Orthotopic Liver Transplantation

Orthotopic liver transplantation (OLT) is a surgical procedure that involves replacing a diseased or damaged liver with a healthy one from a donor. The term "orthotopic" refers to the fact that the new liver is placed in the same location as the original liver.

Indications

OLT is typically performed on patients with end-stage liver disease, including:

• Chronic hepatitis B and C
• Alcoholic cirrhosis
• Non-alcoholic fatty liver disease (NAFLD)
• Primary biliary cirrhosis (PBC)
• Primary sclerosing cholangitis (PSC)
• Autoimmune hepatitis
• Wilson's disease
• Hemochromatosis
• Alpha-1 antitrypsin deficiency

Surgical Procedure

The OLT procedure involves the following steps:

1. The patient is given general anesthesia and placed on a ventilator.
2. An incision is made in the upper abdomen, and the diseased liver is carefully dissected and removed.
3. The donor liver is then implanted in the same location as the original liver.
4. The blood vessels and bile ducts are connected to the new liver.
5. The incision is closed, and the patient is taken to the intensive care unit (ICU) for recovery.

Types of Donor Livers

There are two types of donor livers used in OLT:

• Cadaveric liver: A liver donated from a deceased individual.
• Living donor liver: A portion of the liver is donated from a living individual, usually a family member or close friend.

Post-Operative Care

After OLT, patients require close monitoring and care in the ICU. This includes:

• Immune suppression to prevent rejection of the new liver
• Pain management
• Monitoring for complications such as bleeding, infection, or graft dysfunction
• Nutritional support

Risks and Complications

As with any major surgical procedure, OLT carries risks and potential complications, including:

• Bleeding or hemorrhage
• Infection
• Graft rejection
• Graft dysfunction
• Respiratory failure
• Cardiac complications
• Kidney damage or failure

Outcomes and Prognosis

The outcome of OLT depends on various factors, including the underlying disease, the quality of the donor liver, and the patient's overall health. With proper care and management, many patients can expect to lead active and normal lives after transplantation.

The 1-year survival rate for OLT recipients is approximately 85-90%, while the 5-year survival rate is around 70-80%.