Hepatitis C: An In-Depth Guide


Liver transplantation

People who have been living with hepatitis C for a long time may continue to experience liver problems even after they have been cured of the virus.

Liver transplantation is an option when there is a lot of injury to the liver and it cannot function (a condition known as liver failure). Liver transplantation is very successful in Canada. Some of the advantages are that many people feel better, spend less time in the hospital and are able to lead a more active life.

Transplantation is not a cure for hepatitis C—the hepatitis C virus is still present in the body and can eventually infect the new liver. Living with a transplanted organ can also be challenging. For example, a person will have to take anti-rejection drugs on a regular schedule for the rest of their life to prevent the body from rejecting the transplanted liver.

There are different stages to the liver transplant process. The process begins when a healthcare provider refers a person to a transplant centre. After that there is:


As part of the assessment, a person’s overall health and, in particular, the health of key organs (such as the heart and lungs) will be checked to determine if a transplant is needed and if the person’s health is strong enough to withstand surgery and potential complications.

Liver transplant doctors use a grading system called the Child-Pugh (sometimes also called Child-Turcotte-Pugh, or CTP) criteria or a grading system called Model for End Stage Liver Disease (MELD) to assess how well the liver is doing and if and when you should be listed for transplantation.

There is also a psychological assessment to determine if a potential recipient is mentally and emotionally ready for living with a transplanted organ.

Generally, people who are active substance users are excluded from transplant programs. People are required to be off substances for at least six months or longer, depending on their substance use and the transplant program. People are also required to not drink alcohol for six months before the transplant and indefinitely after the transplant. They may be required to attend a program to help prevent alcohol use.

Some assessments will also take social stability and support networks into account. Social stability helps with monitoring, adherence to medications and self-care, which are all important for long-term success.

Acceptance and Waiting

If a person is approved for transplantation, he or she is put on the transplant waiting list in their province. The waiting list for a liver can vary from days to years, depending on how sick a person is and the availability of a suitable donor liver.

Many transplant clinics will set up ongoing appointments for people on the waiting list. Many clinics also provide one-on-one and group support for individuals and family members to help people cope with stress and connect with others who are going through a similar experience.

Transplant and Recovery

A liver transplant involves surgery and is done under general anesthesia. The procedure usually takes about five to eight hours.

Special medications called anti-rejection drugs (also called transplant drugs or immunosuppressants) are taken to prevent the body from attacking (also known as “rejecting”) the new liver. A healthcare provider will recommend regular checkups to make sure that the body and new liver are working well together.

Most people who receive a transplanted organ begin to feel better immediately. However, despite an improvement in energy, it may take several months for a person to regain his or her strength. Many people eventually return to the activities that they used to enjoy before they became ill and needed a transplant.  

Liver transplants in people who are co-infected with HIV and hepatitis C

Special issues exist for people who have HIV and Hep C and get a liver transplant. In particular, since a person who has a liver transplant needs to take immunosuppressive medications to prevent the body from rejecting the new liver, the level of immune suppression that occurs must be monitored and assessed so that the immune system does not become weakened and increase the risk of a person getting serious infections.

Revised 2018.