What is a Partial Liver Transplant and How Does It Work?

Surviving liver disease can be very challenging. But for many, getting a partial liver transplant offers hope beyond imagining. It is a remarkable procedure that offers a second chance at a healthy life utilizing the liver’s ability to regenerate. It offers evidence of medical advancement and the generosity of living donors, who offer vital solutions to those struggling with severe liver conditions, no matter the cause.

In this article, you will get to understand the procedure and deal with its complexities as well as taking a step to recovery.

Key Insights:

• Partial liver transplants involve transplanting a portion of a living donor’s liver into a recipient with liver failure.

• Liver regeneration allows both donor and recipient to have fully functioning liver post-transplant.

• These transplants reduce wait times compared to deceased donor transplants.

• Donors must meet strict medical and psychological criteria.

• Recipients require lifelong immunosuppression to prevent rejection.

• Success rates are high, with 77% of recipients living at least 5 years.

• Costs average over $1 million, but financial assistance is available.

• The procedure requires a skilled multidisciplinary team.

• Living donation offers emotional and medical benefits.

What is a Partial Liver Transplant?

A partial liver transplant is an innovative surgical procedure where portions of the healthy liver from a living donor is transplanted to a patient with liver failure or with advanced-stage liver disease. 

This approach triggers the unique ability of the liver to regenerate, which allows both the donor’s liver and the transplanted portion in the recipient to grow back to its full size and function, typically after a few months. It plays a critical role in addressing the shortage of deceased donor organs. As of 2023, more than 10,000 liver transplants were done in the United States (US). Among these liver transplants, about 21.7% is partial liver transplant from living donors.

More than 17,500 patients have been on the waiting list in the US, which highlights an urgent solution to this growing problem. The surgeons meticulously plan the amount of liver removed from the living donor to ensure that both will have sufficient liver mass left for healthy function. It is crucial for the safety and success of the procedure. Extensive documentation is available to demonstrate the liver’s regenerative capacity, which confirms its reliability and predictability when used for partial liver transplantation.

Fast facts about liver transplantation

Who Needs a Partial Liver Transplant?

Partial liver transplants are often the life-saving solution for individuals suffering from end-stage liver disease or those that are too advanced to respond to other treatments.

It includes people with advanced cirrhosis, which is severe scarring of the liver, liver cancer, and acute liver failure that develops very rapidly and severely. Partial transplants are particularly beneficial for urgent cases, where the patient’s condition is deteriorating quickly and they could not afford to wait any longer for a deceased donor organ. Common causes for liver transplant also include chronic viral hepatitis (like hepatitis B and C) and alcoholic liver disease. In 2019, more than 7,300 living transplants were performed in the US.

What are the criteria for being a candidate for a partial liver transplant?

To become a candidate for a partial liver transplant, you will go through rigorous evaluation that evaluates both non-medical and medical factors. Candidates are evaluated based on:

• Severity of the liver disease (e.g., end-stage organ disease)

• Overall health (ability to undergo the procedure)

• Presence of other conditions that will increase surgical risks (e.g., cancer, severe infection, or unmanageable heart condition)

• Psychosocial evaluation (e.g., mental and emotional readiness)

• Liver cancers with intermediate MELD score, especially if they are not high on the waitlist

Additionally, there is no absolute criteria governing the donor-recipient relationship. Financial counseling is also added on the list to ensure that patients and their families understand the significant costs involved in both the procedure and recovery.

These criteria are formulated to increase the chances of successful outcome and ensure that the patient is well-prepared for the procedure. The evaluation process is comprehensive and often more detailed than deceased donor transplants.

How is a Partial Liver Transplant Performed?

Performing a partial liver transplantation is a complex surgical procedure that involves a highly coordinated team of medical professionals. The process is planned and executed in several phases from pre-operative evaluations for both the donor and the recipient.

The evaluation is executed to ensure that both individuals are in optimal health so that the procedure is a success.

Two separate operations are involved:

• For the donor

• For the recipient

This is followed by intensive post-operative care.

The end-goal is to safely remove a portion of the donor’s liver and transplant it to the recipient properly, while ensuring proper blood flow and bile drainage are restored.

What happens during the donor surgery?

During a donor surgery, a segment of the healthy donor’s liver is carefully removed for transplantation. It involves the removal of a specific lobe, most commonly the right lobe since it provides sufficient liver mass for the recipient while leaving enough for the donor’s liver to grow back effectively. The procedure is done via general anesthesia and usually takes about 6-8 hours depending on in-surgery circumstances.

The surgical team will employ techniques that will minimize blood loss and ensure a smooth recovery for the donor. Post-surgery, pain management is a key focus, and donors are closely monitored during their immediate recovery period to ensure that their liver begins to regenerate without complications.

What happens during the recipient surgery?

Recipient surgery is the critical phase where the donated liver portion is placed into the patient with liver failure. This procedure involves removing the diseased liver and meticulously connecting the new liver segment to the recipient's blood vessels and bile ducts. This ensures proper blood supply to the new liver and allows bile to flow correctly. The recipient surgery generally takes about 8-12 hours, which is longer than the donor surgery. However, depending on different factors, the duration could be longer. Recipient surgery generally includes:

• Removing the diseased organ

• Placing the donor liver in place

• Establishing the new connections between the recipient and donor liver (e.g., blood flow and bile duct flow)

One of the crucial aspects of post-transplant care is for the recipient to receive immunosuppression therapy. These are medications formulated to prevent the recipient’s immune system from attacking and rejecting the new liver.

Donor and recipient coming together

What Are the Benefits of a Partial Liver Transplant?

A partial liver transplant offers different advantages in comparison to traditional deceased donor transplants. The benefits include a significantly reduced wait time. Patients needing liver transplant often suffer a long and uncertain wait for a suitable deceased donor organ, during which their health can deteriorate.

Having the surgical option of a living donor transplant bypasses this lengthy weight, allowing for a more timely intervention. Donor liver transplant offers better graft quality, which means the transplanted liver portion is healthier and reduced risk for the initial complications. This can lead to improved survival rates. In fact, studies indicate that living donor transplants can have higher long-term survival rates than cadaveric (deceased) donor transplants. The ability to schedule the surgery electively also allows better preparation and optimization of the recipient’s health, further contributing to positive outcomes.

How does a partial liver transplant compare to a full liver transplant from a deceased donor?

When considering a liver transplant, knowing the differences between a partial liver transplant from a living donor and a full liver transplant (cadaveric/deceased donor) is important. While both procedures aim to be life-saving and replace a diseased liver, they differ significantly in several factors, including wait times, associated risk, recovery processes, and overall outcomes. The table below offers a clear comparison between the two:

The comparison highlights that while decreased donor transplants remain a good option, living donor partial liver transplants offer distinct advantages. It is particularly true in terms of reducing wait times and potentially improving long-term outcomes.

What Are the Risks and Complications of a Partial Liver Transplant?

Partial liver transplants offer significant hope. But, while this is so, it is crucial to understand that, like other major surgical procedures, it carries inherent risks and potential complications for both the recipient and the donor. The risks are carefully evaluated during the extensive pre-transplant evaluation to ensure the safety of all involved.

For donors, complications can range from minor issues to, in rare cases, life-threatening events. On the other hand, recipients face risks related to the surgery itself, the new organ, and the necessary lifelong immunosuppression.

What are the common complications for liver transplant donors?

For living liver donors, the risks are generally low but it poses a significant consideration. Common complications include:

• Bile leaks (when bile seeps from the liver or bile ducts)

• Infections at the surgical site

• Bleeding

• Blood clots

• Hernias (rare) at the incision site

Serious complications are rare, occurring in about 1-3% of cases. But if they do happen, they can be severe. Common complications are manageable with appropriate medical intervention. The majority of donors recover fully and the rates are generally very high, which indicate that careful selection process and advanced surgical techniques work.

What are the common complications for liver transplant recipients?

Recipients of partial liver transplant face a different set of potential complications, primarily related to the acceptance of the new organ and the body’s response to it.

The most significant concern is organ rejection. Organ rejection happens when the recipient’s immune system identifies the transplanted liver as foreign and attacks it, which is primarily what a healthy immune system is expected to do. This is the reason why lifelong immunosuppressive medications are essential.

Other complications that are commonly encountered include:

• Infections (because of the increasingly weakened immune system)

• Bile duct problems

• Blood vessel issues, including blockages or leaks

Close monitoring of your condition is therefore important and you need to adhere to medication regimens to ensure that these potential complications are managed. This further increases long-term success of the transplant.

How Long is the Recovery After a Partial Liver Transplant?

The recovery period after a partial liver transplant varies significantly for both recipients and donors. It reflects that different surgical procedures and normal bodily adjustments each individual undergoes matter.

For living donors, the recovery may be quicker, spanning from weeks to a few months, as it gives time to the remaining liver to regenerate and their body heals from the procedure.

For transplant recipients, however, the recovery process involves a more extended recovery timeline. It often requires months to a year or more to fully regain their strength and adapt to life with a new liver. Important things to consider during this period include:

• Careful monitoring

• Rehabilitation

• Significant lifestyle adjustments

All of these things, considered, contribute to long-term success of the transplant.

Did you know fast facts

What is the typical recovery timeline for a liver donor?

The initial recovery typically involves a hospital stay of about 5-7 days. During this time, pain management is crucial and they are encouraged to begin light activity as soon as tolerated.

The first few weeks at home are focused on tests and gradual increase in activity. They should be able to return to light work and daily activities in about 4-6 weeks. Although full recovery, including the complete regeneration of the liver, may take about 2-3 months. 

• Week 1: Initial pain management and light mobility

• Week 2-4: Gradual increase in activity and reduced pain medication

• Week 6-8: Return to most normal activities with continued liver function monitoring

What is the typical recovery timeline for a liver transplant recipient?

Recipient recovery is a more intensive and prolonged process. Immediately following surgery, recipients are typically transferred to the intensive care unit (ICU) for 1-2 days for close monitoring.

The transplant recipient stays in the hospital longer than the donors, which could take 1-2 weeks, during which they are closely monitored for signs of infection or rejection. Their medication regimen is carefully adjusted.

After hospitalization, rehabilitation is initiated, which is a crucial component of recovery. It involves physical therapy to regain strength and mobility. It is normal to feel tired during the first few weeks. About 3-6 months could pass before your full energy returns to normal.

Nonetheless, full recovery including the ability to return to work and normal activities may take longer but it depends on your pre-transplant health and any post-operative complications.

What is the Success Rate of Partial Liver Transplants?

The success rate of partial liver transplants is a crucial measure of their efficiency and offers significant reassurance to candidate patients and their families.

Success is typically defined by the patient and graft survival rates at specific intervals. It could be one year or five years after transplant. These rates demonstrate the long-term viability of the procedure and the quality of life it provides.

Generally, partial liver transplants, especially since it comes from liver donors, boast impressive success rates. Often it is comparable to or even more than deceased donor transplants. It boasts up to 90% survival rates after one year and 77% in five years after liver transplants. The high success rate is proof of the advancements in surgical techniques, immunosuppressive therapies, and comprehensive post-operative care.

How do success rates vary based on the reason for transplant?

The overall success rates for partial liver transplants are high. But even so, the specific reason for needing the transplant can influence the outcome.

For example, patients who got transplants for certain conditions like hepatocellular carcinoma (liver cancer) may have different survival rates compared to those with chronic liver diseases like viral hepatitis or alcoholic liver disease (ALD).

Factors like the following play a significant role:

• Stage of cancer at the time of transplant

• Presence of other underlying comorbidities

• Overall health of the recipient

• How adherent the patient is to the medical regimen

Success rates across different etiologies will vary widely, which offers valuable insights for patient selection and prognosis. However, continuous advancements in medical care and tailored treatment plans aim to improve and enhance the outcomes across any indication.

Who Can Be a Living Liver Donor?

If you want to be a living liver donor, it is an extraordinary act of altruism that requires careful consideration and rigorous evaluation process. Not everyone who wishes to be a living liver donor is eligible to donate. There are strict criteria in place to ensure the safety and well-being of both the donor and recipient.

Potential donors must be:

• Of excellent physical and mental health

• Between ages 18 and 60

• Compatibility factor

• Psychological readiness

The evaluation process is designed to thoroughly assess a candidate's suitability and commitment to the donation process.

What medical tests are required for potential liver donors?

Potential living liver donors undergo a series of medical tests to ensure their health and suitability for donation. The tests include extensive blood work to assess:

• Liver function

• Kidney function

• Screening for infectious diseases

Imaging studies, such as CT scans and MRIs, are performed to evaluate the liver's anatomy, size, and vascular structures, ensuring that a safe portion can be removed. A psychological evaluation is also a critical component, assessing the donor's understanding of the risks and benefits, their motivation, and their emotional stability throughout the process. The purpose of these tests is to identify any underlying conditions that could put the donor at risk or compromise the success of the transplant.

Liver transplantation eligibility criteria

Are there any restrictions or disqualifications for being a liver donor?

Yes, there are restrictions and disqualifications in place, which will prevent just anyone from being a living liver donor. These are in place to protect the donor’s health and ensure the best possible outcome for the recipient.

Common disqualifications include:

• Chronic medical conditions (e.g., heart disease, lung disease, diabetes, or kidney disease)

• Obesity

• Active infections

• History of cancer

• History of substance abuse (e.g., excessive alcohol consumption or illicit drug use)

The presence of any condition that could impair the donor's recovery or compromise the health of the transplanted liver would lead to disqualification. The evaluation process is designed to identify these restrictions early on.

What is the Process for Becoming a Living Liver Donor?

Becoming a living liver donor involves a structured and thorough process designed to ensure the safety and informed consent of the individual. It typically begins with an initial expression of interest and the potential donor receives preliminary information about the donation.

Then, there is a comprehensive evaluation phase, which is the most crucial step, as it involves comprehensive medical and psychological assessments. Once the donor is approved and proven eligible to donate, the donor and recipient teams coordinate the best surgery schedule. The entire process is guided by a multidisciplinary team of healthcare professionals who offer support and guidance at every phase.

Conclusion

A partial liver transplant represents a remarkable intersection of medical science and human generosity, offering a vital lifeline to those battling severe liver disease. This complex procedure, made possible by the liver's unique regenerative capabilities, significantly reduces wait times and often leads to improved outcomes for recipients. While the process involves rigorous evaluations, surgical risks, and a dedicated recovery period for both donor and recipient, the potential for a renewed, healthy life makes it a profoundly impactful option. As medical advancements continue, the promise of partial liver transplantation shines ever brighter, underscoring the power of altruism and cutting-edge healthcare in transforming lives.

Suggested Readings:

How Long Does a Liver Biopsy Take? Understanding the Procedure Duration

How Long Is A Liver Transplant Surgery?

Quick Summary Box

• Partial liver transplants involve a living donor, leveraging the liver's ability to regrow.

• This procedure drastically cuts down wait times compared to deceased donor transplants.

• Both donors and recipients undergo extensive evaluations to ensure safety and compatibility.

• Recovery timelines vary, with donors typically recovering faster than recipients.

• Success rates are high, with a significant majority of recipients living for many years post-transplant.

• The financial cost is substantial, but numerous assistance programs are available.

• The process is a testament to multidisciplinary medical teamwork and donor selflessness.

References

References

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cindyyoung. (2020, February 3). The most active living donor liver transplant programs | UNOS. UNOS. https://unos.org/news/improvement/most-active-living-donor-liver-transplant-programs/ 

Gilgenkrantz, H., & Collin de l’Hortet, A. (2018). Understanding Liver Regeneration. The American Journal of Pathology, 188(6), 1316–1327. https://doi.org/10.1016/j.ajpath.2018.03.008 

Grewal, H. P., Shokouh-Amiri, M. H., Vera, S. R., Stratta, R. J., Wagdi Bagous, & A. Osama Gaber. (2001). Surgical Technique for Right Lobe Adult Living Donor Liver Transplantation Without Venovenous Bypass or Portocaval Shunting and With Duct-to-Duct Biliary Reconstruction. 233(4), 502–508. https://doi.org/10.1097/00000658-200104000-00004 

https://www.facebook.com/WebMD. (2024). Timeline of Liver Donor Recovery. WebMD. https://www.webmd.com/hepatitis/ss/slideshow-liver-donor-recovery 

Kwong, A. J., Kim, W. R., Lake, J. R., Schladt, D. P., Handarova, D., Howell, J., Schumacher, B., Weiss, S., Snyder, J. J., & Israni, A. K. (2025). OPTN/SRTR 2023 Annual Data Report: Liver. American Journal of Transplantation, 25(2), S193–S287. https://doi.org/10.1016/j.ajt.2025.01.022 

Liver Transplant: What to Expect at Home. (n.d.). Myhealth.alberta.ca. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc2592 

Living Donor Liver Transplant. (n.d.). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/transplant/programs/liver/living-donor-liver-transplant 

Living Donor Liver Transplantation | Conditions & Treatments | Center for Liver Disease & Transplantation | Columbia University Department of Surgery. (n.d.). Columbiasurgery.org. https://columbiasurgery.org/conditions-and-treatments/living-donor-liver-transplantation 

Russo, M. W., & Brown, R. S. (2004). Adult Living Donor Liver Transplantation. American Journal of Transplantation, 4(4), 458–465. https://doi.org/10.1111/j.1600-6143.2004.00387.x 

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Frequently Asked Questions

Q: Can a partial liver transplant be done for children?

A: Yes, partial liver transplants are commonly performed in children, often using smaller grafts from living donors. Success rates are high, with many children leading normal lives post-transplant.

Q: Is there an age limit for liver donors?

A: Donors are typically aged 18–60, but older donors may be considered if they are in good health

Q: How long can someone live after a partial liver transplant?

A: Many recipients live normal lifespans, with approximately 77% surviving at least 5 years, depending on health and medication adherence.