Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age
CPT4 code
Name of the Procedure:
Liver Allotransplantation, Orthotopic, Partial or Whole, from Cadaver or Living Donor, Any Age
- Common Names: Liver transplant, hepatic transplant, orthotopic liver transplantation
- Technical Terms: Allogeneic liver transplantation, partial liver graft, whole liver graft
Summary
A liver allotransplantation involves replacing a diseased or failing liver with a healthy one from a donor. This donor liver can come from either a deceased (cadaveric) donor or a living donor. The transplanted liver may be a full organ or just a portion of it, depending on the donor and recipient's needs.
Purpose
- Medical Condition: Severe liver diseases such as cirrhosis, hepatitis, liver cancer, or acute liver failure.
- Goals: To restore normal liver function, improve the patient's quality of life, and extend lifespan.
Indications
- Symptoms of end-stage liver disease (e.g., jaundice, severe fatigue, fluid buildup in the abdomen).
- Acute liver failure.
- Liver tumors that are not resectable.
- Criteria include a thorough medical evaluation to ensure absence of contraindications like active infections or advanced cardiac disease.
Preparation
- Pre-procedure Instructions: May include fasting, avoiding certain medications, and maintaining good nutritional status.
- Diagnostic Tests: Blood tests, imaging studies (like CT or MRI scans), and sometimes liver biopsies.
Procedure Description
- Recipient Preparation: The patient is put under general anesthesia.
- Incision: An incision is made in the upper abdomen to access the liver.
- Liver Removal: The diseased liver is carefully removed, ensuring that blood vessels and bile ducts are properly managed.
- Donor Liver Implantation: The donor liver (whole or partial) is placed in the correct anatomical position. Blood vessels and bile ducts are connected.
- Closure: The incision is closed once the new liver is functioning and all connections are secure.
- Tools and Technology: Surgical instruments, vascular clamps, sutures, and possibly surgical staplers.
- Anesthesia: General anesthesia is used, meaning the patient will be unconscious and pain-free.
Duration
The procedure generally lasts between 6 to 12 hours.
Setting
Performed in a hospital with specialized surgical facilities, typically in a transplant center.
Personnel
- Transplant surgeons
- Anesthesiologists
- Surgical nurses
- Perfusionists (if required)
- Critical care team for post-operative management
Risks and Complications
- Common Risks: Bleeding, blood clots, infection, bile duct complications.
- Rare Risks: Primary non-function of the graft, rejection of the donor liver, and complications from immunosuppressive medications.
- Management: Close monitoring in intensive care, medications to manage symptoms and prevent rejection, and potential additional surgeries if needed.
Benefits
- Restoration of liver function, leading to improved overall health.
- Potentially life-saving for patients with severe liver disease.
- Patients often feel better within days to weeks, with full recovery taking a few months.
Recovery
- Post-procedure Care: Frequent monitoring for signs of rejection and infection, adjustment of immunosuppressive medications, and regular blood tests.
- Recovery Time: Most patients spend 1-2 weeks in the hospital, with full recovery taking up to 6 months. Restrictions may include avoiding heavy lifting and adhering to a strict medication regimen.
- Follow-up: Regular follow-up appointments are essential for long-term success.
Alternatives
- Liver Resection: Surgical removal of the diseased portion of the liver (viable only if the disease is localized).
- Medical Management: Use of medications to alleviate symptoms or manage liver disease.
- Supportive Care: Palliative care focusing on improving quality of life without curative intent.
Patient Experience
- During: The patient will be under general anesthesia and will not feel pain during the surgery.
- After: Pain managed with medications, and patients might experience soreness at the incision site.
- Comfort Measures: Regular pain management, including analgesics and supportive care, to ensure comfort during recovery.
Patients should adhere to all medical advice and follow-up schedules to ensure the best possible outcomes and early detection of any complications.