Liver Transplant For Cirrhosis
Liver transplant for cirrhosis replaces a liver scarred by hepatitis, alcohol, fatty liver or autoimmune disease once it begins to fail, or when a small liver cancer develops. For patients from abroad the new liver comes from a living relative, with both livers regrowing within months. Our transplant team times the operation using the MELD score, evaluates recipient and donor, and follows you once you are back home.
About This Department
When cirrhosis stops responding to treatment, a new liver is the only cure. Timing the transplant well matters as much as the operation.
Liver transplant for cirrhosis replaces a liver scarred beyond repair with a healthy one, from a deceased donor or, in Turkey for most patients, part of a liver donated by a living relative. Cirrhosis ends years of damage. Hepatitis B or C, alcohol, fatty liver disease, autoimmune and bile duct diseases and inherited conditions all lead there. Doctors consider transplant once the liver begins to fail, with fluid in the abdomen, bleeding from swollen veins, confusion or jaundice, or when a small liver cancer develops. In a study of 12,996 patients on the United States waiting list, those who received a transplant had a 79 percent lower risk of death than those still waiting (Merion and colleagues, American Journal of Transplantation, 2005). This page explains the causes and timing, the MELD score, liver cancer in cirrhosis, alcohol-related disease, living and deceased donation, the donor, evaluation, the operation and recovery, life after transplant, and how patients from abroad arrange treatment at Biruni Hospital in Istanbul.
What liver transplant for cirrhosis is
| Cause | How it damages the liver | Note for transplant |
|---|---|---|
| Hepatitis B and C | Years of viral inflammation | Antivirals before and after protect the new liver |
| Alcohol | Direct toxicity | Commitment to lifelong abstinence required |
| Metabolic dysfunction-associated fatty liver disease, MASLD | Fat and inflammation linked to obesity and diabetes | Now among the fastest-growing reasons |
| Autoimmune hepatitis, PBC and PSC | Immune attack on liver cells or bile ducts | Good results, some recurrence possible |
| Wilson disease, hemochromatosis and others | Inherited metabolic disorders | Transplant cures the liver defect |
A transplant does not treat the cause by itself. Hepatitis, alcohol and weight still need control to protect the new liver.
When transplant is needed
| MELD score | Risk without transplant | Usual approach |
|---|---|---|
| Under 15 | Low | Treat the cause and complications, monitor |
| 15 to 25 | Rising | Transplant evaluation and listing |
| Over 25 | High | Transplant as soon as possible |
Survival benefit increased with increasing MELD score. At lower MELD scores, recipient mortality risk during the first post-transplant year was higher than for candidates still waiting (Merion and colleagues, 2005).
Signs that cirrhosis is failing
- Fluid in the abdomen, called ascites, that returns after drainage.
- Vomiting blood or black stools from bleeding swollen veins, called varices.
- Confusion, sleepiness or personality change from toxins the liver no longer clears, called hepatic encephalopathy.
Why these matter
The first episode of any of these complications marks the move to decompensated cirrhosis. From that point, referral to a transplant center should not wait.
| Complication | What it is | Relevance |
|---|---|---|
| Jaundice | Yellow skin and eyes, rising bilirubin | Raises MELD directly |
| Kidney failure, hepatorenal syndrome | Kidneys fail because of the liver | High short-term risk, needs assessment within days |
| Infection of the ascites fluid | Bacterial peritonitis | Marker of advanced disease |
| Muscle loss and frailty | Malnutrition | Affects recovery after transplant |
Liver cancer in cirrhosis
| Criterion | Limit | Meaning |
|---|---|---|
| One tumor | Up to 5 centimeters | Transplant cures most patients |
| Two or three tumors | Each up to 3 centimeters | Same |
| Spread | No invasion of major vessels, no spread outside the liver | Required in all cases |
Transplant treats both the cancer and the cirrhosis that caused it, which no other treatment can do.
Alcohol-related cirrhosis
Do I need six months without alcohol before transplant?
Early transplant in severe alcoholic hepatitis
The cumulative 6-month survival rate was higher among patients who received early transplantation than among those who did not, 77 percent against 23 percent (Mathurin and colleagues, New England Journal of Medicine, 2011).
Who cannot have a transplant
Some patients arrive too ill. Others, too early.
Active alcohol or drug use, cancer that has spread outside the liver, severe heart or lung disease that would not survive the operation, uncontrolled infection, and inability to take lifelong medicines all rule out transplant, at least for now. Age alone does not, and patients in their late sixties and seventies are transplanted when otherwise fit. Severe obesity and frailty raise the risk. Both may need treatment first, with a dietitian and physiotherapist working over weeks or months to bring the patient to a point where surgery becomes safe enough to proceed. When a patient is not a candidate, the team explains why and what could change that.
Living or deceased donor
| Feature | Deceased donor | Living donor |
|---|---|---|
| Source | Whole liver from a brain-dead donor | Right or left lobe from a healthy relative |
| Waiting time | Depends on MELD and organ supply, can be long | Planned, within weeks of evaluation |
| Availability for patients from abroad in Turkey | Allocated through the national system | Available with a related donor |
Receipt of living donor liver transplantation was associated with an adjusted mortality hazard ratio of 0.56 relative to candidates who did not receive one, and the benefit grew to 0.35 as centers gained experience (Berg and colleagues, Gastroenterology, 2007).
The living donor
Who can donate
| Time | Stage | Activities |
|---|---|---|
| Days 1 to 7 | Hospital stay | Walking from the first days |
| Weeks 2 to 6 | Home recovery | Light activity, no lifting |
| Months 2 to 3 | Liver regrown | Return to work and sport |
How risky is right lobe donation?
The donor mortality rate was 0.2 percent across 11,553 donor operations in 71 programs worldwide (Cheah and colleagues, Liver Transplantation, 2013).
Evaluation
| Test | Purpose | Note |
|---|---|---|
| Blood tests, viruses, blood group | MELD, compatibility, infections | Guides medicines after surgery |
| CT or MRI of the liver | Vessels, tumors, clots in the portal vein | Plans the connections |
| Heart ultrasound and stress test | Fitness for surgery | Coronary scan in older patients |
| Endoscopy | Varices | Banding if needed |
The operation and recovery
| Period | Where | Main focus |
|---|---|---|
| Days 1 to 3 | Intensive care | Breathing, blood flow to the new liver, kidney function |
| Days 4 to 14 | Transplant ward | Walking, eating, medicine levels, drain removal |
| Weeks 2 to 6 | Nearby accommodation | Clinic visits two to three times a week |
After transplant
| Item | Frequency | Purpose |
|---|---|---|
| Immunosuppressants, usually tacrolimus | Daily, for life | Prevent rejection |
| Blood tests | Weekly at first, then monthly, then every three months | Liver function, drug levels, kidneys |
| Screening | Yearly skin checks and cancer screening | Immunosuppression raises some risks |
Missing doses is the commonest preventable reason for losing a transplanted liver.
| Sign | Possible cause | Action |
|---|---|---|
| Fever | Infection or rejection | Call the transplant team the same day |
| Yellow eyes, dark urine, itching | Rejection or bile duct problem | Call the team |
| Vomiting, unable to take medicines | Risk of low drug levels | Call the team at once |
Life with a new liver
Energy returns within months.
Confusion, fluid and jaundice disappear with a working liver, appetite and muscle recover, and the majority return to work within three to six months. Driving resumes once the wound heals and strong painkillers stop. Everyone avoids alcohol for life, whatever the original cause. Exercise, a balanced diet and weight control prevent the diabetes and fatty liver that can affect the new organ. Many travel, work and live for decades after transplant.
For patients from abroad
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Donor rules in Turkey
Patients from abroad receive a liver from a living relative. Turkish law requires the relationship between donor and recipient to be documented before surgery.
Planning the trip
| Document | Purpose | Note |
|---|---|---|
| Family register or birth certificates | Proves the relationship | Apostilled or consular-certified |
| Passports of recipient and donor | Identity | Valid for the whole stay |
| Medical records | Diagnosis, MELD, earlier treatment | Sent before travel |
Cost
| Item | Included | Priced separately |
|---|---|---|
| Evaluation | Recipient and donor tests, consultations | Treatment of problems found, such as dental work |
| Surgery | Both operations, intensive care, hospital stay | Extra procedures for complications, retransplantation |
| After discharge | Clinic visits and tests during the stay | Medicines after return home, accommodation |
References
- Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, Wolfe RA. The survival benefit of liver transplantation. Am J Transplant. 2005;5(2):307-313.
- Berg CL, Gillespie BW, Merion RM, et al. Improvement in survival associated with adult-to-adult living donor liver transplantation. Gastroenterology. 2007;133(6):1806-1813.
- Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018-1026.
- Mathurin P, Moreno C, Samuel D, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med. 2011;365(19):1790-1800.
- Cheah YL, Simpson MA, Pomposelli JJ, Pomfret EA. Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy. A world-wide survey. Liver Transpl. 2013;19(5):499-506.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assistant Professor Ertan EMEK, General Surgery.
Medically reviewed by
Assistant Professor Ertan EMEK
General Surgery
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