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Liver transplant for cancer treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was reviewed on February 22, 2022.

If you have liver cancer and your liver is failing, your care team may recommend a transplant. The surgical procedure involves removing the diseased liver and replacing it with a new one. The liver may come from someone who is recently deceased or a living donor who provides a portion of the organ.

Of the almost 400 living-donor liver transplants done in the United States each year, only a few are for patients with liver cancer, according to the American Cancer Society (ACS).

Often, liver cancer patients undergo embolization and/or ablation while they wait for a liver to become available. During embolization, particles are injected into an artery to lower blood flow to the tumor. Ablation is a method that destroys cancer cells and tumors using a needle or probe instead of surgery. Some patients also receive chemotherapy and targeted cancer drugs during their wait for a liver, which can be long.

Liver transplants are performed by a team of experts at a transplant center.

Who might have a liver transplant for liver cancer?

A liver transplant may be an option for those with liver cancer who have small tumors that haven’t grown into nearby blood vessels. You may have one liver tumor smaller than 5 cm in diameter or up to three tumors no larger than 3 cm. You also may be a candidate for a liver transplant if you have a tumor measuring 5 to 7 cm that hasn’t grown for at least half a year.

In a small number of cases, it may be an option for patients with malignant liver tumors that cannot be surgically removed because of where they’re located or because their liver wouldn’t survive if that part of it were surgically removed.

You’re not a candidate if the liver cancer has spread beyond your liver.

To be eligible for a transplant, you can’t smoke or use illegal drugs, and you need to have generally good fitness. Your care team likely will ask you to avoid drinking alcohol for at least six months before the procedure.

To determine whether you’re a candidate, a care team typically conducts an assessment to determine the health of your liver and whether a liver transplant is feasible. The assessment includes liver function tests and an ultrasound of your liver. You may also undergo examinations and tests by a number of different providers to be sure your body can handle the procedure.

Partial liver transplant

It’s possible to have a partial liver transplant, known as a partial hepatectomy. This is most commonly for those who are healthy enough to undergo surgery and who have one tumor that hasn’t spread into nearby blood vessels.

To be eligible for a partial hepatectomy if you have cirrhosis, at least 30 percent of your liver must be able to function normally after the surgery, according to the ACS.

How to prepare for a liver transplant

Your surgery preparation depends on whether you’re getting a liver from a living donor or a deceased donor.

Living donors: If your liver is coming from someone who is living, your care team will schedule the surgeries about four to six weeks out. Your transplant team coordinator can tell you and your donor how to prepare for surgery.

Deceased donor transplant: Computers match donors and recipients according to factors such as blood type and body size. If a liver is found, you’ll be asked to get to the hospital as soon as possible. Your surgery can begin once you and the liver are at the transplant center. You aren’t likely to have a great deal of warning once a suitable liver is found.

In this case, you should plan ahead so that you can be at the hospital within a short time. This includes having a bag packed and making arrangements for children, pets or loved ones in your household who shouldn’t be left alone for a long time.

Once you arrive at the hospital for your transplant, you will undergo testing to make sure you don’t have any infections and that your kidneys are functioning. This usually includes a chest X-ray, blood tests and an echocardiogram.

Your care team checks your vital signs including temperature, blood pressure and breathing rate.

You also meet with the anesthetist who will administer your anesthesia so that you feel no pain during the surgery. The anesthetist may set you up with a pain pump to administer medications during and after your surgery. The pump is attached to a small tube in your back that goes into the fluid around your spinal cord.

You may be given compression stockings to wear in the operating room to help prevent blood clots from forming.

A nurse or physiotherapist may show you some breathing exercises and leg exercises to do to help prevent blood clots and help ward off infections after surgery.

What to expect during surgery

You’ll be given general anesthesia so that you don’t feel any pain. An intravenous (IV) line will be inserted so that you can receive medications and fluids during surgery. You’ll be attached to heart monitors and to a blood pressure monitor.

The surgeon will make a large cut in your upper abdomen, remove the diseased liver and replace it with a healthy liver or portion of liver. The replacement liver has to be attached to your blood vessels and bile ducts.

The surgery is complex and can take up to 12 hours. You likely will need to be given large volumes of blood during the procedure. Your incision will be closed with metal clips or staples.

After the surgery

You may need to remain hospitalized for one to four weeks after a liver transplant.

When you awake, you’ll likely have tubes attached to you, along with drains to remove any blood, bile or fluid that can build up around the site of your incision. Drains are typically removed within a few days.

You may have a tube down your nose to drain bile and prevent you from feeling sick to your stomach, and you may still have an oxygen mask to help your breathing.

A dressing will cover the site of your incision. The staples or metal clips are removed after 10 to 14 days.

You’ll be able to eat and drink as soon as you can tolerate it.

It’s important that you get up and walk, as movement may help speed your recovery.

Your care team will perform blood tests every day to make sure your new liver is functioning properly. You also may have to undergo a liver biopsy at some point.

If you had a transplant from a living donor, the donor’s liver should grow back in a short time after surgery. Your partial liver should also grow to a normal size.

It can take a few months until you’re able to resume normal activities, and you’ll need to be monitored closely.

To prevent your body from rejecting your new organ, you’ll take medications to suppress your immune system. You’ll likely need to take these medications for the rest of your life.

Because you must take immunosuppressants, it’s important that you:

  • Stay away from anyone who is sick
  • Avoid crowds
  • Wash your hands frequently
  • Don’t eat raw meat
  • Take your medications as directed; be sure you check with your pharmacist on the most appropriate way to store your medicines

Risks of liver transplant

A liver transplant is major surgery and carries with it a number of possible risks, including:

  • Blood loss: You can have bleeding internally or externally, and especially if a wound doesn’t close properly.
  • Blood clots: Some people develop blood clots in the deep veins of their legs. The clots can pose a threat if they travel to other parts of your body such as your lungs.
  • Bile duct damage: The tubes that carry bile from your liver to your gallbladder may be damaged during surgery.
  • Infection: You must take strong immunosuppressants to prevent your body from rejecting your new liver. They can weaken your immune system and make you susceptible to serious infections.
  • Cancer spread: Because your immune system is weakened from the immunosuppressants, any cancer you had outside your liver may grow faster than before your transplant. You also are at risk of developing a new unrelated cancer or a second cancer.

Your immunosuppressants may also cause:

  • High blood pressure
  • High cholesterol
  • Diabetes

You can develop complications from the surgery, including from an adverse reaction to the anesthesia. Some pain after surgery is normal, and it can be treated with pain medications.

Your body may reject the new liver, so your blood will be tested regularly. If it appears that you are, you may undergo a biopsy to determine whether you need a different drug regimen.

Benefits of a liver transplant for liver cancer

Patients who undergo a liver transplant greatly reduce their risk of developing a second new liver cancer. And if the transplant is successful, you have a new liver that functions normally.

The long-term success of your liver transplant depends on your cancer and your overall health. According to the Organ Procurement and Transplantation Network, the survival rates for patients who had liver transplants from deceased donors from 2008 to 2015 were:

  • After one year: 89.1 percent
  • After three years: 80 percent
  • After five years: 71.8 percent

During that same time period, the survival rates for those who received a liver from a living donor were:

  • After one year: 88 percent
  • After three years: 82 percent
  • After five years: 77.3 percent

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