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Yilmaz S, Kayaalp C, Isik B, Ersan V, Otan E, Akbulut S, Dirican A, Kutlu R, Kahraman AS, Ara C, Yilmaz M, Unal B, Aydin C, Piskin T, Ozgor D, Ates M, Ozdemir F, Ince V, Koc C, Baskiran A, Dogan SM, Barut B, Sumer F, Karakas S, Kutluturk K, Yologlu S, Gozukara H. Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach. Liver Transpl 2017; 23:751-761. [PMID: 28240812 DOI: 10.1002/lt.24753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/14/2017] [Indexed: 02/05/2023]
Abstract
Reconstruction of anomalous portal vein branching (APVB) during right lobe living donor liver transplantation (LDLT) can be challenging. The goal of this article is to describe our surgical technique, named the Malatya Approach, in case of APVB during right lobe LDLT. The technique unifies the APVB and obtains a funnel-shaped common extension with a circumferential fence by a saphenous vein conduit. In total, 126 (10.6%) of 1192 right lobe grafts had APVB that were divided into 2 groups according to the adopted surgical techniques: the Malatya Approach group (n = 91) and the previously defined other techniques group (n = 35). Both groups were compared regarding portal vein thrombosis (PVT), postoperative 90-day mortality and survival. PVT developed in 3 patients (3.3%) in the Malatya Approach group and developed in 10 (28.6%) patients for the other group (P < 0.001). There were 8 (8.8%) 90-day mortalities in the Malatya Approach group (1 PVT related) and 15 patients (9 PVT related) died in the other techniques group (P < 0.001). Mean follow-up time for both groups was similar (999.1 days for the Malatya Approach group versus 1024.7 days for the other group; P = 0.47), but longterm survival in the Malatya Approach group was better than in the other group (84.6% versus 40%; P < 0.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (P < 0.001). This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. Liver Transplantation 23 751-761 2017 AASLD.
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Affiliation(s)
- Sezai Yilmaz
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Burak Isik
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Emrah Otan
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Abuzer Dirican
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | | | - Cengiz Ara
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Mehmet Yilmaz
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Bulent Unal
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Cemalettin Aydin
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Turgut Piskin
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Dincer Ozgor
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Mustafa Ates
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Fatih Ozdemir
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Volkan Ince
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Cemalettin Koc
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Adil Baskiran
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Sait Murat Dogan
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Bora Barut
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Fatih Sumer
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Serdar Karakas
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Koray Kutluturk
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Saim Yologlu
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Harika Gozukara
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
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