What is the success rate of liver transplants in patients with liver disease?

Liver Transplant Success Rates in Liver Disease

Liver transplantation achieves excellent survival outcomes with current 1-year survival rates of approximately 79-90% across all indications, though success varies significantly by underlying disease etiology and patient characteristics. 1, 2

Overall Survival Rates

Current transplant outcomes demonstrate:

• 1-year survival: 79-90% across all liver disease indications, with experienced centers achieving rates exceeding 85% 1, 2
• 3-year survival: 77-85% depending on the underlying condition 1
• 5-year survival: approximately 70% for most indications 2, 3, 4
• 10-year survival: exceeds 70% for many disease categories 1, 2

These represent substantial improvement from historical data—1-year survival was only 66% in 1986 compared to current rates approaching 90% 2.

Success Rates by Specific Disease Category

Cholestatic Liver Diseases (Best Outcomes)

Primary biliary cirrhosis and primary sclerosing cholangitis achieve the highest success rates:

• 1-year survival: >90% 2
• 3-year survival: approximately 85% 2
• Primary biliary cirrhosis: 81% 1-year survival 1
• Primary sclerosing cholangitis: 81% 1-year survival 1

Metabolic Diseases (Excellent Outcomes)

Metabolic liver diseases demonstrate outstanding results:

• Adults: 1-year survival 88%, 3-year survival 84% 1
• Children: 1-year survival 94%, 5-year survival 92% 1
• Wilson's disease: 86% 1-year survival, with 80-90% survival rates reported 1
• Alpha-1-antitrypsin deficiency: 78-84% 1-year survival 3

Cirrhosis from Various Etiologies

Viral and alcoholic cirrhosis show good but slightly lower outcomes:

• Alcoholic liver disease: 80% 1-year survival 1
• Virus-related cirrhosis: 77% 1-year survival 1
• Autoimmune cirrhosis: 78% 1-year survival 1
• Noncholestatic disorders: 1-year 86%, 3-year 77% 2

Acute Liver Failure (Lower Success Rates)

Fulminant hepatic failure represents the most challenging indication:

• Fulminant hepatic failure: 61% 1-year survival 1
• Subacute liver failure: 69% 1-year survival 1
• Historical conservative management: only 7-36% survival without transplant 1

This contrasts dramatically with the 79-87% 1-year survival achieved with transplantation, demonstrating the life-saving benefit in this population 5.

Hepatic Malignancy (Moderate Outcomes)

Liver cancer shows intermediate success rates:

• Hepatocellular carcinoma: 67% 1-year survival 1
• Cholangiocarcinoma: 58% 1-year survival 1

Pediatric Conditions

Children achieve excellent outcomes, particularly for biliary atresia:

• Biliary atresia: 10-year graft survival 73%, patient survival 86% 1
• Overall pediatric transplants: 1-year survival 80-90% 6

Critical Factors Affecting Success

Age-Related Outcomes

Age influences long-term but not short-term survival:

• 14-37 years: 1-year 83.3%, 5-year 73.8% 3
• 38-54 years: 1-year 79.6%, 5-year 69.7% 3
• 55-63 years: 1-year 76.0%, 5-year 63.0% 3
• >65 years: comparable short-term outcomes but lower long-term survival 2

Disease Severity at Transplant

Pre-transplant clinical status critically impacts outcomes:

• ACLF grade 3 with CLIF-C ACLF score <64: 1-year survival 83.9% with transplant versus 7.9% without 1
• ACLF-3 patients: 5-year survival 67.7%, still excellent despite being lower than ACLF 0-2 1
• Patients requiring mechanical ventilation or with lactate >4 mmol/L have significantly worse outcomes 1

Long-Term Survival Considerations

Beyond the first year, different mortality patterns emerge:

• Patients surviving the first year: approximately 90% 1-year survival thereafter, 70% 5-year survival 2
• 10-year survival: exceeds 70% for many indications 2
• 20-year survival: approximately 37.6% 7

Late mortality causes differ from early post-transplant deaths:

• De novo malignancy: cumulative incidence 16-42% by 20 years, with cancer rates 2-4 fold higher than matched controls 2
• Cardiovascular disease: 9.8% of deaths 7
• Infection: 11.6% of deaths 7
• Graft failure: 21.2% of deaths 7

Common Pitfalls to Avoid

Early referral is critical—delayed transplant evaluation significantly worsens mortality. 1 Patients should be referred when:

• Serum bilirubin exceeds 100 μmol/L 1
• Mayo model score ≥5 or Child-Pugh grade C 1
• Any evidence of decompensated cirrhosis 1

For acute liver failure, immediate contact with a transplant center is mandatory when prothrombin time <50%. 5 The window for successful transplantation in ACLF-3 is narrow—median time from listing to transplant is only 4-8 days, requiring daily reassessment 1.

Never delay transplant evaluation in decompensated patients, as post-discharge prognosis without transplant is dismal with 1-year survival <25%. 8