How long will my liver last after transplantation?

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After undergoing liver transplantation, the expectation is that your liver will last for the rest of your life. It has been said that the liver does not age. That explains why it is perfectly acceptable to put a 70-year-old cadaveric donor liver into a 30-year-old recipient. This adage reflects a unique property of the liver: It is the only organ that is capable of regeneration. In other words, damaged liver cells are normally replaced by healthy functional cells. This process does not seem to decrease enough during a lifetime to result in a poorly functioning liver attributable only to the aging process.

Recurrence of liver disease (see Question 60) may limit the liver’s ability to function indefinitely in the transplant recipient, however. Other life-limiting factors include conditions common to everyone—for example, heart disease, accidents, stroke, and cancer. To accurately address the question about survival after liver transplantation, several universally accepted milestones have been developed:

• Operative mortality: More than 90% of patients are still alive 30 days after liver transplantation. The reasons for operative mortality include anesthetic complications, excessive bleeding from varices during the operation, postoperative infections, hepatic artery thrombosis, and primary graft nonfunction.

• One-year mortality: More than 85% of patients are still alive 1 year after transplantation. The typical causes of death during this time frame are infections, delayed hepatic artery thrombosis, and bile duct problems resulting in jaundice and infection.

• Three-year mortality: Usually, 70% to 80% of patients are still alive 3 years after transplantation. Causes of death include recurrent disease, bile duct problems, chronic rejection, and, less likely, infections.

• Five-year mortality: Approximately 60% to 70% of patients are still alive 5 years after transplantation. Recurrent disease, chronic rejection, heart disease, and kidney failure are the major causes of death in this group.

• Ten-year mortality: Approximately 45% to 60% of patients are still alive 10 years after transplantation. Recurrent disease, chronic rejection, accidents, heart disease, stroke, kidney problems, and other cancers are the primary causes of death.

Note that after 10 years approximately 50% of liver transplant recipients are still alive. To have assessed this group for survival, by definition they must have been transplanted in the early 2000s. Since that time we have seen many advances in surgical techniques, postoperative care, ICU care, and immunosuppression. Additionally, transplant physicians have become more aware of long-term complications and, therefore, manage these problems more aggressively than in the past. It is expected that liver transplant recipients from the 2010s will have better long-term survival than their counterparts from the 1990s and 2000s.

You need time to regain your strength and endurance after your transplant, but eventually your activity level should get back to normal. It may take anywhere from 6 weeks to 6 months before you regain enough strength to return to work or to school. It might be possible to reduce your hours when you first return to work. Follow these guidelines when you get home:

• Do the muscle-toning exercises that you began in the hospital two times every day.

• Do not lift anything that weighs more than 10 to 15 pounds—including babies, children, and groceries— until you have been home from the hospital for 2 months. After 2 months you may gradually begin to lift heavier items if it does not cause discomfort around your incision.

• Walking and stair climbing are excellent exercises for maintaining muscle tone and strength. Consider walking 5 to 10 minutes a day when you first get home, slowly increasing the time you walk each week.

• Do not engage in any strenuous exercise, such as contact sports, jogging, tennis, or body conditioning (weightlifting, push-ups, sit-ups) for at least 2 months after you go home. Talk to your transplant doctor or nurse before you resume these types of activities.

• It is normal to tire easily. Pace yourself and rest when you are tired.

• Talk to your transplant team before you make any travel plans. They can help you maintain the routines you need to follow when you are away and instruct you on what to do if you need medical attention. They also can give you guidelines that will help you avoid infection and other problems when you are away from home.

You can resume sexual activity as soon as you feel able; there are no restrictions. Because you have been through a difficult surgery and are still recovering, it may take several months for your level of sexual desire to return to what you and your partner consider acceptable. Some medicines you are taking might also interfere with sexual functioning. Talk to your transplant team or primary care physician about any problems or concerns you may have. If you are sexually active and do not have a regular partner, you should practice safe sex by using condoms to reduce your risk of sexually transmitted diseases, such as chlamydia, syphilis, herpes, hepatitis, gonorrhea, and AIDS.

The following are things you can do (or avoid doing) to decrease your chance of an infection developing. Your transplant doctor or nurse will tell you when some of these restrictions may be lifted:

• Stay away from people who are obviously sick with the flu or a cold.

• Wash your hands with soap and water before you eat and after you go to the bathroom.

• Shower or bathe regularly. Wash your incision as you would any other part of your body. Do not use lotions or powders on your incision. 

• Clean cuts and scrapes with soap and water, and apply an antiseptic and a bandage to them.

• Do not, under any circumstances, change the litter in the cat box or bird cage without gloves. This could cause a serious infection.

• Do not garden, dig in dirt, or mow the lawn without gloves for 6 to 8 weeks after your transplant. This could cause a serious infection.

• Brush and floss your teeth daily.

• Keep your fingernails and toenails clean and trimmed. If your toenails are hard to manage or are ingrown, see a foot specialist.

• Talk to your doctor about getting the flu vaccine and the pneumonia vaccine. These do not contain a live virus and are safe for you to receive.

• Do not get any vaccine that contains a live virus, such as the smallpox or polio vaccine.

• Talk to your doctor if someone in your house received a live virus, such as the oral polio vaccine or diphtheria vaccine, if you have not already been vaccinated.

• Do not expose yourself to smoke—either first hand or second hand.

• Do not use alcohol.

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