Hepatitis C and liver transplant: Criteria and procedure

According to current practice guidelines, the criteria for a liver transplant require a person to:

• have irreversible liver disease that would be fatal without a transplant
• have no contraindications for the transplant surgery
• pass an extensive transplant evaluation process

Complications resulting from a chronic HCV infection, such as chronic liver disease and liver cancer, are common reasons why a person may require a liver transplant in the U.S.

Cirrhosis occurs when scar tissue eventually replaces the liver’s healthy tissue. This stops the liver from working normally. According to the CDC, approximately 50% of liver cancers in the U.S. are related to HCV. Evidence also indicates that HCV accounts for roughly 700,000 deaths per year because of cirrhosis or liver cancer.

A person with hepatitis C must be healthy enough to undergo liver transplant surgery. A person is not eligible for a liver transplant if they have any of these contraindications:

Other situations might make a person ineligible for a liver transplant. Transplant centers may consider these conditions on a case-by-case basis. Examples include:

Each individual receives extensive testing to determine if they are healthy enough for the surgery and post-transplant care. The evaluation may include:

• a complete history and physical exam to determine other existing medical concerns
• a thorough review of the individual’s current liver disease to determine their prognosis without a transplant
• screenings for any liver disease complications, such as esophageal varices and hepatocellular carcinoma
• thorough heart and lung evaluations
• blood work
• cancer screenings
• screening and treatment for any bacterial, viral, and/or fungal infection
• vaccination updates, if necessary, for pneumonia, flu, DPT, and human papillomavirus (HPV)
• bone density testing
• anesthesia evaluation
• mental health and social support screening
• nutritional evaluation

To try and prevent any potential complications prior to a liver transplant, a person will work with their healthcare team to treat any underlying conditions and ensure they are receiving adequate treatment for the HCV infection. For example, this may involve a person with an alcohol or substance use disorder to have clean time prior to the procedure.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a doctor may schedule surgery 4–6 weeks in advance when a person is receiving a living donor’s liver. Once on the national waiting list for a deceased donor’s liver, the person must be ready to go to the transplant center for surgery immediately when a liver matches.

Doctors perform liver transplant surgery by removing the diseased liver and replacing it with the donor liver. The procedure may take up to 8 hours but can last up to 12 hours or longer. The surgeons must reconnect several structures to the new liver to ensure blood flow and allow bile to drain from the liver. These include the inferior vena cava, the portal vein, the hepatic artery, and the bile duct.

After surgery, a person will likely be taken to a recovery room for a few hours before the healthcare team transfers them to the intensive care unit (ICU). The healthcare team will monitor the transplant recipient closely for several days. Most transplant recipients will stay in the hospital for about 2 weeks.

Click here to learn more about organ transplants.

A transplant recipient needs lifelong outpatient follow-up after receiving a new liver. The transplant treatment team may use a combination of in-person appointments, phone, and video conferences. They will perform routine blood work and checkups on the transplant recipient to:

• detect and treat any transplant complications, such as organ rejection
• review immunosuppressant medication compliance and side effects
• support the transplant recipient and their caregivers

Suggestions to help take care of a new liver may include:

• taking all prescribed medications according to the doctor’s directions, especially immunosuppressive medications
• talking with a doctor before taking any new prescription, over-the-counter medicines, or dietary supplements
• protecting the immune system
• discussing the use of contraceptives and potential risks of pregnancy
• having regular cancer screenings
• recognizing potential symptoms of organ rejection
• staying up to date with vaccines but avoiding live vaccines

Even though most people can resume some activities after a few weeks, the National Health Service in the United Kingdom states it can take up to a year to recover from a liver transplant.

For people receiving liver transplants from deceased donors, the average survival rates listed by the NIDDK are:

• 86% at 1 year
• 78% at 3 years
• 72% at 5 years
• 53% at 20 years

A person’s life expectancy after a liver transplant depends on their overall health and other factors, such as:

• age at time of transplant
• other existing health conditions
• kidney health
• adherence to post-transplant treatment and follow-up

People with untreated chronic HCV infections may eventually develop complications of the liver, such as cirrhosis or cancer. In cases of severe liver damage, a doctor may recommend a liver transplant. Without this treatment, HCV-related liver failure can be life threatening.

After an evaluation, a person may be eligible for a transplant. Until a donor organ is available, they will need to try and maintain their health. Surgery involves replacing the damaged liver with the donor organ, and it can take up to a year for a person to make a full recovery. They will then require regular checkups to ensure the person remains in good health.