Liver transplantation techniques: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
Line 19: | Line 19: | ||
* The liver parenchyma is transected using an ultrasonic scalpel. | * The liver parenchyma is transected using an ultrasonic scalpel. | ||
* A portoportal anastomosis is then made between the donor right portal vein and the portal vein of the recipient. | * A portoportal anastomosis is then made between the donor right portal vein and the portal vein of the recipient. | ||
'''Split-liver transplantation''' | '''Split-liver transplantation''' | ||
* Splitting donor livers into left lateral and extended right grafts for transplantation into a pediatric and an adult recipient. [77] | * Splitting donor livers into left lateral and extended right grafts for transplantation into a pediatric and an adult recipient. [77] |
Revision as of 16:07, 15 December 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Liver trasnsplantation Microchapters |
Overview
Liver transplantation techniques
Left lobe transplantation
- The left and middle hepatic veins, left hepatic artery, and left portal vein are dissected.
- Small portal vein branches are ligated. The left bile duct is divided
- Vascular and biliary structures entering segment 4 are divided or left intact.
- The parenchyma is transected and then the left hepatic artery and left portal vein are divided, releasing the graft.
- The middle hepatic vein is removed with the graft when a full lobectomy is performed. [26-28].
Right lobe transplantation
- The right lobe fits correctly into the right subphrenic space, making the vascular anastomoses easier to perform.
- Right lobe grafts are prone to a variety of technical complications.
- After cholecystectomy, intraoperative ultrasound may be used to delineate the position of the hepatic veins and portal branches [31-33].
- The right hepatic artery and right portal vein are dissected, followed by the retrohepatic vena cava, isolating the origin of the right hepatic vein.
- The right bile duct is isolated, completing mobilization of the right lobe.
- The liver parenchyma is transected using an ultrasonic scalpel.
- A portoportal anastomosis is then made between the donor right portal vein and the portal vein of the recipient.
Split-liver transplantation
- Splitting donor livers into left lateral and extended right grafts for transplantation into a pediatric and an adult recipient. [77]
- Splitting livers into right and left lobes for transplantation has been investigated as a way to increase the supply of donor organs.
- Approximately 20 percent of donors could be split.
- Five-year survival rates were 77 percent, with graft survival rates of 76 percent. [78]
- For children, 5-year survival rates were 75 percent, with graft survival rates of 63 percent.
MARGINAL LIVER GRAFT OUTCOMES
Marginal liver grafts included those with any of the following characteristics: [80]
- Liver donor age >70 years
- Livers discarded regionally and shared nationally
- Livers from hepatitis C positive donors
- Livers with cold ischemia time >12 hours
- Livers from donation after cardiac death donors
- Livers with >30 percent steatosis
- Livers split between two recipients