Alternate Names : Hepatic Transplant, Transplantation of the Liver
In liver transplantation, a healthy liver is removed from a donor who is brain dead and implanted into a person whose own liver is failing. In most cases, liver failure is a long-term condition that results from disease or injury. There are rare cases of sudden liver failure due to viral infection, toxins, or medication reactions.
In most cases, the recipient's own failed liver is removed. In a few cases, however, a person will receive part of a liver from a living or brain dead donor and the diseased liver is not removed.
Who is a candidate for the procedure?
Liver transplantation is only offered to persons with severe liver failure. The reasons for liver transplantation include:
cirrhosis, a chronic disease of the liver
biliary atresia, an obstruction of the bile ducts caused by their failure to develop normally before birth
certain metabolic disorders such as Wilson disease, an inherited disorder in which the body has too much copper
viral hepatitis (B, C, D)
cancerous tumors of the liver or bile duct
noncancerous tumors of the liver
sudden liver failure
problems with the major blood vessels that supply the liver
drug-induced liver injury
A person is evaluated by a team of healthcare professionals to see if he or she is a good candidate for a liver transplant. This team includes surgeons, liver specialists known as hepatologists, social workers, nurses, and transplant coordinators. A few conditions would disqualify a person from receiving a liver transplant. These include:
cancer within the past five years
certain infections, such as tuberculosis or osteomyelitis, a bone infection
severe lung or kidney problems that would make the operation too risky
alcholic liver disease
A candidate for a liver transplant needs to know that he or she will need to take medications to keep the body from "rejecting" the transplant. That is, the body's immune system would normally attack the new liver because it is something foreign. Immunosuppressants are medications that keep the immune system from attacking the new liver. These medications need to be taken for as long as the new liver functions. The person will also need lifelong follow-up with doctors.
If a person is found to be a good candidate for the transplant, the person's name is placed on a waiting list. It can sometimes take years for a recipient to receive a liver from a donor. These are currently 14,000 people in the US waiting for a liver transplant.
How is the procedure performed?
Usually many organs (heart, lungs, kidneys, pancreas, and liver) are being removed from the brain dead donor. There may be two or three teams who operate on the donor at the same time. After the organs are removed, they are packed for transport to the recipient. The donor's chest and abdomen are sewn up and normal preparations for a funeral take place.
The liver can be preserved safely for up to 12 to 18 hours. The transplant surgery needs to take place within this timeframe.
The recipient is given general anesthesia. The transplant operation consists of three major parts.
The diseased liver is cut away from the structures and blood vessels that hold it in place in the abdomen. This part of the operation may be very difficult and may result in a lot of bleeding.
The new healthy liver is then put in place. The 4 major blood vessels are reconnected. These include the suprahepatic vena cava, infrahepatic vena cava, portal vein, and hepatic artery.
Blood flow is restored to the liver. The surgeon checks carefully to see if there is major bleeding and if the liver is getting an adequate supply of blood.
The final connection is made to the bile duct. This small tube carries bile made in the liver to the intestines. Once the connections are complete, the incision is closed and the recipient is taken to the intensive care unit for recovery.