Liver transplantation techniques

	Liver trasnsplantation Microchapters
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Patient Information
Overview
Historical Perspective
Indications
Pre-surgical management
Choice of donor
Epidemiology and Demographics
Techniques
Complications
Acute rejection
Immune therapy
Post-surgical infection
Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D [2]

Overview

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]