Refinements in the Surgical Technique of Liver Transplantation

Abstract

At one time, the operation of orthotopic liver transplantation was viewed as too difficult and dangerous to be practical on a large scale.The image of the procedure as one requiring a virtuoso surgical team has changed during the last few years as the result of technical improvements.These have put the operation within the capability of many competent general and vascular surgeons.In this account, we will discuss various aspects of this still complex undertaking, with emphasis on those recently clarified details that stand above others in importance and significance. DONOR OPERATIONOrthotopic hepatic transplantation is an exercise in futility without a well-preserved and promptly functioning liver.At the present time, liver grafts usually are removed as part of a multiple organ procurement, which can be performed easily in brain-dead donors without jeopardizing any of the organs.! When the liver is used, the most common organ combinations in order of frequency are liver and kidneys; liver, kidneys, and heart; and liver, kidneys, and heart-lung.We do not remove the liver and pancreas from the same donor because the arterial blood supply of both organs is based on the donor celiac axis.