Basic knowledge of medical care involved in treatment of the transplant patient will assist ED physicians in evaluation.
Biliary atresia is a common indication in pediatric patients.
Transplantation considerations Orthotopic liver transplantation involves excision of the recipient s liver, dividing the inferior vena cava, superior vena cava, portal vein, hepatic artery, and common bile duct. Because of the disruption of portal and inferior vena caval blood flow, venovenous bypass is necessary to divert blood from these vessels to the superior vena cava during the anhepatic phase of the procedure. The donor liver is anastomosed at the vascular sites with care taken to preserve hepatic arterial blood flow. The bile duct usually is anastomosed to the recipient s, but choledochojejunostomy may be performed. A T tube is used to stent the biliary duct postoperatively for several weeks, allowing monitoring of bile production as one marker of postoperative hepatic graft function.