How is liver transplant surgery performed?
There are three types of liver transplantation methods. Orthotopic transplantation is the replacement of a whole diseased liver with a healthy donor liver. Heterotopic transplantation is the addition of a donor liver at another site, while the diseased liver is left intact. Reduced-size liver transplantation is the replacement of a whole diseased liver with a portion of a healthy
donor liver. Reduced-size liver transplants are most often performed on children.
When an orthotopic transplantation is performed, a segment of the inferior vena cava attached to the liver is taken from the donor as well. The same parts are removed from the recipient and replaced by connecting the inferior vena cava, the hepatic artery, the portal vein and the bile ducts.
When there is a possibility that the afflicted liver may recover, a heterotopic tranplantation is performed. The donor liver is placed in a different site, but it still has to have the same connections. It is usually attached very near the original liver, and if the original liver recovers, the donor shrivels away. If the original liver does not recover, it will shrivel, leaving the donor in place.
Reduced-size liver transplantation tranplants part of a donor liver into a patient. It is possible to divide the liver into eight pieces, each supplied by a different set of blood vessels. Two of these pieces have been enough to save a patient in liver failure, especially if the patient is a child. It is therefore possible to transplant one liver into at least two patients and to transplant part of a liver from a living donor and have both donor and recipient survive. Liver tissue grows to accommodate its job so long as there is initially enough of the organ to use. Patients have survived with only 15-20% of their original liver, provided that 15-20% was healthy.
Liver transplants usually take from six hours to 12 hours. During the operation, surgeons will remove your liver and will replace it with the donor liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.
During the operation, a tube will be placed through your mouth into your windpipe (trachea) to help you breathe during the operation and for the first day or two following the operation. The tube is attached to a ventilator that will expand your lungs mechanically. A nasogastric tube will be inserted through your nose into your stomach. The N/G tube will drain secretions from your stomach, and it will remain in place for a few days until your bowel function returns to normal. A tube called a catheter will be placed in your bladder to drain urine. This will be removed a few days after the operation. Three tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will remain in place for about one week.
In most cases, the surgeon will place a special tube, called a T-tube, in your bile duct. The T-tube will drain bile into a small pouch outside of your body so it can be measured several times daily. Only certain transplant patients receive a T-tube, which remains in place for five months. The tube causes no discomfort and does not interfere with daily activities.