Why the Gall Bladder is Removed in a Liver Transplant

In liver transplants, the recipient's native liver must typically be completely removed for several critical reasons. This process maximizes the space and ensures an adequate blood supply for the transplanted liver. Additionally, retaining the native liver can pose a long-term risk of cancer formation. With the gallbladder attached to the liver much like fruits are attached to a tree, removing the native liver also necessitates the removal of the gallbladder for similar surgical logistics.

The gallbladder is integral to the liver and cannot be preserved while performing a liver transplant. The reason is that the gallbladder is attached to the liver, and removing the native liver necessitates the removal of the gallbladder as well. Just as it's not possible to leave the fruit on the tree while removing the entire tree, the gallbladder must be removed during liver transplantation to ensure a successful procedure.

Liver Lobes and Gall Bladder Removal

During liver transplants, the left lateral segment is often donated to a child, whereas the left or right lobe can be donated to an adult. In cases of liver lobe donation, the line where the liver is divided usually passes through the area where the liver is attached to the gallbladder. Therefore, the gallbladder must be removed to make the transplant possible. Theoretically, the gallbladder could be partly separated from the liver bed up to the line of division and preserved, provided the blood vessels to it are preserved.

However, this is rarely done due to two primary concerns. First, there is a risk that the lymphatic and neural connections between the liver and gallbladder could be divided, making the gallbladder dysfunctional and causing donor complications in the future. Second, in right lobe donation, the artery to the gallbladder typically arises from the artery to the right lobe. If the gallbladder is preserved, it would leave the right lobe with a very short artery, which can complicate the surgical procedure.

Confirming Bile Duct Anatomy

Despite the use of MRI for assessing bile duct anatomy in donors, most medical groups prefer to confirm it through a cholangiogram. This involves injecting a dye into the gallbladder duct and taking a real-time X-ray, allowing for precise division of the bile duct without compromising its connection to the opposite lobe or the common duct. This process helps minimize the risk of donor complications.

Furthermore, the removal of the gallbladder carries the potential benefit of reducing the risk of gallstones and gallbladder cancer, which are common issues for many individuals. While less than 1% of donors experience any problems from the gallbladder removal, the overall trade-off is seen as a reasonable one, given the potential benefits it offers.