Conceptually, liver transplantation is simple: bad liver comes out, new liver goes in. In reality, it remains one of the most complex and challenging operations performed today.
Remarkably, this operation is still in its relative childhood (twenty years ago, it was still considered experimental by many healthcare systems and providers), but it has quickly evolved into a life-saving standard of care for patients with end-stage liver disease.
The liver is the largest solid organ in the body. It is responsible for the synthesis of many important components necessary for the body’s normal function. In addition, the majority of the lower body’s blood returns to the heart through the liver via the portal vein or the inferior vena cava (see diagram below).
Liver transplant is the treatment of choice for any acute or chronic liver condition that progresses to irreversible liver dysfunction. It is most commonly performed for liver diseases that lead to scarring or cirrhosis of the liver. In select cases of primary liver and bile-duct cancer, transplantation it is the only chance for cure.
Dr. Elizabeth Pomfret, Chief of Transplant Surgery (right) with Dr. James Pomposelli, Surgical Director of Liver Transplant
The first successful liver transplant was performed here at the University of Colorado Hospital (then called Colorado General Hospital) in 1963 by Dr. Thomas Starzl. Since that time, significant improvements in immunosuppression have made liver transplant a safe and effective treatment for end-stage liver disease and selected liver and bile-duct cancers.
For 25 years, our team was led by Dr. Igal Kam. During that time, we performed the first adult live-donor liver transplant in the United States and over 1,700 liver deceased-donor liver transplants. Dr. Kam's philosophy, teaching, surgical methods, and focus on patient care helped mold the University of Colorado Hospital's liver transplant program in to the thriving medical practice it is today.
In 2016, Dr. Elizabeth Pomfret and Dr. James Pomposelli joined our team. Together, they have performed the most adult living-donor liver transplants in the US and continues the legacy of living donor liver transplants at the University of Colorado Hospital. The University of Colorado performs nearly 100 liver transplants annually, and that number is continuing to grow due to the success of our living donor program, placing the University of Colorado Hospital Transplant Center as one of the centers in the nation.
It takes a large support system for a successful liver transplant program. At University of Colorado Hospital, we have a team of specialized hepatologists, anesthesiologists, interventional radiologists, social workers, and coordinators who all lend support to the transplant surgeons who perform the procedure.
The operation requires removal of the diseased liver, which is then replaced with a healthy donor liver. Most transplants can be performed through a limited abdominal incision that extends from the sternum under the right ribs. In the context of advanced cirrhosis, removal of the diseased liver demands careful attention to enlarged veins that result from portal hypertension.
During transplantation, the liver is dissected free of its surrounding connections, the blood flow into and out of the liver is isolated and suspended, and the liver is removed in its entirety. During a short period of time, the body has no functional liver. (This is known as the anhepatic phase of the operation.) The new liver is sewn in, and all the major blood vessels are reconnected. After blood flow is reestablished, the new bile duct is reconnected, and the new liver is given time to begin functioning.
The operation is a major endeavor. Typical operating times range from 4-6 hours but can extend much longer depending on the complexity of the case and the condition of the patient. Most patients stay in the hospital for 7-10 days after the operation, then transition to outpatient care. Recovery times can also vary greatly based on patient characteristics and potential complications.
The experience of the liver transplant team at the University of Colorado is unparalleled in the entire Rocky Mountain region. We continue to provide innovative care and excellent results for these most complex surgical patients.