47147 Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each

Name of the Procedure:

Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each
Common Name: Liver graft arterial reconstruction
Technical Term: Arterial anastomosis for liver graft

Summary

In this procedure, blood vessels of a liver graft (either from a deceased or living donor) are surgically connected to prepare the liver for transplantation into a recipient. This step ensures that the liver will have an adequate blood supply once transplanted.

Purpose

The procedure addresses conditions requiring liver transplantation due to liver failure or severe liver disease. The goal is to ensure the liver graft has a proper arterial blood supply, critical for the organ's function and survival after transplantation.

Indications

• End-stage liver disease (e.g., cirrhosis)
• Hepatic tumors
• Genetic liver conditions
• Acute liver failure
• Criteria include being a suitable candidate for liver transplantation as determined by medical evaluation.

Preparation

• Fasting: Patients may be required to fast for a specific period before the procedure.
• Medications: Adjustments to medications, especially blood thinners, may be necessary.
• Diagnostic Tests: Blood tests, imaging studies (e.g., CT or MRI), and overall health assessments.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient remains unconscious and pain-free.
2. Preparation: The liver graft is prepared on a backbench, outside the recipient's body.
3. Arterial Anastomosis: Surgeons carefully connect the donor liver's arteries to ensure proper blood flow. This may involve trimming and suturing vessels to match the recipient's anatomy.
4. Verification: Blood flow through the newly connected artery is checked to confirm successful anastomosis.

Tools Used: Surgical instruments, arterial clamps, and sutures.

Duration

The arterial reconstruction typically takes 1-2 hours, but this can vary depending on the complexity of the case.

Setting

This procedure is performed in a hospital operating room equipped for transplantation surgery.

Personnel

• Transplant surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Common Risks: Bleeding, infection, blood clot formation
• Rare Risks: Arterial obstruction, graft failure, or thrombosis
• Management: Close monitoring and possible surgical intervention or medical therapy if complications arise.

Benefits

• Ensures a reliable blood supply to the transplanted liver.
• Increases the chances of successful transplant and graft function.
• Expected benefits realized immediately upon successful transplantation.

Recovery

• Post-Procedure Care: Monitoring in the Intensive Care Unit (ICU), immunosuppressive medications to prevent rejection, pain management.
• Recovery Time: Hospital stay typically ranges from 7-14 days, with several weeks to months for complete recovery.
• Restrictions: Limited physical activity; follow-up appointments for ongoing assessment.

Alternatives

• Treatment Options: Other medical management for liver disease, alternative liver reconstruction techniques.
• Pros and Cons: Non-surgical therapies may not be effective for end-stage liver disease; alternative vascular reconstruction methods may be less effective.

Patient Experience

• During Procedure: No awareness or pain as general anesthesia is used.
• After Procedure: Some discomfort or pain at the surgical site managed with medications. Ongoing monitoring and support from the healthcare team during recovery.