When drugs and other medical interventions can no longer control complications in end stage liver disease, liver transplantation can be a lifesaving option for the appropriate candidate.

Indications for Liver Transplantation

Adult

• Hepatitis C
• Hepatitis B
• Primary Biliary Cirrhosis
• Primary Sclerosing Cholangitis
• Alcoholic Liver Disease
• Autoimmune Hepatitis
• Cryptogenic Cirrhosis

Pediatric

• Biliary Atresia
• Hepatitis/Fulminant Failure
• Metabolic DIseases
• Alpha 1 Antitrypsin
• Cryptogenic Cirrhosis
• Liver Tumors

Liver Transplant Surgical Procedure
The abdomen is opened with an incision that looks like an upside down “Y”, which begins at the breastbone and extends along the ribs on both sides. A retractor is placed to allow the surgeon to have exposure to the liver and the connecting arteries and veins. The left segment is separated from the diaphragm, and the hepatogastric and hepatoduodenal ligaments are divided.

The next step in the process involves the right and left branches of the hepatic artery, common bile ducts, and cystic ducts, which are removed and divided. The rest of the dissection involves detachment of the liver from the space it usually occupies and exposure of the vena cava, which is a major vein in the abdominal and chest cavity. Clamps are then placed on the portal vein and upper part of the vena cava, and the liver is removed.

Transplantation
The liver transplant actually occurs when the connections are made from the donor’s to the recipient’s vena cava, followed by attachment of the portal vein. The recipient’s hepatic artery is reconstructed using a part of the donor celiac artery and a branch-patch of the recipient artery at the level of the gastroduodenal bifurcation. Biliary drainage via a choledochojejunostomy and placement of a T-tube is then obtained. Three drains are placed around the liver, and the abdomen is closed.
The surgical procedure usually takes approximately 4-6 hours, and the patient is then transferred to the Surgical Intensive Care Unit for stabilization and intensive monitoring for approximately 24 hours. Unless there are post op complications, the patient is usually transferred to the surgical floor the following day for continued monitoring and post op convalescence.

Post Operative Care
After surgery, the patient is transferred to the Surgical Intensive Care Unit for a recovery period of approximately 24 hours, then to the nursing unit, where convalesence continues. During the hospital stay, the patient interacts with many members of the team. Physical therapy, dietary, nursing, pharmacy and other team members will be involved in providing care and education about liver transplant.