Living Donor Liver Transplantation

The most common approach to a liver transplant is an orthotopic transplantation where the recipients liver is replaced by the donor organ, or a section of a living donors liver. Once transplanted the donor's remaining liver returns to its normal volume and function, usually within a couple of months of surgery. And the section of transplanted liver grows restoring normal liver function in the recipient. London Bridge Hospitals transplant team perform living donor liver transplant only.

Donor surgery:

The donor will have had a section of their healthy liver removed for transplantation to the recipient in a parallel theatre. The donors liver will regenerate over the course of several weeks.

Recipient surgery:

An incision is made in the recipient's upper abdomen and the diseased liver is removed. The section of healthy liver will then be attached to the recipients blood vessels and bile ducts. Drains are attached to remove excess fluid, remaining in place for a few days. Both donor and recipient will then be moved to the intensive care unit to recover.

Emergency Auxiliary Partial Orthotopic Liver Transplants:

In the case of acute liver failure, in emergency situations the team at London Bridge Hospital can mobilise at speed to perform an auxiliary partial orthotopic liver transplant (APOLT). This is where the failing liver is supported by the transplanted section from a living donor. This graft remains in place until the host liver regenerates and regains functionality after which the transplanted auxiliary, section atrophies with the gradual withdrawal of immunosuppressant drugs. This removes the need for a lifetime of medication.

Both donor and recipient undergo intense medical and psychiatric assessment prior to acceptance at London Bridge Hospital for transplantation. Once accepted into the programme, the donor and recipient are scheduled for surgery in parallel theatres, minimising ischaemic time of the graft, thereby avoiding damage to the tissue. Donors and recipients are discussed in multidisciplinary team meetings including transplant surgeons, hepatologists, anaesthetists, intensivists, clinical nurse specialists and transplant coordinators. Patients with complex needs are reviewed, where appropriate by cardiac, respiratory, renal and diabetes specialists.

Both donor and recipient undergo intense medical and psychiatric assessment prior to acceptance at London Bridge Hospital for transplantation. Once accepted into the programme, the donor and recipient are scheduled for surgery in parallel theatres, minimising ischaemic time of the graft, thereby avoiding damage to the tissue. Donors and recipients are discussed in multidisciplinary team meetings including transplant surgeons, hepatologists, anaesthetists, intensivists, clinical nurse specialists and transplant coordinators.

Patients with complex needs are reviewed, where appropriate by cardiac, respiratory, renal and diabetes specialists.

Following surgery the donor and recipient will spend time in London Bridge Hospitals Level 3 Intensive Care Unit. Crucially these patients are supported by intensive care consultants with expertise in liver transplantation.

After a minimum of two days the donor is likely to be moved onto the liver ward under the care of both the transplant surgeons and transplant hepatologists. The recipient, once stable, usually goes back to the ward after three days in intensive care.

Immunosuppression and transplant rejection, renal function and infection are the key focus of aftercare all require close monitoring by the multidisciplinary team of transplant surgeons, hepatologists and clinical nurse specialists.