Liver Transplant Surgery: What to Expect

Liver Transplantation at the Transplant Institute

A liver transplant can be a life-changing experience—and the day a donor liver becomes available is a significant and hopeful moment. At the Transplant Institute at Beth Israel Deaconess Medical Center (BIDMC), our dedicated team is here to support you through every step of your surgery and recovery.

Your transplant will be performed on the West Campus at BIDMC by our experienced liver transplant team. We use advanced surgical techniques and personalized care plans to help make your experience as smooth and comfortable as possible. 

The Liver Transplant Process

Once you arrive at BIDMC, we prepare you promptly for surgery. You’ll receive general anesthesia, so you’ll be asleep and pain-free during the entire procedure.

Removing Your Diseased Liver

The surgeon begins by making an incision in the shape of an upside-down “Y.” This includes a horizontal incision across the upper abdomen (about 12–16 inches) is usually made, and sometimes a smaller vertical incision extending a few inches up the chest Your surgeon will then carefully remove your liver and gallbladder. The donor liver also comes with a gallbladder, which is removed during the procedure.

Implanting the Donor Liver

We replace your liver with a healthy donor liver—either a full liver or a portion of one (in the case of a living donor transplant). The new liver, or graft, is placed in the same position as your original liver. 

To connect the donor liver, we can use a surgical method called the “piggyback technique”, which preserves your main vein (inferior vena cava) to reduce blood loss and enhance safety, the bicaval technique which is when we replace your old inferior vena cava with the donor’s inferior vena cava. The donor’s main vein is connected to your own, and we proceed to reattach the remaining blood vessels.

Restoring Blood Flow and Bile Drainage

Once the liver is in place, your surgical team restores blood flow by connecting the portal vein (which brings blood from your intestines and pancreas) and the hepatic artery ( which delivers oxygen-rich blood to the liver). The liver typically begins functioning immediately—producing bile and clotting factors and taking on its vital roles.

Finally, the surgeon reconnects your bile duct to either your existing bile duct or a section of your small intestine. The incision is then closed with sutures or staples. Surgery usually takes 4 to 8 hours. Your care team will update your family throughout the procedure. 

After Your Liver Transplant Surgery

After surgery, you’ll recover in the surgical intensive care unit (SICU), where our specialized transplant team will monitor you closely. Most patients stay here for at around 24 hours. You may feel drowsy, and you may notice:

• Soft restraints (to protect your IV lines)
• Compression stockings (to improve circulation)
• Multiple IV lines or monitors

After surgery, you may have:

• Abdominal drains: Small tubes that remove fluid near the liver
• Roux-en-Y tube: If your bile duct is connected to a loop of intestine, this tube helps healing
  and stays in for 6 weeks

Once stable, you’ll transfer to our dedicated transplant recovery floor. Here, you’ll:

• Begin walking and regaining strength
• Learn how to care for your incision and drains
• Receive education on medications, diet, and signs of complications

Our team will ensure you feel confident and prepared before going home.

Your transplant journey continues after discharge, with close monitoring and follow-up care. Our team is here to support your healing and long-term health—so you can return to the life you’ve been waiting for.