Liver Transplant


A liver transplant is an operation to remove a diseased liver and replace it with a healthy liver from a donor.



Signs can be divided into:

Signs related to the transplant procedure:

  • Mercedes Benz scar, although not all patients have the classic Mercedes Benz scar
  • Transplant should not be palpable underneath

Signs of previous chronic liver disease may be present such as:

  • Palmar erythema
  • Dupuytrens contracture
  • Leuconychia
  • Spider naevi
  • Gynaecomastia

Complications/side effects of immunosuppressants:

  • Cushingoid: thin skin, bruising, fingerprick marks on the fingers from diabetes which all suggest steroid use
  • Skin malignancy, hypertension, diabetes and tremor due to tacrolimus
  • Hypertension, hirsutism and gum hypertrophy associated with ciclosporin

Comment on transplant function:

  • Presence of jaundice, ascites or encephalopathy indicates the liver transplant may not be functioning.

It is highly unlikely for the patient to have any of these signs in the exam. The absence of them indicates that the transplant is likely to be functioning well and you should mention this to the examiner


Lastly, search for signs indicating the aetiology of the liver transplant:

  • Tattoos, piercings, previous injection sites – hepatitis
  • Obesity – Non-alcoholic fatty liver disease
  • Dupuytrens contracture –may suggest alcoholic liver disease
  • Middle aged woman may have had autoimmune hepatitis or primary biliary cirrhosis



If the transplant is functioning and the patient is tolerating the immunosuppressant medications there should be no symptoms

Symptoms indicating a failing transplant include increasing drowsiness suggesting encephalopathy, jaundice, ascites, abdominal pain, or fever.



Cirrhosis of the liver (from any cause but most commonly alcohol in the UK)

Acute hepatic failure – most common reasons are viral hepatitis or paracetamol


Hepatic malignancy



Investigations prior to liver transplant include:

Full liver screen to determine aetiology of liver disease (see chronic liver disease document)

Up to date FBC/U+E/LFT/clotting

Viral serologies – HIV/Hep B/C and CMV

G+S and cross match

Tissue typing




Pulmonary function tests

Up to date cervical smear – women

Up to date dental checkup



Patients are reviewed routinely at specialist centre

Regular blood tests checking U+E/FBC/LFT/coagulation screen

Assessment for transplant function as well as for side effects and complications of immunosuppressant medications:

Women need regular cervical smear

Patients are instructed to wear a medic alert bracelet/necklace

Advice to contact doctor if fever or prolonged illness

Annual influenza vaccination

Advice regarding smoking cessation and weight loss


Top tips:

Try to work out and suggest a possible underlying cause for the liver transplant.


Written by Jo Corrado

Resources used to write this document are listed in the references section of this webpage