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

1. Recipient Preparation: The patient is put under general anesthesia.
2. Incision: An incision is made in the upper abdomen to access the liver.
3. Liver Removal: The diseased liver is carefully removed, ensuring that blood vessels and bile ducts are properly managed.
4. Donor Liver Implantation: The donor liver (whole or partial) is placed in the correct anatomical position. Blood vessels and bile ducts are connected.
5. 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.