Medical Oncologist
CION Cancer Clinics
The liver transplant operation: what actually happens | CION Cancer Clinics
In a liver transplant, surgeons remove your whole diseased liver, tumour included, and replace it with a healthy liver or part of one. The operation is long, commonly six to twelve hours. This page walks through each stage in theatre, what the team watches for, the tubes you will wake up with, and why the removed liver is examined so closely when the reason was cancer. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed October 2026, next review due October 2027
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On this page
- What happens during a liver transplant operation, and how long does it take?
- What do the surgeons actually do, step by step?
- What can go wrong during and soon after the operation?
- What are all the tubes and lines attached to me afterwards?
- What this page cannot tell you
- Common questions about the transplant operation
The short answer
What happens during a liver transplant operation, and how long does it take?
The surgeons remove the whole diseased liver, tumour and all, and put a healthy liver or part of a liver in its place. It is a long operation, commonly somewhere between six and twelve hours, and your transplant team will give you their own estimate.
Why it takes so long
Taking out a cirrhotic liver is slow, careful work. Scarring raises the pressure in the veins around it, so there are many swollen vessels that bleed easily. Then the new liver has to be joined to four separate connections, each stitched by hand. In a living donor transplant, a second team operates on the donor at the same time.
Who this page is for
This page is for families of someone being assessed or listed for a transplant for primary liver cancer, usually hepatocellular carcinoma (HCC, cancer that starts in the liver cells) with cirrhosis. If the cancer spread to the liver from the bowel or elsewhere, transplant is not the usual route; start with the transplant for liver cancer page. CION's surgical oncologists assess and plan, and your team will tell you where the operation takes place.
In the operating theatre
What do the surgeons actually do, step by step?
Anaesthetic and lines
You are put fully to sleep. Thin tubes are placed in veins in the neck and arm and an artery in the wrist, so the team can give blood and fluid quickly and watch your pressure every second.
The incision
A long cut is made across the upper abdomen, often shaped like an upside-down letter J or Y, to reach the liver under the ribs.
Removing the diseased liver
The surgeons free the liver, clamp its blood vessels and bile duct, and lift it out. This is usually the riskiest part, because of bleeding from the swollen veins.
Joining the new liver
The new liver is connected to the large vein that drains it, then the portal vein, then the hepatic artery that feeds it, then the bile duct. Blood is let back in and the liver turns pink as it starts working.
Checks and closing
An ultrasound on the table confirms blood is flowing. Drains are left beside the liver and the abdomen is closed. You go straight to intensive care.
Not sure whether this applies to you?
Ask an oncologistWhat the team watches for
What can go wrong during and soon after the operation?
These are the problems surgeons plan around. Your own team will explain which matter most for your liver and your body.
Bleeding
Cirrhosis thins the blood and swells the veins, so blood loss can be heavy. Blood is kept ready, and families are often asked to arrange donors beforehand. See arranging blood donors.
A clot in a new connection
A clot in the artery or portal vein can starve the new liver. This is why ultrasound scans are repeated often in the first days, and why some people go back to theatre quickly.
A bile leak or narrowing
The bile duct join can leak or tighten. Many are fixed with a drain or an endoscopy rather than another open operation.
The new liver is slow to work
Rarely, the new liver does not start working properly. Your team will tell you how they would respond, which can include an urgent second transplant.
Your surgeon can tell you how often each of these happens at that centre. It is a fair question to ask.When you wake up
What are all the tubes and lines attached to me afterwards?
- Breathing tube
- Some people wake with a tube in the throat connected to a breathing machine. It is usually removed once you are awake and breathing well on your own.
- Neck line
- A thin tube in a large vein in the neck, used for medicines, fluids and blood tests without repeated needles.
- Abdominal drains
- Soft tubes coming out of the wound area, carrying away fluid and showing the team early if there is bleeding or a bile leak.
- Urinary catheter
- A tube into the bladder so the team can measure exactly how much urine the kidneys are making.
- Nose tube
- A tube through the nose into the stomach, sometimes used to keep the stomach empty or to feed you early.
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Did you know
The liver that is taken out is sent to a pathologist, who slices it and counts every tumour under the microscope. For people with liver cancer this report matters a great deal. It shows whether there were more tumours than the scans suggested and whether any had reached small blood vessels. Your team uses it to plan how closely you are watched for the cancer coming back.
Being straight with you
What this page cannot tell you
It cannot tell you how your own operation will go. The length, the blood loss and the recovery depend on how scarred your liver is, whether you have had earlier abdominal surgery or tumour treatments, your heart and kidneys, and whether the liver comes from a living or a deceased donor. Only the transplant surgeon who has seen your scans can talk about that.
Who this does not apply to
Not everyone with liver cancer can have a transplant. Cancer that has spread outside the liver, tumours growing into the main blood vessels, or tumours well beyond the size and number limits usually rule it out. The who is not eligible page explains this. For many, surgery to remove part of the liver, ablation or TACE is the better road.
The donor is a separate patient
In a living donor transplant, the donor has a major operation too, with real risk. Their side is covered on what happens to the donor. Buying or selling an organ is illegal in India.
Questions we are asked
Common questions about the transplant operation
How long will the family be waiting outside?
Usually most of a day, and sometimes longer once preparation and moving to intensive care are counted. The team generally sends updates at set points. Agree beforehand who in the family will receive the calls, so information is not lost between relatives.
Is the whole liver replaced, or only the part with the tumour?
The whole of your own liver is removed. That is the point of a transplant for cancer with cirrhosis: it takes away the tumour and the scarred liver that could grow new tumours. With a living donor, you receive part of a healthy liver, which grows to a working size.
Does the donor operation happen at the same time?
Usually, yes. Two teams work in neighbouring theatres. The donor operation starts first, and your liver is removed once the team is sure the donor's portion is suitable. This keeps the time the new liver spends without blood flow as short as possible.
Will I need a blood transfusion?
Many people do, because cirrhosis makes bleeding more likely. The centre will tell you how much blood to keep ready and whether family members are asked to donate in advance. Donated blood replaces what the bank uses; it is not reserved only for you.
How big is the scar?
Large. It runs across the upper abdomen below the ribs, often with an upward extension in the middle. It fades with time. Some centres use smaller or keyhole cuts for the donor, but the recipient operation is almost always done through an open cut.
How long will I be in intensive care?
It varies with how the new liver and your kidneys are doing. Some people move to the ward within a few days; others need longer. The first week after transplant page explains what that time looks like.
Can the cancer come back after a transplant?
It can. Cancer cells may already have left the liver before the operation without showing on any scan. That is why you will have regular scans and AFP blood tests afterwards. The pathology report on the removed liver helps decide how often.
What does CION do, if the operation is elsewhere?
CION's surgical oncologists assess whether transplant fits your cancer, the tumour board reviews your scans, and the team coordinates referral to a licensed transplant centre. Afterwards, CION can manage cancer follow-up and surveillance alongside the transplant team.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- NIDDK — Liver Transplant - NIDDK
- MedlinePlus — Liver Transplantation
- American Cancer Society — Surgery for Liver Cancer
- NHS Blood and Transplant — Liver - Organ transplantation - NHS Blood and Transplant
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Intensive care and the first week after transplantThe next step, once the operation is overThe transplant assessment: every test you will haveWhat comes before the operationLiving donor liver transplant in IndiaHow most transplants in India are doneCancer coming back after a transplantWhy follow-up scans continue for years
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