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The Liver Transplant Operation

University of Pennsylvania Medical Center

Abraham Shaked, MD, PhD

University of Pennsylvania Medical Center, shake{at}mail.med.upenn.edu

The cadaveric donor operation, the live donor operation, and the recipient operation are described. In the cadaveric donor operation, the incision extends form the sternal notch to the symphysis pubis. A median sternotomy is performed. All hepatic ligaments are dissected toward the suprahepatic and infrahepatic vena cavae, and the right colon and small intestine are mobilized. The ligament of Trietz is taken down. The common bile duct (CBD) is dissected. The gallbladder is incised and emptied. The inferior vena cava (IVC) is transected in the chest and above the renal veins in the abdomen. The hepatic artery is dissected, and the supraceliac aorta is exposed on the left. The portal vein is exposed. Cutting across the right adrenal gland and dividing the hepato-pulmonary ligament completes the donor nephrectomy. In the live donor operation, the left lateral segment of a healthy adult is transplanted into a small child. The most common graft from a live donor for an adult recipient is a right lobe (segments V-VIII) with or without hepatic vein. In the recipient operation, a bilateral subcostal incision with a midline upper extension is made. The left triangular and gastrohepatic ligaments are taken down. In the porta hepatis, the CBD is exposed. Portal venous bypass is established. Hepatic ligaments are transected, and the liver is removed. The donor liver is put in place. The suprahepatic IVC anastomosis is performed followed by the portal vein anastomosis. The liver can be perfused. The hepatic artery and CBD anastomoses are completed.

Key Words: liver transplantation • controlled non-heart-beating donor • split liver grafts

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