The Liver Transplant Operation
There are risks with any surgery, and general anesthesia in particular. But with advances in surgical technique and pharmaceutical breakthroughs, transplanted livers are lasting longer and functioning better. Transplantation success improves overall patient survival rates and enriches the quality of life. Some patients transplanted at BIDMC have had their transplanted liver for more than 20 years.
Transplanting a liver can be a lengthy operation, taking anywhere from 4 to 12 hours to complete. The surgeon begins by making an incision shaped like an upside-down and lopsided "Y." It stretches from one side of the rib cage to the other. The short, straight portion of the incision that extends up to the breastbone is 3 to 4 inches long. The incision from one side of the rib cage to the other is from 12 to 16 inches long.
The transplant operation is done in phases:
- Removing the diseased liver
- Implanting the new donor liver using a "piggyback" technique, and
- Connecting the portal vein, hepatic artery and bile duct
Along with your diseased liver, the transplant surgeon also removes your gallbladder. The donor liver comes with gallbladder attached, because it stores bile for the liver, but you receive only the donor liver. You do not need a gallbladder, so the transplant surgeon removes it before transplanting the liver.
The transplant surgeon replaces your old liver with all - or part of - the healthy donor liver. This new liver, also called a graft, is placed in the same exact location as your original liver.
During the transplant, the surgeon uses a "piggyback" technique, which preserves your own inferior vena cava. The vena cava is a large vein that returns blood to the heart from the abdominal organs (including the liver) and the lower limbs. Preserving the vena cava using this piggyback technique is safer because there is less blood loss, and it eliminates the need for a "venovenous bypass," which would be required if the vena cava is removed with your liver. In the piggyback technique, the transplant surgeon attaches the large vein at the top of the donor liver, called the suprahepatic vena cava, to your suprahepatic vena cava.
Restoring Blood Flow
The next phase of the operation is to attach the vessels and restore blood flow to the transplanted liver. The transplant surgeon connects the donor to recipient portal veins, and the donor to recipient hepatic arteries. With all arteries and veins connected, and blood supply restored, the new donor liver should begin to make bile, clot blood and be a healthy "pink" color.
The last part of the operation is to connect the donor common bile duct, to either your own bile duct or to your small intestine.
The team will close your incision with staples or sutures and cover the area with a gauze dressing. With the operation complete, you will go to the surgical intensive care unit (SICU). The surgeon will let your family members know how you are doing.