In this communication we will discuss three questions about orthotopic liver transplantation (liver replacement). First, what are the indications for hepatic transplantation? Second, what have been the results? Third, what is the outlook for improving these figures?
Orthotopic liver transplantation is often difficult, mainly because of the liver pathology that essentially always creates severe portal hypertension and extensive venous collaterals. Thus, removal of the native liver may be an extremely formidable undertaking. Revascularization of the graft is performed in as anatomically normal a way as possible: anastomosing the portal vein and hepatic artery end-to-end and reconstructing the vena cava above and below the liver (Fig. 1).
Fig. 1
Orthotopic liver transplantation: the recipient operation. In most recent cases, cholecystoduodenostomy has been performed for biliary drainage as shown. C.a., celiac axis; C.d., common duct; G.B., gallbladder; H.a., hepatic artery; I.V.C., inferior vena ...
By far the most unsatisfactory aspect of this operation has been bilary duct reconstruction. In most of our cases, we have anastomosed the gallbladder to the duodenum after ligating the distal common duct. This method has real advantages under conditions of immunosuppression because it can be performed without stents and drains. However, there have been a number of lethal complications with these cholecystoduodenostomies, a point to which we will return later.