Main indications for surgery
The need for organ transplantation arises in critical conditions when the native tissues cannot cope with their functions. The main medical indications are:
- Congenital hypoplasia of the bile ducts.
- End-stage liver cirrhosis.
- Liver and bile duct cancer.
Due to the high sensitivity of hepatocytes to oxygen deprivation, the procedure carries a risk of severe hemodynamic and metabolic shifts in the patient.
Liver transplantation methods
In medical practice, there are three main approaches to transplantation:
- Orthotopic transplantation — the most common method, in which the diseased liver is removed and the donor organ is placed exactly in its anatomical site. This restores normal bile outflow into the intestine and physiological hemodynamics.
- Heterotopic transplantation — preservation of the recipient's own liver with the implantation of an accessory organ into another region (e.g., the left hypochondrium, subhepatic space, or pelvis). Domestic modifications led by Prof. E. I. Galperin propose extraperitoneal heterotopic transplantation of the left lobe to reduce risks.
- Temporary extracorporeal connection — connecting a donor organ (often a pig's liver) to the limb vessels in reversible acute liver failure to clear toxins from the blood.
Donation issues and artificial support
The main factors hindering the development of transplantology remain the shortage of donor organs, the complexity of immunological compatibility, and strict ischemia requirements. An ideal donor is considered to be a beating-heart individual with confirmed "brain death". In cases of circulatory arrest, mechanical cardiac massagers are used for organ harvesting.
Temporary maintenance of body functions includes xenoperfusion methods and the use of artificial liver devices. The biological purification method using columns with viable hepatocytes is recognized as more advanced compared to simple toxin adsorption by sorbents.
Briefly: answers to topical questions
What is the essence of extraperitoneal heterotopic transplantation according to the E. I. Galperin modification?
The essence of the technique according to E. I. Galperin's modification lies in the extraperitoneal heterotopic transplantation of the left lobe of the liver.
Key advantages of this modification: comparative technical simplicity of execution, reduction of the threat of serious complications, and the possibility of removing the graft in case of rejection or loss of function.
What methods of mechanical artificial liver support exist and how do they differ?
The study guide indicates the following operating principles for artificial liver devices:
| Method | Operating principle | Feature |
|---|---|---|
| Toxin adsorption | Adsorption of toxins on ion-exchange resins or activated charcoal | Sorbents are used |
| Biological method | Columns with viable hepatocytes | Hepatocyte purification is considered more advanced than sorbents |
It is also noted that the lack of reliable methods for liver function support, unlike hemodialysis for the kidneys, holds back transplantology.
Three pillars of liver transplantation: Ortho (in its place — replacement), Hetero (in another place — addition), Extra (outside — temporary blood purification).
Class and exam questions
What three main methods of liver transplantation are currently used?
Modern practice utilizes orthotopic transplantation (organ replacement), heterotopic transplantation (preserving the native liver while adding a donor liver), and temporary extracorporeal connection.
What is the essence of temporary extracorporeal connection?
The method is used for reversible disorders of native liver functions. The donor organ (usually animal) is connected to the limb vessels for 1–2 hours to clear toxins from the blood and unload the diseased liver.
What are the main disadvantages of heterotopic transplantation?
The main disadvantages are the phenomenon of "competition" between the two livers, lack of space in the abdominal cavity, the need for a small graft size, and the risk of hemodynamic disorders due to the abnormal position of the organ.
What else to study on this topic
- History of experimental liver transplantation (F. Moore, C. Welch, T. Starzl)
- Domestic developments in extraperitoneal heterotopic transplantation of the left lobe (Prof. E. I. Galperin)
- The role of V. I. Shumakov's cardiac massager in solving ischemia problems during organ harvesting
- Operating principles of artificial liver devices and biological hepatocyte columns
- Immunological problems and features of xenotransplantation
Master the complete topic in the "Topographic Anatomy" course
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Other topics in the section "Internal Organ Transplantation (Overview)"
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