The operation

A liver transplant takes around between six and ten hours on average. Removing your diseased liver is the most difficult part of the operation. This is due to the risk of developing a serious haemorrhage from a combination of portal hypertension, defective clotting and the defective dissolving of clots (fibrinolysis). Improvements in surgical techniques and anaesthesia have resulted in large reductions in blood loss, and the average requirement for transfusion is now four units of blood. After the operation you will spend several days in intensive care and then a few weeks in hospital recovering from the operation. For the first two months after the operation your liver functions tests will be checked regularly and you will be checked for any signs of rejecting your new liver.

The shortfall in donor livers has resulted in the development of new techniques to make the most use of the livers available. At present they only account for a small percentage of transplants. Most transplants are still whole liver transplants from dead donors.

Split livers
Since the liver can regenerate, the liver from a dead person can be split into two pieces and transplanted into two recipients, where each piece will grow into a fully functioning organ. Split liver transplants produce the best results when the larger right lobe is given to an adult and the smaller left lobe goes to a child. In some cases, split liver transplants may be appropriate for two adults, depending on donor and recipient size. The number of split liver operations is still low. They may become more widely used if ways to accelerate liver regeneration can be developed. Split liver transplants carry higher risk of biliary complications, possibly because bile ducts are more likely to be heavily damaged when the liver is divided.

Liver reduction techniques
This is similar to splitting a liver except that one of the lobes is not used. Liver reduction techniques were developed to overcome a shortage of size matched livers for young children. By successfully being able to cut down livers from large donors to make them suitable for transplanting in small children it has increased the potential donor pool.

Auxiliary Liver Transplants
This is one of the most recent techniques in liver transplantation. It involves grafting part of a donor liver onto a patients diseased liver to allow it to regenerate. The advantage of this technique is that it offers the possibility of long-term survival without the need for immuno-suppressive drugs. The operation has a success rate similar to the standard liver transplant. It appears that in around 80% of those who survive the operation the native liver does regenerate. About two thirds of patients can be tapered off immunosuppressive drugs after two years. When the immunosuppressant drugs are stopped the body then rejects the auxiliary graft and it should just wither away. Between 2001 and 2005, 52 auxiliary transplants were carried out in the UK (mostly at Kings College Hospital in London). Out of the 52, 5 of the operations were on people with post hepatitis C cirrhosis.

Living Donor Transplants
In a living donor transplant, a piece of liver is taken from a live person, usually a relative (although livers do not require close genetic matching like some other organs) and transplanted into the patient where it will grow back to full size. While living donor transplants have the potential to dramatically increase the supply of organs, the procedure is not without risk to the donor. A study in the USA published in 2003 found that 65 of 449 donors (14.5%) experienced at least one complication, including bile leakage, infection, and excessive bleeding and death. There were 31 living donor transplants in the UK between 2001 and 2005. 5 of these were for HCV-induced cirrhosis.

In the USA transplant survival rates amongst HCV patients have been significantly lower for those who received livers from living donors. It is now thought that this is due to the complexity of the operation and the surgical teams lack of experience in performing this type of transplant. In units with greater experience of the operation survival rates were similar to those who received livers transplanted from people were dead (cadaveric transplantations).