Liver Transplant

Under general anaesthesia and via an upper-abdominal hockey-stick or inverted-Y incision, the surgical team mobilises the cirrhotic liver, divides ligamentous attachments, and clamps the vena cava and portal vein before hepatectomy. The donor liver is then implanted with end-to-end anastomoses of the suprahepatic and infrahepatic IVC, the portal vein and the hepatic artery, with reperfusion in stages. Bile drainage is restored by direct duct-to-duct anastomosis or Roux-en-Y choledochojejunostomy. Drains are placed and the abdomen is closed.

1. 1Comprehensive transplant assessment: MELD/UKELD scoring, cardiac and pulmonary work-up, dental review, infection screen.
2. 2Listing on the national transplant registry with regular re-evaluation; or living-donor work-up if relevant.
3. 3Optimise nutrition (high-protein, branched-chain amino acids) and manage ascites, encephalopathy and varices.
4. 4Vaccinations (hepatitis B, pneumococcus, influenza) before transplantation.
5. 5Pre-operative bloods and cross-match; psychological preparation for lifelong immunosuppression.

1. 1Day 0-3: Intensive care monitoring, ventilator support, daily Doppler ultrasound of vascular anastomoses.
2. 2Days 3-14: Step-down ward; initiation and titration of tacrolimus-based immunosuppression; physiotherapy.
3. 3Weeks 2-4: Hospital discharge once graft function is stable, drains removed and patient self-caring.
4. 4Weeks 4-12: Frequent outpatient blood tests, immunosuppression dosing, surveillance for rejection and infection.
5. 5Months 3-6: Gradual return to office work; close monitoring of liver enzymes, drug levels and CMV.
6. 6Lifelong: Annual review, cancer surveillance and lifelong immunosuppression.