About the operation

A liver transplant is a surgery which replaces a diseased liver with a healthy liver. The donor liver can come from a living donor (part of the liver is surgically removed from a healthy person) or a deceased donor (a whole liver recovered from a person who has passed away).

The surgery usually takes 5 to 8 hours, but may be longer depending on the patient. One of two incisions will be made, a side to side incision below both sides of your rib cage or straight down the middle of your upper abdomen. The incision is 10 inches or more.

Your old liver and gall bladder are removed first to make room for the new liver. Your new liver is attached to your body by:

  • The donor's bile duct to your own bile duct or to a loop of your bowel.
  • The donor's artery to your artery.
  • The donor's veins to your veins.

liver transplant 

When these connections are completed, the muscle layers of your abdomen are stitched together. Staples are usually used to close the surgical incision. We take out the staples 2 to 3 weeks after surgery.

You can expect to stay in the hospital for 10-14 days

If you receive part of a liver it will grow to whatever size is needed to provide normal function. This growth occurs over 6 to 8 weeks.

Liver transplant surgery facts

Every recipient and every donated liver has a slightly different structure and the attachment of each liver will change somewhat because of this.

Sometimes a small tube, called a stent, is placed in the duct to give it support. Usually this tube passes out of your body on its own in your stool, but sometimes it will need to be removed by your doctor. If needed, this is done a few weeks after surgery by gastroscopy. 

Some patients may have drainage tubes placed in their abdomen to allow any extra fluid to drain for a few days after surgery. These tubes will be removed before you are discharged.

You may receive blood products such as packed cells, plasma, or platelets during the operation. There is a small chance (10-15%) you will go on a bypass machine to keep your blood pressure stable during surgery. If this happens, you will have 2 small incisions in your left groin and in your left armpit.

Read our guide below to learn more about your kidney transplant surgery, or click on the topic that matters most to you. If you have questions or need more information, talk to your transplant surgeon or your transplant coordinator.

When You are Called In

Once your liver transplant evaluation ​is complete, you are placed on the liver transplant waiting list. When a liver becomes available, you will receive a call from a Transplant Coordinator. The call for a transplant may come at any time of the day or night.​

The transplant coordinator on-call will call you in this order:

  1. Home phone number
  2. Alternate phone numbers, such as a cell number

The transplant coordinator on-call will ask you a few questions:

  • How are you feeling?
  • Do you have any symptoms of a cold or fever?
  • Are you taking any antibiotics?
  • Have you had any new medications prescribed?

We expect you to arrive at the hospital as soon as possible after getting the call for transplant. Your estimated time of arrival will need to be discussed with the transplant coordinator. The transplant coordinator will tell you where to go once you arrive to the hospital. Do not eat or drink from this time on.

  • Time is critical when your liver becomes available. The transplant coordinator will call all your contact numbers repeatedly for 1 hour. Messages will be left where answering machines are available. If they cannot reach you, another organ recipient must be chosen.
  • If you are unable to reach the person who pages or calls you, contact the Transplant Inpatient Unit at 416 340 5163; ask to speak to the charge nurse.
  • You are responsible for arranging your own transportation to the hospital.
  • If you refuse to come in when called for transplant, you will immediately be placed on hold and we must contact your transplant coordinator to discuss your situation.

What should I bring when I am called in?
  • Your health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver's license or passport.
  • Any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
  • Your spouse/partner, a trusted friend or family member.
  • A list of your medications. (names, doses, frequency) or bring the medications with you in their original packages.
What if I am called in as a back-up?

In some cases, you may be called in as a back-up. This happens when there is a chance that the primary person will not receive the liver. Whenever possible, we will try to have you stay at home during this waiting period for the final decision. If tests show that the primary person on the list is not a good match, then you, as the back-up will be offered the liver.

Is there a chance my transplant will be cancelled?

Yes. Your surgery can be cancelled for many reasons:

  • We may have found a problem with the donor liver at the last minute.
  • One of your tests may have an unusual result and the operation cannot safely proceed.
  • In some cases, there may be an issue in matching an organ to a recipient.
  • Occasionally, another person on the waiting list may require the organ more urgently than you do

You and your family may feel shock, disappointment, and sadness when this happens. All of these feelings are normal. You should call your transplant coordinator to talk about any concerns you have about a cancellation.

You are still on the transplant waiting list and now know what to expect the next time you are called in.

What if I am too sick for transplant?

Sometimes, you can become too sick to undergo transplant surgery.

There are several possible reasons:

  • If you become bedridden
  • If you develop serious infections and do not respond to antibiotics
  • If you have a liver tumour and it becomes too big, or spreads outside of the liver

If you become too sick to have a transplant, we will work with your referring or family doctor to plan your care. If you need to remain in hospital, you will be admitted to the one closest to your home.

Coming to the Hospital
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Living Donor Recipients must stop eating and drinking by midnight on the night before your operation. Your stomach needs to be empty.

When do I come to the hospital?

If you are receiving a living donor liver transplant, you will be admitted the day before your surgery, to have a final assessment and ensure you are fit for surgery.

For deceased donor liver transplants, you will have the same assessments done right before the surgery to make sure it is safe to go ahead with the transplant.

Hospital Arrival
What happens when I arrive at the hospital?

You will be admitted to the Transplant Inpatient Unit and examined by the liver transplant team.

Between 6 am to 11 pm go to:

Admitting Department
Toronto General Hospital
200 Elizabeth Street
Ground Floor, Eaton Wing - Elizabeth Street entrance
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Between 11pm and 7 am, go to:

Emergency Department
Toronto General Hospital
At the corner of Elizabeth St. and Gerrard St.
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What will happen before my operation?
  • Nurses and doctors will examine and prepare you for the operation.
  • Nurses will ask for a urine sample.
  • Blood tests, an ECG, and a chest x-ray will be done.
  • An intravenous line (IV) will be inserted into your arm.
  • You not be given anything to drink or eat.
  • Doctors will see you to discuss the operation and answer any questions you may have

After Your Operation

On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.

What will happen right after my operation?
  • You will wake up in the Medical Surgical Intensive Care Unit (MSICU) or the Acute Care Unit (ACU). The average stay there is 2 – 3 days, but varies with each recipient. Our first priority is making sure your new liver is working well. Your transplant team will watch you closely for signs and symptoms of any complications, rejection or infections and will make changes to your care as needed.
  • Visiting is also limited in the ACU. There is a designated patient rest period from 3:00 pm – 5:00​ pm and no visiting is allowed during this time.
  • Rejection happens when your body's immune system recognizes your new liver as foreign matter. The body will try to react and damage your new liver. Blood tests monitor for changes that may be a sign of rejection. Identifying the early signs of rejection is important so that this process can be stopped and your new liver can continue to work well for you. In most cases, the liver can recover from acute rejection without permanent damage. Your transplant team will monitor and treat early signs of rejection. They will adjust your medication and therapy accordingly. We will also teach you the signs and symptoms of rejection so that you know what to watch for at home.
  • You will immediately start taking immunosuppressive drugs. These stop your immune system from rejecting your new liver. When you are immunosuppressed, you are also at more risk for infections. The tests we do to watch for rejection also help watch for early signs of infection. A culture sample will also be sent to check for infection. Your transplant team will monitor and treat early signs of rejection and adjust your medication and therapy accordingly. We will also teach you the signs and symptoms of rejection and infection so that you know what to watch for at home.​
How will I feel after my operation?
  • Once you have recovered from the anesthetic, you will likely feel some pain at the site of your incision. You will have to take pain medicine regularly for a short period of time. It will help you start moving around, sitting, and walking sooner.
  • Our pain management team will work with you during and after surgery to make sure your pain is well managed.

How can I take care of myself after my operation?

After the operation, you will immediately begin treatment with medication designed to prevent your immune system from rejecting your new liver. These types of medication are known as immunosuppressants. You will now take these medications for life.

Moving your body is an important part of your recovery.

  • Start some deep breathing and coughing exercises. We'll show you an exercise called incentive spirometry
  • You will shower while you are in the hospital.
  • Wiggle your toes and move your feet. This helps the blood in your legs to circulate.
  • Sitting up in a chair, performing self-care, and walking in the hallway are excellent ways to improve your strength and stamina.
  • You will be encouraged to sit up and walk as soon as you are able.

Nurses, pharmacists, dietitians, physiotherapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital.

Will I learn about my medication?

On the Transplant Inpatient Unit, you will learn about your new life with a liver transplant, including how and when to take your new transplant medicines and any side effects you may have. You will meet with one of our transplant pharmacists. The pharmacist will answer any questions you may have about your new medicines. You can also visit our patient toolbox to learn more about your transplant medicines and life after transplant.

What happens after I leave the ACU?

You will complete your recovery back on the Transplant Inpatient Unit. Our transplant nurses will help you continue to recover, gain strength, and learn how to manage with your organ transplant. Accommodation on this unit may be in a private or semi-private room. Private rooms are first allocated to patients requiring isolation, then to patients with private insurance coverage or those who have arranged to pay the daily fee for a private room.

How long will I stay in the hospital?
  • You can expect to be in the hospital for 10 – 14 days.
  • Before you leave the hospital, your transplant team will give you a schedule that will tell you how and when to take all of your transplant medicines and when you will need to come to the hospital for regular blood tests and clinic visits.
  • Your schedule will be based on your progress and your doctor's recommendations. Over time, your clinic visits and blood tests will become less frequent.
Back at home
How can I take care of myself when I go home?
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  • Eating a healthy diet by following Canada's Food Guide will help give you a balance of protein, fats, and carbohydrates and help you to maintain a healthy body weight.
  • Avoid eating junk food
  • It is not uncommon to gain weight after your transplant. Losing weight is as challenge for transplant patients as it is for everyone.
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    You cannot eat grapefruit or drink grapefruit juices after transplant. It interferes with the absorption of your immunosuppressive medications

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  • You might get tired easily. Listen to your body and don't do more than you can handle.
  • Our transplant psychiatry team is here if you need help with the following:


    1. Anxiety and depression
    2. Smoking cessation
    3. Stress management
    4. Support and coping
  • The Transplant Psychiatry Program offers a Mindfulness-Based Stress Reduction (MBSR) program, please call: 416 340 4452 or fill out the Mindfulness-Based Stress Reduction (MBSR) program application form​​.
  • If you are looking for counseling, referrals, support groups or a mentor program please talk to a transplant social worker, transplant coordinator or your family doctor.
  • Don't lift heavy things for 3 months after your operation. Anything over 5 kilograms or 10 lbs. is too heavy.
  • Do not perform strong exercises such as: sit ups or strong upper body exercises such as: push ups, pull ups and pushing or pulling heavy objects.
  • You can use small weights of 1 to 2 pounds to increase arm strength but be careful not to strain your shoulder joints.
  • Lifting larger amounts may result in stress to your incision and can affect your healing, and may cause a hernia in the incision.
  • Please do not lift your child. Some problem solving will be required to work around this.
  • Walking is the best exercise. Try to increase the distance and speed you walk.
  • In winter, many people walk in malls to avoid icy surfaces and cold conditions or they use a treadmill if they have access to one.
  • Don't take anti-inflammatory medication such as Motrin, Advil® or Ibuprofen for 2-4 weeks after the operation, unless your surgeon has told you to continue taking them.
  • Don't take aspirin (ASA) for pain, it can make your blood difficult to clot and can irritate your stomach.
  • Please consult your transplant team for direction in managing any cold symptoms.
  • Tylenol in small doses is safe to take for minor pain, headaches when necessary. The maximum amount of this drug in 24 hours is 2000 mg (equal to 6 of the regular 325 mg strength or 4 of the extra 500 mg strength)
  • You cannot have any type of live vaccine as it could be harmful to you. This includes measles, mumps, rubella, shingles vaccine and yellow fever vaccine.
  • If you have diarrhea we do not recommend that you take antidiarrheal medications such as Imodium. There are many reasons to have diarrhea and the cause of these needs to be assessed first before using these medications
  • Do not drive for 6 or 8 weeks after operation.
  • Do not take long car trips. If you are travelling a long distance, stop every 2 hours to urinate.
  • Discuss readiness for driving at your clinic appointment.
  • You must not drive while taking narcotic pain medication. You need to be sufficiently strong, and flexible enough to move your leg and foot on the pedals, and be able to check your blind spot.
  • If your driving license was suspended pre-transplant, it may take several weeks or months to re-activate your license once you are fit enough to drive.
  • Always wear your seatbelt when you are driving or riding in a vehicle. If the belt causes discomfort where it crosses your incision, place a towel under the belt.
  • We will not provide letters to excuse you from wearing your seatbelt.
  • You can use public transportation any time after your transplant.
  • It is best that you do not travel by plane for one year after your transplant. Please talk to your transplant team about your travel plans to make sure it is safe for you to travel.
Follow-up appointments

Before you leave the hospital we will arrange your follow-up clinic appointments. A detailed plan will be given to you, based on your progress and your doctor's recommendations.

Blood tests

2 times a week.

​Liver Transplant Clinic
Toronto General Hospital
Peter Munk Building - 12th floor
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What to Expect
You will need to have regular blood tests. The results will be viewed by the transplant team who will follow-up as necessary.

Weekly clinic visits

You will also be seen every week in the Liver Transplant Clinic. Over time, your clinic visits and blood tests will become less frequent. Follow-up appointments usually take 1 -2 hours.

When you arrive at the Liver Transplant Clinic your blood work will be done, a review of your most recent bloodwork will be provided and we will adjust medications if required. At the end of every clinic you will be given a prescription for your transplant medications.

What to bring

  • OHIP health card, or another piece of government issued photo ID, such as a passport or driver's license.
  • Bring all medications and a list of your medications to each clinic visit
  • Bring a list of questions or concerns
  • Have your bloodwork, chest X-ray and ECG (echocardiogram) done before the clinic, as instructed by your transplant coordinator.

To change an appointment, call your transplant coordinator by using the Easy Call system.

My contacts
Who do I call if I experience complications?

If you are experiencing health issues or concerns please use Easy Call to leave a message for your transplant coordinator. Use Easy Call if you have any of these symptoms:

  • Your temperature goes higher than 38ºC (100ºF), and/or you feel chills.
  • There is significant redness or increased pain at your incision.
  • Your urine flow has decreased, or if you cannot pass urine at all.

If your health issue is urgent or requires immediate attention please go to your local emergency department.

Who do I call with general post-operative questions?

Use Easy Call to speak with your transplant coordinator about post-operative questions.

Who Do I Call With In An Emergency?

If you have an emergency, please go to the closest emergency room or call 911.

Can I Email My Coordinator?

Talk to your transplant coordinator about email options, a consent form is required.

Please DO NOT call your surgeon's clinic with post-operative questions.

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