Your liver transplant

What happens during the surgery and what to expect when you wake up from the operation

The liver transplant operation

The surgical procedure starts by opening the abdomen with an incision (usually shaped like an “L”). The sick liver and the gallbladder are removed, then the new liver is ‘implanted’, which means that it is put in the abdomen in place of the old liver, and connected to the blood vessels. Typically, in liver transplants, the common bile duct from the donor is joined to the recipient common bile duct. In PSC transplants, this doesn’t usually happen because the old bile duct still has the potential to have PSC and so the surgeons don’t usually create a normal anastomosis (join). In PSC, the existing bile duct is removed, and something called a Roux loop (Roux en Y) is formed.

How long does a liver transplant take?

The procedure usually takes up to 8 hours but can be longer or shorter, depending on the complexity of the case.

What happens after my liver transplant?

After surgery, you'll wake up in an intensive care unit (ICU). You may have tubes in your mouth (to help with breathing), nose (to provide fluids and nutrients) and wound (to drain excess fluid).

These will be removed after a few days and you'll be moved to a regular hospital ward.

What is the post-transplant ‘psychosis’ that can occur for some patients after a long anaesthetic?

After a big operation, patients can sometimes appear muddled. This is referred to as post-transplant ‘psychosis’. It is often due to a number of reasons: the operation, a complication of the operation and sometimes due to the immunosuppressant drugs. However, doctors find the cause and can reverse the situation rapidly.

How long will I spend in ICU after the operation?

This varies from patient to patient. Normally though, it is 48-72 hours before you will be stepped down to needing less intensive medical and nursing care.

How soon do they take out/off all of the tubes and wires?

Often there is a sequence for the tubes to be removed. First of all, when you are able to breath yourself comfortably, the doctors remove the tube from your lungs (the so-called endotracheal tube). Over the next 48 hours doctors will then normally remove a number of lines from your neck that have been used to monitor you during the operation. These include tubes called a bypass line, a central line, an arterial line and a Swanz Ganz sheath. Obviously if you are not recovering quickly and you need to spend more time on the intensive care unit, the doctors may delay removing these tubes so they can monitor you more carefully.

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