ABSTRACT
This chapter discusses the operative principles of liver, renal and orthotopic liver transplantations. Human leukocyte antigens are histocompatibility antigens, and are defined by tissue typing. The six human genes (A, B, C, DP, DQ and DR) are located on chromosome 6. HLA matching at A, B and DR loci are important in renal and/or pancreatic transplantation. HLA-C, HLA-DP and HLA-DQ do not appear to be important in transplantation. ABO blood groups must be identical or compatible in renal, hepatic, cardiac and pancreatic transplants. Access is via a curved muscle-cutting incision in the contralateral iliac fossa where the donor kidney is implanted. The donor renal artery is anastomosed to the external iliac artery, usually including a patch of donor aorta. The diseased liver is mobilized, the inferior vena cava (IVC) is clamped and the liver is removed. The donor and recipient portal veins are anastomosed end to end and the graft may be flushed to remove the preservation fluid.
