An orthotopic liver transplant (OLT) is a surgical procedure that replaces a diseased liver with a healthy one from a donor. It is a treatment for severe, irreversible liver disease when other medical treatments are no longer effective. The term “orthotopic” signifies that the donated organ is placed into the same anatomical position as the original liver. This procedure is the most common form of liver transplantation, aiming to extend life and improve its quality for those with end-stage liver failure.
Indications for Transplantation
A transplant is considered when the liver is so damaged it can no longer perform its functions, a condition known as end-stage liver disease. The most frequent cause is cirrhosis, which is severe scarring of the liver. This scarring can result from chronic conditions like viral hepatitis C and B, long-term excessive alcohol consumption, and non-alcoholic steatohepatitis (NASH).
Other medical situations also necessitate transplantation. Acute liver failure, a rapid loss of liver function, may require an urgent transplant and can be caused by factors like acetaminophen overdose. Additionally, certain primary liver cancers, such as hepatocellular carcinoma, may be treated with a transplant if the tumor meets specific criteria. Genetic and autoimmune disorders, like Wilson’s disease or autoimmune hepatitis, can also lead to the need for a new liver.
The Transplant Evaluation and Waiting Process
Once a patient is referred to a transplant center, they undergo a comprehensive evaluation to determine if they are a suitable candidate. This process involves a multidisciplinary team of specialists, including hepatologists, surgeons, and social workers. The evaluation includes a review of the patient’s medical history, a physical examination, and extensive laboratory tests. Imaging studies such as CT scans or MRIs are used to examine the liver’s structure.
A psychosocial assessment is also a standard part of the evaluation. This step assesses a patient’s mental and emotional preparedness for the transplant, their understanding of the procedure, and their social support system. The team works to ensure the candidate can manage the physical and emotional demands of the surgery and the lifelong care that follows.
For those with chronic liver disease, prioritization on the national transplant waiting list is determined by the Model for End-Stage Liver Disease (MELD) score. This score is calculated using lab values for serum bilirubin, serum creatinine, and the international normalized ratio (INR). A higher MELD score, which ranges from 6 to 40, indicates more severe liver disease and gives the patient higher priority on the list. This system ensures that donor organs are allocated to the sickest individuals first.
The Surgical Procedure
The orthotopic liver transplant operation is a complex procedure performed in distinct phases. The first stage is the hepatectomy, which involves the surgical removal of the patient’s diseased liver. Surgeons must carefully dissect the organ from its attachments and major blood vessels to prepare the site for the new organ.
Following the removal of the native liver, the patient enters the anhepatic phase, a period where they are without a liver. During this time, which surgeons aim to keep as short as possible, the body’s circulatory stability is maintained through medical support. The surgical team works efficiently to prepare for the implantation of the donor organ.
The final phase is the implantation of the healthy donor liver. Surgeons connect the new organ by suturing the major blood vessels, including the hepatic artery, portal vein, and hepatic veins. Once blood flow is restored, the final connection is made to the bile duct to aid in digestion. The entire operation lasts several hours, after which the patient is transferred to the intensive care unit for close monitoring.
Life After Transplant Surgery
The period immediately following surgery involves a stay in the intensive care unit (ICU) for close monitoring. Medical teams watch for signs of bleeding, infection, or problems with the new liver’s function. Pain is managed with medication, and liver function is assessed through blood tests. Patients remain in the ICU for a few days before moving to a regular transplant floor.
To prevent the body’s immune system from attacking the new liver, patients must take immunosuppressant medications for the rest of their lives. These drugs work by dampening the immune response to the donor organ. While necessary for the transplant’s success, these medications can have side effects and increase the risk of infections, requiring careful management.
Long-term management is a collaborative effort between the patient and their medical team. It involves regular follow-up appointments and blood tests to monitor liver function and check for signs of organ rejection. Organ rejection is a potential complication, but it is often detected early through routine tests and can be treated successfully.
Living a healthy life after a transplant also requires lifestyle adjustments. Patients are counseled on diet and exercise to maintain a healthy weight and manage potential medication side effects like high blood pressure or diabetes. Emotional support from family, friends, and support groups is also a component of recovery, helping patients navigate the changes that come with a new organ.