Orthotopic liver transplantation

Orthotopic Liver Transplantation (OLT) is a surgical procedure performed to replace a diseased liver with a healthy liver from a donor. This life-saving procedure is indicated for patients with end-stage liver disease, acute liver failure, or certain liver cancers. Orthotopic refers to the transplantation of the organ into its normal anatomical position, distinguishing it from heterotopic transplantation, where the new organ is placed in a different location.

Indications

Orthotopic liver transplantation is indicated for patients with:

• End-stage liver disease (ESLD) due to conditions such as cirrhosis, hepatitis C, alcoholic liver disease, and non-alcoholic steatohepatitis (NASH).
• Acute liver failure (ALF), which can result from drug-induced liver injury, viral hepatitis, or other causes.
• Hepatocellular carcinoma (HCC), within certain criteria.
• Metabolic liver diseases such as Wilson's disease and alpha-1 antitrypsin deficiency.

Procedure

The procedure involves several key steps:

1. Removal of the diseased liver from the recipient.
2. Preparation of the donor liver, which may come from a deceased or living donor.
3. Implantation of the donor liver into the recipient, connecting the hepatic artery, portal vein, and bile ducts.

Postoperative Care

Postoperative care is critical for the success of the transplantation. It includes:

• Immunosuppressive therapy to prevent organ rejection.
• Monitoring for complications such as infection, rejection, and vascular thrombosis.
• Regular follow-up with the transplant team for lab tests and imaging studies.

Complications

Complications of orthotopic liver transplantation can include:

• Rejection of the transplanted liver.
• Infection due to immunosuppressive medications.
• Vascular complications such as hepatic artery thrombosis.
• Biliary complications, including bile leaks or strictures.

Outcomes

The outcomes of orthotopic liver transplantation have improved significantly over the years, with advances in surgical techniques, immunosuppression, and postoperative care. Survival rates vary depending on the indication for transplantation, the health of the recipient, and other factors.