Liver transplantation

Abstract

This assessment of the role of liver transplantation in treating end-stage liver disease today is based on two major series, one from Denver and the other from the Cambridge/Kings College Hospital, England. The findings of these groups are highlighted, as are the changes in technique that have led to considerably improved survival in the past two years.

Figure 1

Techniques of biliary duct reconstruction acceptable to us for most transplantation recipients. A, Choledochocholedochostomy. Note that the T-tube is placed, if possible, in recipient common duct. B, Cholecystojejunostomy. C, Choledochojejunostomy after removal of gallbladder. (From Starzl, T. E., Koep, L. J., Halgrimson, C. G., et al.: Liver transplantation, 1978. Transplant. Proc., 1978. in press. By permission.)

Figure 2

Diagram showing the completed anastomoses between Hartmann's pouch and the donor common duct and the fundus and the recipient's common duct. The T-tube is splinting both anastomoses. (From Calne, R. Y.: A new technique for biliary drainage in orthotopic liver transplantation utilizing the gallbladder as a pedicle graft conduit between the donor and recipient common bile ducts. Ann. Surg., 184:605–609, 1976. By permission.)

Figure 3

Retroportal artery. Posterior views of upper abdominal organs to show the usual configurations of this artery. A. Retroportal artery ascending to join the right hepatic artery supplying the common bile duct en route (20 percent of specimens). B, Retroportal artery joining the retroduodenal artery, and sending small branches to the supraduodenal common bile duct (60 percent of specimens). CA, celiac axis; CBD, common bile duct; IPDA, inferior pancreatico-duodenal artery; PV, portal vein; RDA, retroduodenal artery; RHA, right hepatic artery; RPA, retroportal artery; SMA, superior mesenteric artery. (From Northover, J., and Terblanche, J.: Bile duct blood supply. Its importance in human liver transplantation. Transplantation, 26:67–69, 1978. By permission.)

Figure 4

Retroportal artery. Photograph and drawing of a cast to demonstrate this vessel; in the drawing it is emphasized in black. It arises from the dorsal pancreatic branch of the celiac axis, and in this case conforms to both patterns shown in Figure 3. (From Northover, J. and Terblanche, J.; Bile duct blood supply. Its importance in human liver transplantation. Transplantation, 26:67-69,1978. By permission.)