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Though each child and each transplant is unique, many of the surgical processes that take place during a liver transplant are similar. The following account of a recent liver transplant offers a sense of what happens in the OR.
The operation was conducted on a four-year-old boy who suffered from glycogen storage disease. He received a whole, cadaveric liver (a liver from a non-living donor) from a young donor.
It took several hours to remove the boy's diseased liver and replace it with the new liver. His surgical transplant team consisted of the following:
The patient was intubated and connected to a ventilator to help him breathe during the transplant surgery. After a thorough cleaning, the skin over his abdomen was covered tightly by a thin drape filled with betadine. This helped prevent any remaining microbes from entering the incision.
The surgeons carefully isolated the patient's diseased liver from his body, bypassing or clamping off veins, arteries, and bile ducts. Throughout the liver transplant procedure, they exposed blood vessels slowly to ensure minimum blood loss. Meanwhile, the donor liver already waited on a back table in the same operating room, preserved in sterile, iced cold storage solution.
The anesthetist stood near the patient's head, monitoring his vital signs and the amount of anesthesia being given.
About halfway through the operation, the boy's liver was ready for removal. It was transported to the pathology department for study. A short period of time followed in which the boy was ahepatic, or without a liver. On average, recipients are ahepatic for about 40 minutes during their transplant surgery, until the donor liver is attached.
The new liver was placed inside the boy's chest cavity, and the surgeons began making connections. First they attached the cava vein (the largest vein in the body), then the portal vein.
After connecting the portal vein, the lead surgeon opened the clamps, and the liver entered a "time of profusion." As blood flowed into the new liver, it turned from beige to pink to a darker, healthy purple. A little blood came out of the new liver's artery, another sign of good blood flow. Next, the arteries were connected. The sutures used were made of a synthetic material which is very smooth and never dissolves.
The surgeons could see that the new liver was carrying out its function by the yellow bile it had already begun to produce. They performed what is called a Kasai procedure, or (Roux-en-Y), which provides bile duct drainage to the intestine. The length of intestine between the bile duct and the stomach prevents food from refluxing into the liver.
Before closing the abdomen, two technicians came in with an ultrasound machine. The ultrasound allowed them to confirm that blood was still flowing through the arteries and veins.
With the new liver in place and working properly, the surgeons were ready to close the incision. Afterwards, the recipient was taken to the ICU, still sleeping.
As he comes out of the anesthesia and can breathe on his own again, doctors will remove him from the ventilator. He will spend one to three days in the ICU, and then move to a room in the hospital's transplant unit, where he will spend approximately two weeks. Once the patient is discharged, he will stay in the Pittsburgh area and attend a clinic twice a week for two weeks. At clinic, the transplant team can determine how well his new liver is functioning, adjust medication dosages, and address any problems he may be experiencing. Once the immunosuppression regimen is set, the boy can go home under the care of his local doctor. He will return to the clinic with decreasing frequency for follow-up.
Learn more about Living Donor Transplantation.
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