, body size, location and how urgently they need a liver. [1]
Surgery can take up to 12 hours, followed by several days in intensive care and one to three more weeks in the hospital. [1]
Anti-rejection medicines are needed for life, and they raise the risk of infection and some other health problems. [1]
Most people return to work within about three months and to all activities within six to 12 months. [1]
Who needs a liver transplant?
A liver transplant is usually a last resort for people whose liver can no longer support the body. Doctors consider it for these conditions: [1]
Acute liver failure: the liver becomes very sick very quickly.
Chronic liver failure: scarring from cirrhosis slowly stops the liver from working.
Primary liver cancer: such as hepatocellular carcinoma or cholangiocarcinoma (bile duct cancer).
Cancer that has spread to the liver: for example, from colorectal cancer.
The four main stages from referral to going home.
Who may not be able to have a liver transplant?
Some health problems make a transplant too risky or unlikely to succeed. The care team must also be confident you are well enough for surgery and likely to recover. [1]
Condition | Why it matters |
Cancer outside the liver (unless successfully treated) | Cancer could keep growing elsewhere |
Congestive heart failure or severe lung disease | The body may not survive major surgery |
Severe pulmonary hypertension | High pressure in the lung arteries raises surgical risk |
Infections that medicines cannot control | Anti-rejection drugs would make them worse |
Dementia or severe, unmanaged mental illness with psychosis | Lifelong medicines and follow-up are hard to manage |
Active substance use disorder | It can damage the new liver |
Sources: [1]
How does the liver transplant waiting list work?
Your doctor refers you to a transplant hospital, where a team of specialists decides whether you are a good candidate. Each hospital has its own criteria. If you are accepted, you join the national waiting list run by the United Network for Organ Sharing (UNOS). [1]
A donor liver is matched to you based on: [1]
A compatible blood type, which helps prevent rejection
A similar height and weight, so the liver fits (children can receive a small part of an adult liver)
Living in the same region, so the liver arrives in time
How urgently you need the organ
People with acute liver failure who need a liver right away move to the top of the list. Most people have chronic liver disease, which gets worse more slowly. They are ranked by a MELD score (Model for End-Stage Liver Disease) or, for children, a PELD score. Both come from blood test results. [1]
Far more people need a liver than there are donor organs, and some people die or become too sick for surgery while they wait. [1] A living donor, who gives part of their liver, can shorten the wait. [2] Read more about how organ donation and transplantation work.
How do you prepare for a liver transplant?
When a matching liver is found, the transplant coordinator calls you to come to the hospital right away. Surgery starts once both you and the liver have arrived. [1]
While you wait for surgery, you will: [1]
Have standard screening tests
Meet your surgeon and your anesthesiologist
Have family or friends nearby, who will get updates during the operation
Before you are listed, your team may also run tests such as a liver biopsy to understand your liver disease.
What happens during a liver transplant?
A liver transplant is major surgery under general anesthesia and can take up to 12 hours. [1]
You will have several tubes and lines, including IV lines in your arm or hand and in your neck or thigh, a breathing tube connected to a ventilator, drainage tubes in your abdomen, a nasogastric tube and a urinary catheter. [1]
The main steps are: [1]
A long incision is made across the abdomen to reach the liver.
The liver is freed from the ligament that attaches it to the abdominal wall.
Clamps are placed on the bile ducts and blood vessels connected to the liver.
The diseased liver and gallbladder are removed.
The new liver is placed and connected to your blood vessels and bile ducts.
The incision is closed, and you move to recovery.
Liver transplant at a glance
Item | Typical detail |
Anesthesia | General (you are asleep) |
Operating time | Up to 12 hours |
Intensive care stay | Several days |
Further hospital stay | 1 to 3 weeks |
Scar | 6 to 12 inches (15 to 30 cm), across the abdomen or V-shaped |
Return to work | Within about 3 months |
Return to all activities | 6 to 12 months |
Sources: [1]
How long does recovery from a liver transplant take?
Full recovery from a liver transplant can take up to 12 months. [1]
Typical recovery milestones after a liver transplant.
In intensive care, you get fluids and nutrition through an IV until you can handle liquids and solid food, plus pain medicine as needed. Blood tests check how the new liver is working, and the team manages your blood sugar, blood volume, electrolytes and fluids. [1]
On a regular ward, once your vital signs are stable and the liver works well, you stay another one to three weeks. Before you go home, the team teaches you about wound care, your medicines, checking your blood pressure and pulse, spotting infection and when to call. [1]
At home, you will have frequent follow-up visits. Most people return to work within three months and to all activities within six to 12 months. Your scar may be red or brown and raised at first, and it may fade over time. [1]
What medicines are needed after a liver transplant?
After a transplant, you take immunosuppressants (anti-rejection medicines) for the rest of your life. Doses usually start high and are lowered to a maintenance dose over time. Regular blood tests guide changes to your dose. [1]
Medicine group | Examples |
Corticosteroids | Methylprednisolone, prednisone |
Monoclonal antibodies | Basiliximab |
Calcineurin inhibitors | Cyclosporine, tacrolimus |
Antimetabolites | Mycophenolate mofetil, azathioprine |
mTOR inhibitors | Sirolimus, everolimus |
Sources: [1]
These medicines stop your immune system from attacking the new liver, but they also make you more prone to infection. Possible side effects include high blood sugar and type 2 diabetes, high blood pressure, a higher risk of some cancers, and kidney disease or kidney failure, especially if your kidneys were already damaged. [1]
What are the risks of a liver transplant?
The main benefit of a liver transplant is that it can save the life of someone whose liver has failed. Like any major surgery, it also carries risks. [1]
Risk | What it means |
Bile leak | Bile escapes from the new bile duct connection |
Blood clots in the new liver | Rare, but needs treatment right away |
Heavy bleeding | Livers bleed easily and liver disease can make it worse; a transfusion or more surgery may be needed |
Infection | More likely because anti-rejection drugs weaken the immune system |
New liver does not work | About 5% of donor livers fail to work well, and another transplant is needed quickly |
Ongoing rejection | About 5% of people keep having rejection episodes despite treatment, which can lead to liver failure |
Sources: [1]
If you need surgery on part of the liver rather than a full replacement, see our guide to hepatectomy (liver resection). For bleeding caused by high pressure in the liver's veins, a TIPS procedure is sometimes used while people wait for a transplant.
What is the outlook after a liver transplant?
Average survival after a liver transplant.
About 90% of people survive at least one year after a liver transplant, about 73% are alive after five years, and nearly 65% are alive after 10 years. Some people live for decades. [1]
Your own outlook depends on: [1]
Your age and overall health at the time of surgery
Any other health conditions you already have
Complications or side effects from your medicines
The condition that led to your transplant
To protect your new liver, avoid alcohol completely, stop smoking, eat a liver-friendly diet (a dietitian can help) and add light physical activity. Wash your hands often, avoid sick people and crowds when you can, and ask which vaccines are safe for you. Take every medicine exactly as prescribed, never skip a dose, and check with your team before starting any new medicine or supplement. [1] Support for alcohol use matters, because returning to drinking is common after a transplant for alcohol-related liver disease. [3]
When should you call your doctor after a liver transplant?
Call your transplant team right away if you notice any of these signs: [1]
Belly (abdominal) pain or chest pain
Fever
Unusual tiredness
Passing less urine than usual
Severe headache
Shortness of breath
Vomiting
Yellowing of the skin or eyes
Conclusion
A liver transplant can give people with liver failure or liver cancer a second chance at life. Most people survive the first year, and many live for decades with their new liver. [1]
Success depends on careful matching, lifelong anti-rejection medicines, regular follow-up and quick action on warning signs. If you or a loved one has advanced liver disease, ask your doctor whether a referral to a transplant center is right for you.
Keep learning: Explore our guide to acute liver failure to understand when a transplant is needed urgently, or read about liver cancer and its treatment options.
FAQ
What is a liver transplant?
A liver transplant is surgery that replaces a diseased liver with a healthy whole or partial liver from a deceased or living donor. It is usually a last resort for liver failure or liver cancer.
Who needs a liver transplant?
People with acute liver failure, chronic liver failure from cirrhosis, primary liver cancer or some cancers that have spread to the liver may need a liver transplant.
How does the liver transplant waiting list work?
Candidates join a national waiting list and are matched by blood type, body size, region and urgency. People with chronic liver disease are ranked by their MELD or PELD score.
How long does liver transplant surgery take?
Liver transplant surgery can take up to 12 hours under general anesthesia.
How long will I stay in the hospital after a liver transplant?
Most people spend several days in intensive care, then one to three more weeks on a regular hospital ward.
How long is recovery after a liver transplant?
Most people return to work within about three months and to all activities within six to 12 months.
Do I need medicine for life after a liver transplant?
Yes. Anti-rejection medicines (immunosuppressants) are taken for life to stop the immune system from attacking the new liver.
What are the risks of a liver transplant?
Risks include bile leaks, blood clots in the new liver, heavy bleeding, infection, a donor liver that does not work and rejection.
What is the survival rate after a liver transplant?
About 90% of people survive at least one year, about 73% are alive after five years and nearly 65% are alive after 10 years.
How do I prepare for a liver transplant?
You have standard screening tests to make sure you're ready for the operation, and you meet your surgeon and anesthesiologist to go over the plan and prepare for surgery. [1]
Does a liver transplant hurt, and what anesthesia is used?
A liver transplant is done under general anesthesia, so you are asleep throughout the procedure. [1] After surgery you receive pain medicine as needed. [1]
When should I call my doctor after a liver transplant?
Call right away for abdominal or chest pain, fever, unusual tiredness, passing less urine, severe headache, shortness of breath, vomiting or yellowing of the skin or eyes.
Related Reading
MELD Score: What It Measures, How to Read It and What It Means for a Liver Transplant explains the score used to rate liver disease severity and how urgently a liver transplant is needed.
References
Cleveland Clinic. Liver Transplant: Criteria, Procedure, Recovery & Outlook. Last updated December 1, 2025. https://my.clevelandclinic.org/health/procedures/8111-liver-transplantation
Barbetta A, Aljehani M, Kim M, et al. Meta-analysis and meta-regression of outcomes for adult living donor liver transplantation versus deceased donor liver transplantation. Am J Transplant. 2021;21(7):2399-2412. PMID: 33300241. https://doi.org/10.1111/ajt.16440
Chuncharunee L, Yamashiki N, Thakkinstian A, et al. Alcohol relapse and its predictors after liver transplantation for alcoholic liver disease: a systematic review and meta-analysis. BMC Gastroenterol. 2019;19(1):150. PMID: 31438857. https://doi.org/10.1186/s12876-019-1050-9
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own situation before making decisions about your health. If you think you have a medical emergency, call your local emergency number right away.
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