Chapter 23 - Surgical procedure

Summary

A successful liver transplant requires a number of procedures, including donor hepatectomy, preparation of the donor liver, recipient hepatectomy, and implantation of the liver graft. A midline laparotomy and sternotomy are performed and can be extended using transverse abdominal incisions to maximize surgical access. Preparation of the liver for transplantation is usually performed following a period of efficient cooling in an ice box and transportation to the recipient center. The hepatectomy begins with division of the left triangular ligament, falciform ligament, and lesser omentum before moving to the hilum. The greatest challenge when performing the portal venous anastomosis is the presence of portal vein thrombosis (PVT), which was originally an absolute contraindication to liver transplantation, but is now part of standard practice. Reperfusion of the liver is often the most dangerous part of the transplant procedure, and close communication between surgeon and anesthetist is crucial.