We all know the liver is one of the body’s largest and most complex organs. Adults weigh roughly three pounds and are composed of a spongy mass of wedge-shaped lobes. The liver performs a variety of vital activities.
The liver aids in the digestion of carbs, lipids, and proteins, as well as the storage of vitamins. In addition, it converts nutrients from food in the intestines into elements the body requires for survival.
Those with severely damaged livers or who have undergone liver failure undergo hepatic transplantation. However, these persons are typically placed on waiting lists until the donor’s livers become available for transplant.
The following person on the waiting list is contacted when a compatible liver becomes available. There are two very different surgical approaches to liver transplantation. The orthotopic and heterotopic approaches can take up to ten hours to complete.
Let us put some light on orthotopic transplants in this blog!
Table Of Contents
- What Is An Orthotopic Liver Transplant?
- When Is This Surgery Required?
- Evaluation For Orthotopic Liver Transplant
- Orthotopic Liver Transplant Procedure
- Post-Surgery Care For Orthotopic Liver Transplant
- Expert’s Advice
- The Final Say
- FAQs
What Is An Orthotopic Liver Transplant?
Orthotopic Liver Transplantation is a surgical operation that replaces a sick native liver with a new one taken from a recently dead individual in the same anatomic position. Orthotopic Liver Transplant is the treatment for end-stage liver disease (chronic liver failure).
A deceased donor is someone who has vowed to donate their organs after death. The surgery is complicated, requiring careful harvesting of the donor organ and installation into the recipient. Because a liver transplant is a high-risk procedure, requiring significant lifestyle adjustments following the process.
Orthotopic liver transplantation (OLT) therapy is suitable for patients with advanced liver disease. It involves the substitution of a diseased native liver with normal liver or a part of the normal liver from a living donor or a deceased person. Those with irreversible acute and chronic liver damage should consider OLT.
When Is This Surgery Required?
Orthotopic Liver Transplantation is recommended for those with an acute or chronic liver illness that cannot be addressed with non-surgical therapies or alternative surgical procedures. Therefore, OLT is performed on patients (including adults and children) with acute or chronic liver disease. The most common reasons are as follows.
• Cirrhosis (Alcohol-Related, Viral, Cryptogenic)
• Hepatitis B And Hepatitis C
• Cholestatic Liver Disease
• Primary Biliary Cirrhosis (Pbc) Or Primary Sclerosing Cholangitis (Psc)
• Non-Cholestatic Liver Disorders
• Persistent Hbv Infection (Autoimmune Hepatitis Or Cryptogenic Hepatitis)
• Metabolic Liver Disease
• Alpha-1-Antitrypsin Deficiency, Wilson’s Disease, Hereditary Hemochromatosis,
• Acute Liver Failure
• Primary Malignancies Of The Liver
• Hepatocellular Carcinoma,
• Liver Tumour
• Biliary Atresia
• End-Stage Liver Failure
Evaluation For Orthotopic Liver Transplant
Firstly, eligibility tests of the donor and recipient are carried out by performing several full-body checkups. A complete bodily examination assists doctors in identifying any pre-existing medical issues that may play a role during or after the transplant surgery.
The risks and consequences and the procedure’s benefits are described to the patient, and a written agreement is sought. The assessment process’s goals are to identify whether the recipient is
- Healthy enough to tolerate the procedure medications
- Assess any systemic conditions that might interfere with the success of the transplant
- The living donor should be willing to take medications as directed and follow the suggestions of the transplant team
The following tests, procedures, and consultations may be recommended.
• Lab blood and urine tests
• Imaging tests
• Tests of the heart to determine the health of the cardiovascular system
• A general health exam, such as routine cancer screening tests, evaluates the overall health. Also, to check for any other illnesses that may impact the success of the transplant.
The evaluation process makes include the following steps.
- Nutritional counselling: To go over pre- and post-operative diets.
- Psychological evaluation: This determines the patient’s mental health.
- Meetings with social workers: Speak with friends and relatives to ensure that the transplant is not imposed and is totally at the option of the individual.
- Addiction counselling: The evaluation of any problematic habits and their elimination or control. Its impact on transplant treatment will also be examined.
- Financial counselling: To prepare for the costs of the entire surgery, both before and after the transplant.
After the tests and evaluations are completed, a meeting with the transplant and ethics committee of the transplant hospital is scheduled. The donor and recipient families are questioned to prevent violent and criminal acts. The patient is placed on the transplant waiting list once the committee is satisfied.
Orthotopic Liver Transplant Procedure
The procedure for orthotopic liver transplant includes
- Pre-surgical Phase
Liver-support therapy may be recommended before transplant surgery. The orthotopic approach is used in almost all liver transplants.
- Anaesthesia Phase
Patients are sedated to give excellent pain control in the immediate postoperative period and to allow for less general anaesthesia during the treatment. However, the anesthesiologist provides general anaesthetic throughout the surgical operation.
- Surgical Phase
The transplant procedure is classified based on the existence of the liver in the body
• Hepatectomy phase: Removal of the liver
• Anhepatic phase: No liver phase
• Postimplantation phase: After the transplant
The procedure is carried out through an incision in the upper abdomen. All ligamentous attachments to the liver, common bile duct, hepatic artery, vein, and portal vein must be divided during a hepatectomy.
Most of the time, the inferior vena cava’s retrohepatic section is removed together with the liver. Yet, another method retains the recipient’s vena cava. An ice-cold organ preservation solution replaces the donor’s blood in the liver until the allograft liver is placed.
The inferior vena cava, hepatic artery, and portal vein are all connected during the procedure. Then, as blood flow is restored to the new liver, the bile duct is constructed by connecting it to the recipient’s bile duct or small intestine.
The operation would take at least eight to ten hours. Depending on the severity of the process, it may be longer or shorter. However, long and short-term complications can stay longer.
Most liver transplants, particularly those performed on adults, use the complete liver of a deceased donor. However, due to a decline in donors, LDLT is widespread in India, where a portion of the liver is extracted from a healthy liver.
The discovery of reduced-size liver transplants is a significant accomplishment in paediatric liver transplantation. An infant or young toddler receives a portion of an adult liver transplant.
- Cooling
Between the time the liver is removed from the donor and placed in the recipient, it is preserved in a temperature-controlled preservation solution. The lower temperature postpones the degradation process caused by regular metabolic activities. The storage solution was created expressly to counteract the negative consequences of cold ischemia.
- Closure
Finally, absorbable sutures are used to seal the skin.
- Pain Management
Pain medication is administered at the surgeon’s discretion, based on the patient’s pain level and tolerance. It is recommended that the patient begin tapering off the pain medication a few days after the operation.
Post-Surgery Care For Orthotopic Liver Transplant
Orthotopic liver transplantation is a complex procedure requiring extensive aftercare. However, some points that may be useful are as follows.
- Joining liver transplant support groups on social media or those in the same locality may help share experiences and the do’s and don’ts before or after the surgery
- Connecting with rehabilitation services
- Setting realistic goals for nutrition and exercise management. Unlearning destructive behaviours like alcohol consumption could be the first step towards a brighter future
- Regular intake of immunosuppressant drugs as advised by the doctor
- Follow up with the liver transplant team regularly to ensure timely investigations and appropriate adherence to immunosuppressive medicines
Expert’s Advice
Since the liver is a vital organ in our body that conducts numerous essential activities. As a result, liver surgery and post-operative care are critical. After the surgery, you must take drugs daily and maintain a balanced diet and exercise programme.
The Final Say
OLT is done in individuals with irreversible acute and chronic liver disease forms. It is a life-saving surgery. Proper care is essential following surgery. You must follow your doctor’s recommendations and maintain contact with them.
Bansal Hospital Bhopal’s liver transplant and hepato-pancreato-biliary surgery department have the best facilities in the town. We are dedicated to providing you the best healthcare services in town with an outstanding team of doctors and medical professionals.
FAQs
Infections are a widespread complication after a liver transplant. The most common infections are chest infections or urine infections. It is generally straightforward to treat them with antibiotics tablets.
Because either your body is attacking the new liver (rejection) or the new liver is not working correctly (graft failure) due to a blockage/ leak in one of your bile ducts- bile is a fluid secreted by the liver that passes out through tubes called bile ducts).
Older adults are not usually offered transplants because of very fewer chances of surviving the operation. There is no upper age limit; a healthy person in the seventies can have successfully undergone transplants.
The average treatment cost of a Liver Transplant in India is approximately Rs. 22,56,000 to 30,50,000.
You might suffer a few minor symptoms if rejection happens, though some people might feel fine for a while. Fever above 100° F or 38° C, elevated liver function tests, yellowing of the eyes or skin, and exhaustion are among the most prevalent early signs disease.
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