Types of liver transplant

The finer details of this would perhaps draw more interest from the surgical crowd.

For the pragmatic intensivist, the most important questions are "where are the sites of anastomosis" and "how much liver is in there, and of what quality".

Orthotopic transplantation: you remove the whole recipient liver, and you put the whole donor liver into the normal anatomical position.

Auxiliary transplantation: Some of the recipient liver is removed, and a small incomplete donor graft is attached to the site. This has advantages in the context of acute liver failure - eventually, when the recipients native liver recovers, one may stop the immunesuppressant drugs, and allow the graft to be destroyes. The disadvantage is the complexity of the procedure- all sorts of vascular and biliary tree elements need to be completely reconstructed.

Sites of anastomosis:

  • Hepatic artery to hepatic artery
  • Portal vein to portal vein, or to bypass graft (if there is portal vein thrombosis)
  • Vena cava may be preserved, or there may be a portal vein bypass

Quality of the donated organ:

  • There may be an entire liver
  • There may be a split graft - half of a liver (this tends to have more complications)
  • If it is a non-beating heart donor, the warm ischaemia time cannot exceed 30 minutes.

References

Chapter 101  (pp. 1040)  Liver  transplantation by Anish  Gupta,  Simon  Cottam  and  Julia  Wendon

Roberts, Mark S., et al. "Survival after liver transplantation in the United States: a disease‐specific analysis of the UNOS database." Liver transplantation 10.7 (2004): 886-897.

Onaca, Nicholas N., et al. "A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation." Liver transplantation 9.2 (2003): 117-123.

Vaid, Arjun, et al. "Molecular adsorbent recirculating system as artificial support therapy for liver failure: a meta-analysis." ASAIO Journal 58.1 (2012): 51-59.

Bañares, Rafael, et al. "Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute‐on‐chronic liver failure: The RELIEF trial." Hepatology 57.3 (2013): 1153-1162.

Schroeder, Rebecca A., et al. "Intraoperative fluid management during orthotopic liver transplantation." Journal of cardiothoracic and vascular anesthesia 18.4 (2004): 438-441.

Kirby, R. M., et al. "Orthotopic liver transplantation: postoperative complications and their management." British journal of surgery 74.1 (1987): 3-11.

Hannaman, Michael J., and Zoltan G. Hevesi. "Anesthesia care for liver transplantation."  Transplantation Reviews 25.1 (2011): 36-43.

Moreno, Rosalba, and Marina Berenguer. "Post-liver transplantation medical complications."  Ann Hepatol 5.2 (2006): 77-85.