Liver transplantation is often the ultimate treatment option in case of irreversible damage. Orthotopic being the most common technique to make the transplant more efficient for the patient.
Liver diseases affect a large segment of world population. There are millions of people who suffer from these disorders of varying severity. The most severe form is often signified with irreversible damage, and in such cases, a transplant is the only feasible option. Liver transplant surgeries account for the second most leading organ transplant surgeries in the US, with kidney transplant being the most sought after.
What Exactly is the Procedure Like?
Liver transplant involves replacing a part or whole of the diseased liver with the one of a healthy donor. When the diseased liver is removed from the patient’s body and a new healthy liver is transplanted, the procedure is referred as orthotopic liver transplant. In this procedure, the donor is a person who has recently died. This procedure is recommended in the cases of total liver failure. If only a part of liver is malfunctioning, then partial liver transplant can be performed. In this process, only a part of the donor’s liver is transplanted in the recipient’s body. In such cases, the donor is a living person, often a relative of the person. Sometimes, partial liver transplant is also advised as a temporary measure, until a suitable liver can be arranged.
In this surgery, the new liver is placed in the same anatomical position as the old or native liver. Hence, this surgery is highly invasive and complicated. Venovenous bypass and piggyback are the two main techniques employed. A transverse incision is made in the patient’s abdomen through which the diseased liver is mobilized using diathermy. Then the porta hepatis is dissected to divide the common bile duct and the common hepatic artery. In case of venovenous bypass, both the femoral and the axillary veins are dissected and cannulated. Vascular clamps are placed on the portal vein and inferior vena cava, which is located above and below the liver. After the diseased liver is excised, a new one is implanted by suturing the supra-hepatic and then the infra-hepatic vena cava.
Contraindications to Watch Out
Not every patient with a chronic liver disease is a candidate for a transplant. Metastatic liver cancer outside the liver is an important factor which rules out the treatment option. Besides, active alcohol and drug abuse also disqualifies a person from seeking this treatment option. Active substance abuse may further lead to failure of the newly transplanted liver, which defeats the whole purpose of the treatment. Earlier, patients suffering from HIV were also not considered eligible for an orthotopic liver transplant, however, this is no more a case, owing to advanced medical treatments. Besides, old patients and those suffering from severe pulmonary disorders are also advised against undergoing this surgery.
As mentioned above, this is a very complicated surgery and involves some amount of risk. The dense network of blood vessels makes it very difficult to separate. A component responsible for blood clotting is made in the liver itself. This component is present in very less amount in these patients. As a result, there is profuse bleeding during the surgery, which further increases the risk. Besides, severe scarring is found in patients suffering from liver cirrhosis, which makes it difficult for the native liver to be separated from the surrounding tissues.
After an orthotopic liver transplant, the new liver takes some time to function normally. It is also normal for it to bleed for a few days. In rare cases, an additional surgery may be required to remove the leaked blood.