Liver Transplantation

The liver is an essential organ in human body with a range of criticalfunctions. Altogether, the organ is thought to be responsible for up to 500 separate functions, usually in combination with other systems and organs. These include decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification. It main functionality is to produces bile, an alkaline compound which aids in digestion. Hence, a healthy liver is quite vital for survival.

Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease. Living donor transplantation is a multidisciplinary approach and requires the coordination of highly skilled doctors from multiple specialties. Innovative technology and technical expertise of the support staff is also very crucial.

Liver transplant is also called as hepatic transplantation. The procedure involves the replacement of a damaged liver of a person with a healthy liver of another person. It serves as the last remedy for patients with acute or chronic condition resulting in irreversible liver dysfunction. Advanced age and serious heart, pulmonary or other disease can prevent transplantation (relative contraindications). Most liver transplants are performed for chronic liver diseases that lead to irreversible scarring of the liver, or cirrhosis of the liver.

Virtually all liver transplants are done in an orthotopic way, where the native liver is removed and the new liver is placed in the same anatomic location. The transplant operation can be conceptualized as consisting of the hepatectomy (liver removal) phase, the anhepatic (no liver) phase, and the postimplantation phase. The operation is done through a large incision in the upper abdomen.

The hepatectomy stage involves division of all ligamentous attachments to the liver, as well as the common bile duct, hepatic artery, hepatic vein and portal vein. Implantation involves anastomoses (connections) of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new liver, the biliary (bile duct) anastomosis is constructed, either to the recipient's own bile duct or to the small intestine. The surgery can take up to seven hours.

The large majority of liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients. A major advance in pediatric liver transplantation was the development of reduced size liver transplantation, in which a portion of an adult liver is used for an infant or small child. Further developments in this area included split liver transplantation, in which one liver is used for transplants for two recipients, and living donor liver transplantation, in which a portion of a healthy person's liver is removed and used as the allograft.

Liver transplantation is unique in that the risk of chronic rejection also decreases over time, although the majority of recipients need to take immunosuppressive medication. It is possible to be slowly taken off anti rejection medication but only in few cases.

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