Transplant Procedure

Indications for liver transplantation are listed in Table86:2. The harvested liver can tolerate ischemia up to 24 h, but it functions best if ischemia time is less than 8 h. The risk of preservation injury increases after this time. Most patients undergo bilateral subcostal incision with upper midline extension to the xiphoid process. After recipient hepatectomy, the donor liver is placed in the recipient typically in the same (orthotopic) location as the liver it is replacing ( Fig 86:1). Venovenous bypass, used in most centers, may predispose the patient to thrombosis and pulmonary embolism. Normal color and consistency return to the organ in approximately 15 min. Early bile production after vascular reanastomosis is most indicative of graft function. 3 The preferred method for biliary tract reconstruction is an end-to-end choledochocholedochostomy. The use of a percutaneous biliary drain varies by center and when used typically stays in place 3 to 6 months. In children and in those whose anatomy will not allow choledochocholedochostomy, Roux-en-Y hepaticojejunostomy is performed. Newer techniques being used increasingly in pediatric patients include reduced-size liver transplant, split liver transplant, and living-related transplantation. 4

rVhMi p Uhài iniKvéil ivlitanm url nma^isém hémma

iiruH^k l.->«ii iUvfil* !"■.< -J >i.r-irH

Ac-Lin lmLhuii ■ jbuLT

TABLE BS-2 Indications for Liver Transplantation


FIG. 86-1. End-to-end choledochocholedochostomy. If the recipient's system permits, this is the preferred method for reconstruction of the biliary system, the last part of the operative phase in liver transplantation.

Was this article helpful?

0 0
How To Cure Yeast Infection

How To Cure Yeast Infection

Now if this is what you want, you’ve made a great decision to get and read this book. “How To Cure Yeast Infection” is a practical book that will open your eyes to the facts about yeast infection and educate you on how you can calmly test (diagnose) and treat yeast infection at home.

Get My Free Ebook

Post a comment