is a procedure in which a non-performing or diseased liver is removed and replaced with a healthy donor liver. This procedure is suggested by doctors only when the liver disease is in a critical stage and if not treated in time could lead to liver failure. The donor’s liver is acquired either from deceased or living ones who have voluntarily donated it but generally, the availability of liver is very scarce compared to the demand which makes the procedure further complicated. Owing to these same reasons, the Liver transplant procedure is highly regulated and cannot be done by just any medical centers. This procedure can only be performed in designated medical centers and is done under the administration of a highly trained transplant physician.
Types of Liver Transplant
In today’s medical advancement there are a lot of Liver transplant procedures available that works on different circumstances of the patient’s liver condition and its severity. The procedures vary for an adult looking for a transplant as well as a kid looking for a transplant. Below mentioned are the list of liver transplant procedures and details of each one of them.
1. Orthotopic transplant
Orthotopic word comes from the Greek words Ortho – straight and topos – place. So as the word says in this procedure an excision of the recipient’s liver is done followed by division of the inferior vena cava, superior vena cava, portal vein, hepatic artery, and common bile duct. As there is disruption of the portal and inferior vena caval blood flow, it is necessary to conduct a venovenous bypass to divert blood from these vessels to the superior vena cava during the anhepatic phase of the procedure.
After this, the donor liver is anastomosed at the vascular sites, with carefully preserving hepatic arterial blood flow. Also generally bile duct too is anastomosed to the recipient’s, but there is a probability of choledochojejunostomy to be performed.
2. Living donor transplant
As the name suggests in the Living donor transplant, a portion of the liver is taken from a donor’s liver and then placed in the recipient’s body whose existing liver is not working anymore. The donor’s liver naturally grows back to its natural shape and size while the liver put in the recipient too slowly grows into a full-size liver and starts performing to its full potential.
This procedure is generally used more in children than in adults as a suitable sized deceased liver availability is rare among children than men. People who receive a liver from a living donor have better short term survival rates than those who get it from a deceased donor. But the longterm result is a bit complicated as people who get liver from living donors are generally not as sick as the ones who receive it from the deceased donor liver.
3. Split type of liver transplant
The split liver transplant procedure is one of the most effective transplant methods as 2 people can receive the donated liver rather than just one in the regular procedure. This procedure proves important as the demand for donated liver way more than the supply of it. There are two major concepts in split liver transplant procedures. The most common method provides left lateral and a right extended liver graft which can be transplanted into one child and one adult respectively. The second principle involves splitting the liver providing two full hemi grafts on the left side for a small adult or big child and the right for a medium-sized adult patient. This full right/left splitting is a very important means of harnessing more out of an adult liver graft pool but this is a very complex procedure that requires high technical skills along with a comprehensive knowledge of all types of anatomic variations.
4. Auxiliary liver transplantation
The Auxillary liver transplantation was developed looking into the fact the severe scarcity of donor scarcity. In this procedure, both the graft and the recipient’s liver are reduced. The size reductions are ideally performed on the opposite sites i.e. removing the right segment of the graft and removing left segments of the recipient’s liver or the other way round. This is done so that the patient has an approximately normal overall liver volume. The surgical team does have an option of topography and extent of the resections provided that an anatomical transection of the liver is performed. This is completely dependent on the size of the graft and the severity of the recipient’s encephalopathy. The part of the liver not used for the auxiliary transplantation is used in another patient by using the splitting procedure. Hence the technical skills of splitting too need to be present in the surgeon. The splitting procedure, however, increases the duration of the back table procedure and decreases the size and the length of both portal and arterial vessels.
Because patients Auxillary liver transplantation is at increased risk, this procedure should only be performed for a patient who is below 40 years of age and the patient should not have any chronic liver disease and without haemodynamic instability. Also, the amount of hepatocytes given with this technique is lower than the standard technique, only ABO- compatible, nonsteatotic grafts harvested from young donors with normal liver function tests should be used.
So In conclusion, although there are different liver transplant methods available, the right method completely depends on the patient’s condition of the liver, age, and availability of matching donor’s liver. A liver transplant specialist doctor would be the best person to judge the right procedure to undertake for the liver transplant.
Ruby Hall Clinic- India’s leading hospital for liver transplant and care
Ruby Hall Clinic is India’s leading hospital offering all forms of organ transplant under one roof – including liver transplant. Our team of expert doctors evaluates and treats patients with this complex disease, who are typically not considered for liver transplantation elsewhere because of factors, including age, body mass index or disease severity. We provide analysis and transplants for both children as well as adults not only in India but abroad as well.