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. 1988 Mar;17(1):33-51.

Surgical technique of orthotopic liver transplantation

L Makowka  1 , A C Stieber, L Sher, D Kahn, L Mieles, J Bowman, J W Marsh, T E Starzl
Affiliations

Surgical technique of orthotopic liver transplantation

L Makowka et al. Gastroenterol Clin North Am. 1988 Mar.

Abstract

Although significant strides have been made in the surgical technique of orthotopic liver transplantation, numerous problems and nuisances are still encountered. Further surgical refinements will certainly evolve. The development of better preservation techniques, the use of intraoperative flowmeters, and the availability of new technologies, such as an artificial liver, should impact and advance the techniques of liver transplantation significantly and improve the overall results even further.

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Figures

Figure 1
Figure 1
Veno-venous bypass without systemic heparinization during the anhepatic stage of liver transplantation. (Reprinted by permission of Thomas E. Starzl, M.D., Ph.D., University of Pittsburgh, and Surg Gynecol Obstet 160:270–272, 1985.)
Figure 2
Figure 2
The fashioning of the suprahepatic caval cuff: The stumps of the main suprahepatic veins are opened in continuity with the main lumen, forming a common funnel. (LHV = left hepatic vein; MHV = middle hepatic vein; RHV = right hepatic vein; IVC = inferior vena cava)
Figure 3
Figure 3
Anastomosis of the suprahepatic vena cava.
Figure 4
Figure 4
Performance of the infrahepatic caval anastomosis, with flushing of the liver during suture of the anterior wall.
Figure 5
Figure 5
Technique of portal vein anastomosis and of portal vein reconstruction using free-standing donor iliac vein graft. “Growth factor”—the two ends of the running suture are tied together away from the vessel wall to prevent suture line stenosis.
Figure 6
Figure 6
Various methods for primary anastomosis of the hepatic artery.
Figure 7
Figure 7
Reconstruction of the donor hepatic artery when a right branch from the superior mesenteric artery is present.
Figure 8
Figure 8
A. Performance of the retropancreatic tunnel for placement of an aortohepatic arterial graft. B. Cross-sectional view.
Figure 9
Figure 9
The various tunnel routes for the aortohepatic graft. A. Long tunnel; B. short tunnel; C. medium tunnel.
Figure 10
Figure 10
The techniques of aortic “conduits” in pediatric recipients
See this image and copyright information in PMC

References

    1. Esquivel CO, Iwatsuki S, Gordon RD, et al. Indications for pediatric liver transplantation. J Pediatrics. in press. - PMC - PubMed
    1. Gordon RD, Shaw BW, Jr, Iwatsuki S, et al. A simplified technique for revascularization of liver homografts with a variant right hepatic artery from the superior mesenteric artery. Surg Gynecol Obstet. 1985;160:474–476. - PMC - PubMed
    1. Griffith BP, Shaw BW, Jr, Hardesty RL, et al. Veno-venous bypass without systemic anticoagulation for transplantation of the human liver. Surg Gynecol Obstet. 1985;160:270–273. - PMC - PubMed
    1. Lerut J, Gordon RD, Iwatsuki S, et al. Biliary tract complications in human orthotopic liver transplantation. Transplantation. 1987;43:47–51. - PMC - PubMed
    1. Shaw BW, Jr, Gordon RD, Iwatsuki S, et al. Retransplantation of the liver. Semin Liver Dis. 1985;5:394–401. - PMC - PubMed

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