The Liver Transplant Operation
A liver transplant involves the removal of and preparation of the donor liver, removal of the diseased liver, and implantation of the new organ. The liver has several key connections that must be re-established for the new organ to receive blood flow and to drain bile from the liver. The structures that must be reconnected are the inferior vena cava, the portal vein, the hepatic artery, and the bile duct. The exact method of connecting these structures varies depending on specific donor and anatomy or recipient anatomic issues and, in some cases, the recipient disease.
For someone undergoing liver transplantation, the sequence of events in the operating room is as follows:
- Evaluation of the abdomen for abnormalities that would preclude liver transplantation (for example: undiagnosed infection or malignancy)
- Mobilization of the native liver (dissection of the liver attachments to the abdominal cavity)
- Isolation of important structures (the inferior vena cava above, behind, and below the liver; the portal vein; the common bile duct; the hepatic artery)
- Transection of the above mentioned structures and removal of the native, diseased liver.
- Sewing in the new liver: First, venous blood flow is re-established by connecting the donor’s and the recipient’s inferior vena cava and portal veins. Next, arterial flow is re-established by sewing the donor’s and recipients hepatic arteries. Finally, biliary drainage is achieved by sewing the donor’s and recipient’s common bile ducts.
- Ensuring adequate control of bleeding
- Closure of the incision