47141 Donor hepatectomy (including cold preservation), from living donor; total left lobectomy (segments II, III and IV)

Name of the Procedure:

Donor Hepatectomy (including cold preservation), from Living Donor; Total Left Lobectomy (segments II, III, and IV)

Summary

A donor hepatectomy involves surgically removing the left lobe of the liver from a living donor for transplantation into a recipient. The left lobe, which consists of segments II, III, and IV, is preserved in a cold solution to maintain its viability until transplantation.

Purpose

This procedure is primarily performed to provide a suitable liver graft for a patient in need of a liver transplant due to severe liver disease or failure. The goals include saving the recipient's life and improving their quality of life by replacing their diseased liver with a healthy one from a living donor.

Indications

• The recipient has end-stage liver disease, acute liver failure, or certain cancers of the liver.
• The donor is in good health, with a compatible blood type and no underlying conditions that would contraindicate surgery.
• Pediatric or small adult recipients may particularly benefit from a left lobectomy due to size compatibility.

Preparation

• The donor will undergo thorough medical evaluations including blood tests, imaging studies (such as CT or MRI), and psychological assessment.
• Donors must fast for at least 8 hours before the surgery.
• Donors may need to stop taking certain medications as advised by their physician.
• Both donor and recipient need to arrange for postoperative care at home.

Procedure Description

1. Anesthesia is administered to the donor, who will be fully asleep during the procedure.
2. The surgeon makes an incision in the donor's abdomen to access the liver.
3. The hepatic artery, portal vein, bile duct, and hepatic vein are carefully dissected and divided to mobilize the left lobe.
4. The left lobe (segments II, III, and IV) is resected and immediately preserved in a cold preservation solution to maintain its viability.
5. The surgical site is closed using sutures or staples.
6. The preserved liver lobe is prepared for transplantation into the recipient.

Duration

The procedure typically takes between 4 to 6 hours, depending on the complexity.

Setting

The procedure is performed in a hospital's surgical suite, often at a specialized transplant center.

Personnel

• Lead surgeon (hepatobiliary or transplant surgeon)
• Assistant surgeons
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, bile leakage.
• Rare risks: Blood clots, liver failure in the donor, complications from anesthesia.
• Long-term risks: Potential for donor liver growth issues or remaining liver dysfunction.
• Complications are managed with medications, further surgeries, or supportive care as needed.

Benefits

• Offers a life-saving option for recipients with liver failure.
• Faster recovery and healthier liver function compared to deceased donor transplants.
• Immediate availability of the liver graft.

Recovery

• Donors typically stay in the hospital for about 5-7 days post-surgery.
• Full recovery can take 6-8 weeks, during which donors may need to avoid heavy lifting and strenuous activity.
• Follow-up appointments are crucial for monitoring liver function and overall recovery.

Alternatives

• Deceased donor liver transplant: No risk to a living donor but may involve longer waiting times.
• Liver regeneration therapies: Still largely experimental with varying efficacy.
• Supportive treatments: Managing liver disease symptoms without transplant but may not be a permanent solution.

Patient Experience

• During the procedure: The donor is under general anesthesia and will not feel anything.
• After the procedure: Postoperative pain managed with medications, discomfort from the incision, potential nausea.
• Long-term: Emphasis on lifestyle adjustments to promote liver health, regular monitoring for any signs of complications.

Pain management strategies and emotional support are provided throughout the recovery process to ensure donor comfort and well-being.