Orthotopic Liver Transplant: Purpose, Procedures and Risks

Orthotopic Liver Transplant

Treatment Duration

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6 Hours

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12 Hours

Treatment Cost

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15,00,000

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27,00,000

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Orthotopic Liver Transplant

Orthotopic liver transplantation (OLT) is a treatment for an eligible patient at the end-stage of liver disease. OLT surgery involves the substitution of a diseased native liver with normal liver or a part of the normal liver from a living donor or a deceased person. OLT is recommended for individuals who have irreversible forms of acute and chronic liver disease.

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What is Orthotopic Liver Transplant?

Orthotopic liver transplantation (OLT) is a treatment for an eligible patient at the end-stage of liver disease. OLT surgery involves the substitution of a diseased native liver with normal liver or a part of the normal liver from a living donor or a deceased person. OLT is recommended for individuals who have irreversible forms of acute and chronic liver disease.

 

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Anatomy and Physiology of Orthotopic Liver Transplant

The liver is situated on the right-side upper portion of the abdominal cavity, below the diaphragm, and above the right kidney, stomach, and intestines. The liver is a dark reddish-brown and a cone-shaped organ. The liver weighs around 1.3 kilograms. 

The liver gets blood from two distinct sources:

  1. The hepatic portal vein helps in nutrient-rich blood flow to the liver.
  2. The hepatic artery helps in oxygenated blood flow to the liver.

The liver consists of two main lobes, and the lobes are made up of eight segments that contain 1000 lobules. These small lobes/lobules are attached to small ducts that further connect with the larger ducts to form a common hepatic duct. This common hepatic duct helps transport the bile (made from liver cells) to the duodenum (first part of the small intestine) and gallbladder through the common bile duct.

 

Conditions Treated with Orthotopic Liver Transplant

OLT is done on the patient (adults and children) who have an acute or chronic liver condition. The common reasons are:

  1. Cirrhosis (alcohol-related, viral, cryptogenic)
  2. Cholestatic liver disease
  3. Acute liver failure
  4. Metabolic liver disease
  5. Liver tumours
  6. Biliary atresia
  7. Early stage hepatocellular carcinoma (HCC) 
  8. End-stage liver failure

Who needs Orthotopic Liver Transplant?

OLT is done in individuals who have irreversible forms of acute and chronic liver disease.

 

How is Orthotopic Liver Transplant performed?

The doctor will do the following things to the patient:

  1. After the patient is placed in the supine position, the procedure is performed through endotracheal intubation (via mouth or nose, a tube is placed in the trachea/windpipe)
  2. Separate the diseased liver from the surrounding structures and organs.
  3. Clamp the veins and arteries to restrict the blood flow into the diseased liver.
  4. Remove the diseased liver after it is detached from the blood vessels through endotracheal intubation.
  5. Check the donor liver before attaching
  6. Attach the donor liver to the blood vessels and the bile ducts.
  7. Close the cut with stitches.

During Orthotopic Liver Transplant 

Position during the surgery: The patient will be placed in a supine (lying on the back) position with the arms spread at 90o.

Cleaning and draping: Draping and cleaning will be done to avoid infection and protect the privacy and comfort of the patient.

 

What to Expect Before and On the Day of Orthotopic Liver Transplant?

Before the surgery, the doctor will do the following things:

  1. Explain the entire procedure to the patient
  2. Ask them queries (if they have any)
  3. Give the patient sedative medicine to help them relax

On the day of Orthotopic Liver Transplant

The doctor will ask the patient to sign a consent form to allow them to do the surgery.

 

What to expect after Orthotopic Liver Transplant?

The recovery process in the hospital:

The patient:

  1. Maybe advised to stay in the hospital for more than one to two weeks. 
  2. Will have a tube in the throat to breathe.
  3. Will be given antibiotics.
  4. Blood samples will be taken to check the new liver.
  5. Will be told to move and walk around the bed.

The recovery process after hospital discharge:

  1. The patient will be instructed to:
  2. Keep the area dry and clean.
  3. Not to drive until instructed by the doctor.
  4. To take medicines that suppress their immune response forever to avoid organ rejection.

First follow-up appointment

The patient's first follow-up will be after one week of the surgery to check the recovery and remove the stitches.

 

Risk and Complications after Orthotopic Liver Transplant

Possible side effects which normally occur after Orthotopic Liver Transplant are:

  1. Breathing problems
  2. Side effects of anaesthesia
  3. Bleeding from the surgical area
  4. Heart attack 
  5. Stroke

Risks/complications of the surgery:

  1. Postoperative fatigue
  2. Postoperative pneumonia
  3. Failure of the donated liver
  4. Ascites (fluid accumulation in the abdominal cavity)
  5. Damage to the bile ducts causing bile duct scarring or bile leakage

Sequelae of infection:

  1. Jaundice
  2. Diarrhoea
  3. Fever
  4. Jaundice
  5. Redness of liver
  6. Swelling and tenderness of liver

Risks of Delaying Orthotopic Liver Transplant

The disease may lead to end-stage liver disease (chronic liver failure), a life-threatening and severe liver condition if the surgery is delayed.

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