Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi, India
Part 5 of 12 in Liver Transplant
Survival Rates After Liver Transplant, and Why It's a Cure, Not Just a Therapy
August 11, 2024
Asked directly about survival rates, Dr. George gave real numbers: more than 90% of liver transplant patients are alive at 1 year, 80-85% at 3 years, more than 75% at 5 years, and 65-70% at 10 years.
Why the liver doesn't have an expiry date
Unlike some transplanted organs, a liver transplant has no fixed expiry: the liver's capacity to regenerate means that, with proper adherence to treatment, patients can live for a very long time after transplant. This regenerative capacity is also central to why living donation is viable, covered in more detail elsewhere in this series.
Cure versus lifelong management
A question during the session asked whether transplant is a genuine cure or simply a therapy. Dr. George's answer: it is a cure in that the patient's underlying liver disease and symptoms fully resolve, but because lifelong immunosuppressant medication is required, the patient remains in medical care indefinitely, even though the disease itself is gone.
This article is based on a Jivo Masterclass session conducted by Dr. Ashish George, Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a liver transplant consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Ashish George taught doctors across Africa on August 11, 2024.
FROM THE LIVE Q&A
Jivo Doctor Partner (name unclear from transcript)
Who is eligible to donate a liver?
Dr. Ashish George
Legally, the donor must be a relative of the patient. Medically, the ideal donor is blood-group compatible (A or O for an A recipient, B or O for a B recipient, any group for an AB recipient, only O for an O recipient; Rh status doesn't matter), aged 18 to 55, and free of diabetes or advanced uncontrolled pulmonary disease. An incompatible donor can still be evaluated if no compatible one exists, with longer preparation, higher cost and slightly increased risk.
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Frequently Asked Questions
Is there research correlating liver transplant and COVID-19 survival, and what are the nutritional considerations before, during and after liver transplantation?▼
Post-transplant patients who contract COVID-19 usually develop mild disease since the immunosuppressed body can't mount a severe response, though those who do develop severe COVID-19 can have poorer survival due to vulnerability to secondary infections. On nutrition: patients awaiting transplant should follow a high-protein, high-calorie diet to fight muscle loss (sarcopenia); after transplant, only freshly cooked meals, clean water, and peeled fruits/vegetables eaten immediately are advised, plus reduced red meat, due to immunosuppression and cardiovascular risk.
How long does it take for a donor's liver to regrow after donation, is it true that a donor only has ten years of survival left, and what is the age limit to donate?▼
About 70-80% of eventual growth happens in the first two to four weeks, and 95-97% of original size is reached by six months. The '10 years survival' claim is an absolute myth: once recovered, a donor's life expectancy, work, family and sexual life are completely unaffected. The donation age range is generally 18 to 55, and a person can only donate a liver once.
For someone who already had a liver transplant and requires another one, what are the possibilities, and how many times is it possible to have a repeat transplant?▼
Re-transplant is needed in about 5-7% of patients, due to disease recurrence, chronic rejection, or other causes. It is technically more challenging than a first transplant but achieves equal long-term results when performed by a skilled team; some patients have undergone two, three, or even four transplants over the years.
Is it possible for a healthy person without liver disease to have a partial hepatectomy stored, so that if they develop liver disease later it can be transplanted back to them?▼
No, this has not been thought of or done. Only a very small subset of the general population ever needs a liver transplant, so removing a healthy liver segment as a major surgery isn't advisable, and there is no method to preserve a graft for years, only for hours to a few days using specialised machines.
What is the time limit for liver cells to survive outside the body before transplant, and what is the recommended alcohol limit for a patient after liver transplant given a history of alcohol use?▼
A deceased-donor liver can be preserved up to 16 hours in solution, though shorter is always better. Living donor transplant avoids this almost entirely since donor and recipient surgeries happen side by side, keeping the liver outside the body for only half an hour to two hours. The prescribed alcohol limit after transplant for alcoholic liver disease is zero, and at least six months of abstinence is recommended before transplant, and none at all afterward.
What are liver transplant survival rates?▼
More than 90% at 1 year, 80-85% at 3 years, more than 75% at 5 years, and 65-70% at 10 years.
Is a liver transplant a cure or a lifelong treatment?▼
Both: the underlying disease and symptoms fully resolve (a cure), but the patient needs lifelong immunosuppressant medication and ongoing medical follow-up.
In This Series: Liver Transplant
- 1.Liver Transplant
- 2.Indications for Liver Transplant: Acute and Chronic Liver Disease
- 3.Liver Transplant for Liver Cancer: HCC, the UCSF Criteria and Downstaging
- 4.Contraindications and the MELD-Sodium Score for Timing Transplant
- 5.Survival Rates After Liver Transplant, and Why It's a Cure, Not Just a Therapy
- 6.Living Donor Evaluation: Compatibility, Safety and Liver Regeneration
- 7.Who Can Donate a Liver: Eligibility, Compatibility and the Ten-Year Myth
- 8.Hepatitis B and C in Liver Transplant Candidates
- 9.Re-Transplantation: When and How Often It's Possible
- 10.Nutrition Before and After Liver Transplant
- 11.Immunosuppression After Transplant: COVID-19, Cardiovascular and Renal Risk
- 12.Cold Ischemia Time and Post-Transplant Alcohol Limits