Orthotopic Liver Transplant

Liver diseases affect a large segment of world population. There are millions of people who suffer from liver disorders of varying severity. The most severe form of liver disease is often signified with irreversible damage to the liver. In such cases, liver transplant is the only feasible option. There are various types of liver transplant surgeries available to the ailing patients. Liver transplant surgeries account for the second most leading organ transplant surgeries in the US, with kidney transplant being the most sought after organ transplant surgery. Orthotopic liver transplant surgery is the most commonly performed liver transplant surgeries.

What is Orthotopic Liver Transplant
Liver transplant procedure involves replacing a part or whole of the diseased liver with a healthy donor liver. When the diseased liver is removed from the patient's body and a new healthy liver is transplanted, the procedure is referred as orthotopic liver transplant. In this procedure, the donor is a person who has recently died. This procedure is recommended in the cases of total liver failure. If only a part of liver is malfunctioning, then partial liver transplant can be performed. In this process, only a part of the donor's liver is transplanted in the recipient's body. In such cases, the donor is a living person, often a relative of the person. Sometimes, partial liver transplant is also advised as a temporary measure, until a suitable liver can be arranged.

Surgery
In this surgery, the new liver is placed in the same anatomical position as the old or native liver. Hence, this surgery is highly invasive and complicated. Veno venous bypass and piggyback are the two main techniques of orthotopic liver transplantation. A transverse incision is made in the patient's abdomen through which diseased liver is mobilized using diathermy. Then porta hepatis is dissected to divide the common bile duct and the common hepatic artery. In case of veno-venous bypass, both the femoral and the axillary veins are dissected and cannulated. Vascular clamps are placed on the portal vein and on inferior vena cava, which is located above and below the liver. After the diseased liver is excised, a new donor liver is implanted by suturing the supra-hepatic and then the infra-hepatic vena cava.

Contraindications of Orthotopic Liver Transplant
Not every patient with a chronic liver disease is a candidate for orthotopic liver transplant. Certain conditions may impede successful liver transplant in some patients. Metastatic liver cancer outside the liver is an important factor, which rules out the liver transplant treatment option. Besides, active alcohol abuse and drug abuse also disqualify a person from seeking this treatment option. Active substance abuse may further lead to failure of the newly transplanted liver, which defeats the whole purpose of the treatment. Earlier patients suffering from HIV were also not considered eligible for a orthotopic liver transplant, however this is no more a case, owing to advanced medical treatments. Besides, old patients and those suffering from severe pulmonary disorders are also advised against undergoing this surgery.

Complications
As mentioned above, this is a very complicated surgery and involves some amount of risk. The dense network of blood vessels in liver makes it very difficult to separate. A component responsible for blood clotting is made in the liver itself. This component is present in very less amount in liver transplant patients. As a result, there is profuse bleeding during the surgery, which further increases the risk. Besides, severe scarring is found in patients suffering from liver cirrhosis, which makes it difficult for the native liver to be separated from the surrounding tissues.

After orthotopic liver transplant, the new liver takes some time to function normally. It is also normal for it to bleed for a few days. In rare cases, an additional surgery may be required to remove the leaked blood.