By Dr Ananya Mandal, MD
Liver transplant is performed in people who have severely damaged livers or have developed liver failure. These people are usually put on waiting lists for the donor livers to be available for transplant. As soon as a suitable liver is available the next person on the waiting list is contacted. The new liver has to match the recipient’s blood group, tissue type and size. 1-6
From the time the transplant center contacts a potential recipient he or she is advised not to take anything by mouth (not even water) so as to be ready for the operation as early as possible.
A liver transplant may be undertaken as soon as the general health check-up of the patient including heart and lung functions are assessed. This surgery is a major one and requires general anesthesia. For general anesthesia to be administered the person needs to remain on an empty stomach and heart and lung functions need to be assessed.
Three types of liver transplant
There are three different types of liver transplant that may be offered to a person:
Orthotopic transplant or transplant of a liver from a recently deceased donor
A living donor transplant
A split type of liver transplant
An orthotopic transplant is the most common type of liver transplant. The whole liver is taken from a recently deceased donor. This is usually from a donor who has pledged his or her organs for donation prior to death and has not transmissible illness or cancers that may be transmitted to the recipient.
For the surgery the surgeon makes an incision over the abdomen and removes the diseased liver. The donor liver will then be put in position and all the blood vessels and bile ducts would be connected. The incision is then closed with dissolvable stitches or surgical staples.
Drainage tubes are attached to drain away extra fluids. These are left for several days after surgery. Patient is then shifted to the intensive care unit for recovery.
Living donor transplant
Living donor transplant means the donor is a willing living person. The donor has the operation first in which the surgeon removes either the left or right side (lobe) of their liver.
Right lobe transplants are usually recommended for adults while left lobes are used in children. This is because the right lobe is bigger and better suited for adults, while the left lobe is smaller and better suited for children.
The recipient is then opened up and the diseased liver is removed. Then the part of the liver taken from the donor is replaced making the connections with blood vessels and bile ducts as in an orthotopic transplant.
Following transplantation, the transplanted lobe will quickly regenerate itself. Even for the donor the removed portion of the liver grows back. In the recipient the new lobe usually grows to 85% of the original liver size within a week.
Split type of liver transplant
Split donation involves transplantation of a liver from a recently deceased individual to two recipients. This is possible if the next suitable recipients are an adult and a child. The donated liver will be split into the left and right lobes. The adult normally receives the larger right lobe and the child will receive the smaller left lobe.
As with living donor transplants, the transplanted portions of the liver grow back to the original size by regeneration. This method benefits two persons at a time.
Auxiliary liver transplantation
Auxiliary liver transplantation is a variety of liver transplantation where the recipient’s own liver is not completely removed. Its purpose is to retain the native liver in case of spontaneous recovery or if there is a potential for future gene therapy in cases of hereditary or metabolic liver diseases (except primary oxalosis, Wilson’s disease or tyrosinaemia in which there is a risk of cancer in the residual liver).
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)