Liver Transplant Surgery Procedure

Need for liver transplant

A healthy liver is essential for survival. You may require a liver transplant if your liver stops performing properly.

If you have end-stage liver disease, a liver transplant may be recommended (chronic liver failure). This is a life-threatening liver condition. It can be caused by a variety of disorders affecting the liver.

End-stage liver disease is frequently caused by cirrhosis. It's a type of liver illness that's been there for a long time. When healthy liver tissue is replaced with scar tissue, this occurs. The liver is unable to function correctly as a result of this.

Other illnesses that can lead to liver failure include:

  • Acute hepatic necrosis is a type of liver necrosis that occurs suddenly. This is when the liver tissue dies. Acute infections and medication, drug, or toxin responses are all possible causes.
  • Hepatitis is caused by a virus. Hepatitis B or C are two of the most common causes.
  • Diseases of the metabolism. Disorders that impair the chemical function of the liver's cells.
  • Cancers of the liver that aren't secondary. These are malignant tumors that begin in the liver and spread throughout the body.
  • Hepatitis caused by autoimmunity. The liver is reddened or swollen (inflammation). When your body's disease-fighting system (immune system) destroys your liver, you get cirrhosis.

Decompensate Liver Disease Signs and Symptoms

  • Bleeding in the intestines: The barrier to portal blood flow increases as the liver scars, resulting in increased pressure in the portal venous system. Alternative channels for blood to return to the heart are required due to portal hypertension. Due to the abnormally high amount of blood running through them under increased pressure, small veins throughout the abdomen, but outside of the liver, become swollen and thin-walled. Varices are fragile veins that line the gastrointestinal tract, particularly the esophagus and stomach, and are prone to rupturing and bleeding.
  • Many proteins circulating in the bloodstream, including albumin, are synthesized in the liver, which contributes to fluid retention. Albumin and other proteins in the bloodstream exert an oncotic (or osmotic) pressure, which keeps fluid in the vascular area. Low albumin levels in liver failure drive fluid out of the bloodstream, which can't be reabsorbed. As a result, fluid builds up in tissues and body cavities, most commonly in the abdominal cavity, causing "ascites." Fluid can build up in the legs (peripheral or pedal edema) or the chest cavity (chest edema) (hydrothorax). Fluid retention is treated in three ways: first, by restricting salt consumption in the diet, then with drugs (diuretics) that compel higher salt and water loss through the kidneys, and finally, by intermittent drainage via a needle inserted into the stomach or chest cavities.
  • Encephalopathy occurs when the liver fails to remove ammonia and other poisons from the bloodstream, allowing them to build up. Toxins cause cognitive impairment, which can range from disrupted sleep-wake cycles to mild disorientation to coma.
  • The liver's major role is to remove the degradation products of hemoglobin, the molecule that transports oxygen in our blood. Bilirubin is one of the breakdown products that the liver processes and excretes. Bilirubin is not eliminated from the body in liver failure, and blood bilirubin levels rise. The skin, as well as all other body tissues, will turn yellow.

Click here for more indications of liver transplant you should know.

Liver Transplant Surgery Procedure

What Happens When You Have a Liver Transplant?

Even though each person and each transplant is unique, many of the surgical procedures involved in a liver transplant are the same.

During the transplant procedure, the patient is incubated and linked to a ventilator to assist him to breathe. The skin above his abdomen is wrapped securely with a thin drape packed with betadine after thorough cleansing. This helped to keep any leftover bacteria out of the wound.

Bypassing or clamping off veins, arteries, and bile ducts, the surgeons carefully detach the patient's damaged liver from his body. Doctors carefully expose blood arteries during the liver transplant process to ensure little blood loss. Meanwhile, the donor's liver is kept in a sterile, iced cold storage solution on a back table in the same operating room.

The anesthetist keeps a close eye on the patient's vital signs and the amount of anesthetic being administered.

The liver is ready to be removed about halfway through the procedure. It's taken to the pathology department to be examined. After that, the person is hepatic, or without a liver, for a short length of time. During transplant surgery, recipients are usually hepatic for roughly 40 minutes until the donor's liver is attached.

Putting the New Donor Liver in Its Rightful Place

The new liver is surgically implanted into the boy's thoracic cavity, and the surgeons begin connecting the organs. They connect the cava vein (the body's largest vein) first, then the portal vein.

The clamps were opened once the lead surgeon connected the portal vein, and the liver entered a "time of profusion." The new liver changed color from beige to pink to a dark, healthy purple as blood poured into it. Another indicator of healthy blood flow was a small amount of blood coming out of the new liver's artery. The arteries are then connected. Sutures will be composed of a synthetic substance that is extremely smooth and does not dissolve.

By the yellow bile it has already begun to create, the doctors can determine that the new liver is doing its duty. Food does not reflux into the liver because of the length of the intestine between the bile duct and the stomach.

Two technicians with an ultrasound machine enter the room before shutting the abdomen. They can use ultrasound to make sure blood is still flowing through the arteries and veins.

The surgeons will be able to close the incision after the new liver is in place and functioning appropriately. Following that, the patient will be transported to the ICU while still asleep.

Recovery from a liver transplant

Doctors will take the patient off the ventilator once he has recovered from anesthesia and is able to breathe on his own. He'll stay in the ICU for one to three days before being transferred to a room in the hospital's transplant unit, where he'll stay for around two weeks. After being discharged, the patient will remain in the Pittsburgh region for two weeks, attending a clinic twice a week. The transplant team can assess how well his new liver is working, change medication dosages, and treat any issues he may be having at the clinic. The youngster can return home under the care of his local doctor once the immunosuppressive regimen has been established. He'll visit the clinic less frequently in the future for follow-up.