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Tevar AD, Jorgensen D, Newhouse D, Ganoza A, Gunabushanam V, Ganesh S, Molinari M, Hughes C, Humar A. Back table Preparation of the Right Lobe Live Donor Liver Allograft: A Crucial Part of the Adult Live Donor Liver Transplant Procedure. J Surg Res 2022; 279:796-802. [PMID: 35985148 DOI: 10.1016/j.jss.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/01/2022] [Accepted: 05/22/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION We aimed to describe our procedure for vascular reconstruction and back table bench preparation for the right lobe live donor allograft. Live donor liver transplantation (LDLT) remains an important option for the expansion of the donor pool. The procedure has been widely used, and its success is dependent on a technically perfect operation with appropriate inflow and outflow of the allograft. Adequate preparation of the right lobe (RL) allograft prior to implantation remains a vital part of the procedure. METHODS Our technique of back table vascular reconstruction of the RL allograft has been performed using a hepatic vein patch venoplasty, inferior hepatic vein inclusion, portal vein reconstruction, and segment V and VIII reconstruction for all of our LDLTs. RESULTS Between March 2009 and January 2020, 321 consecutive adult LDLTs were performed and underwent back table reconstruction with the techniques described. During that time period, no patients had hepatic insufficiency. There was a single thrombosis of a superior mesenteric vein (SMV) to PV jump conduit. CONCLUSIONS Our technique of back table reconstruction of the LDLT right lobe graft remains a crucial part of the operative procedure. Our experience with RL grafts without middle hepatic vein (MHV) and our systematic approach for inflow and outflow reconstruction has yielded excellent results with no technical outflow issues and minimal inflow complications.
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Affiliation(s)
- Amit D Tevar
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania.
| | - Dana Jorgensen
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania
| | - David Newhouse
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Armando Ganoza
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania
| | - Vikraman Gunabushanam
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania
| | - Swaytha Ganesh
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania
| | - Michele Molinari
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania
| | - Christopher Hughes
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania
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Sakamoto K, Ogawa K, Tamura K, Ito C, Iwata M, Sakamoto A, Matsui T, Nishi Y, Nagaoka T, Uraoka M, Funamizu N, Takai A, Takada Y. Importance of reconstruction of middle hepatic vein tributaries of right-lobe grafts in living donor liver transplantation: demonstration of the reconstruction technique. Langenbecks Arch Surg 2022; 407:1585-1594. [PMID: 34997276 DOI: 10.1007/s00423-021-02398-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/03/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of the present study on living donor liver transplantation (LDLT) using a right-lobe graft without the middle hepatic vein (MHV) was to investigate the clinical impact of MHV tributary reconstruction using our criteria and techniques. METHODS The medical records of 40 patients who underwent adult LDLT using a right-lobe graft without the MHV between April 2008 and December 2020 were retrospectively reviewed. In this cohort, the criterion for MHV tributary reconstruction was estimated drainage volume of each MHV tributary greater than 100 mL. The drainage vein of segment 8 (V8) was reconstructed as the common orifice of the right hepatic vein and V8 using a venous patch graft, and that of segment 5 was reconstructed using artificial vascular grafts. The outcomes were compared between the groups with and without MHV tributary reconstruction. Factors associated with postoperative massive ascites were also investigated. RESULTS Twenty patients underwent MHV tributary reconstruction. There were no significant differences in the amount of postoperative ascites, Clavien-Dindo classification ≥ III postoperative complications, and 90-day in-hospital mortality between the groups (P = 0.678, P = 1.000, and P = 0.244, respectively). On multivariate analyses, a low-estimated functional graft-to-recipient weight ratio, which was calculated using estimated graft volume minus the territory of MHV tributaries that was not reconstructed, was identified as an independent predictor of postoperative massive ascites (odds ratio, 40.479; 95% confidence interval, 3.823-428.622). CONCLUSION The present study suggests that selective MHV tributary reconstruction might be useful for achieving successful graft function.
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Affiliation(s)
- Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Chihiro Ito
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Miku Iwata
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akimasa Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takashi Matsui
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yusuke Nishi
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Nagaoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mio Uraoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naotake Funamizu
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akihiro Takai
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Ozbilgin M, Unek T, Egeli T, Agalar C, Ozkardeşler S, Altay C, Astarcioglu I. Comparison of Patients With and Without Anterior Sector Venous Drainage in Right Lobe Liver Transplantation From Live Donors in Terms of Complications, Rejections, and Graft Survival: Single-Center Experience. Transplant Proc 2019; 51:1127-1133. [PMID: 31101185 DOI: 10.1016/j.transproceed.2019.01.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/21/2019] [Indexed: 12/28/2022]
Abstract
AIM The issue of performing an anastomosis of the anterior sector veins to the vena cava in living donor liver transplantation is still controversial. We aimed to research whether there was any difference in terms of complications, rejections, and graft survival between patients with and without anterior sector venous drainage to the vena cava. PATIENTS AND METHODS Patients were retrospectively investigated for demographic data and ratio of graft needed to available graft weight. Donors had volumetric calculations and middle hepatic vein anterior sector drainage documented in detail. RESULTS Seventy-three donors with middle hepatic vein drainage were included. Thirty-five had anterior sector venous drainage performed and 38 patients did not have drainage procedures performed. The incidence of general complications was higher in the group without anterior sector drainage (78.3% and P = .002). Biloma linked to bile leaks were observed in 8 patients without drainage (72.8%) and 3 patients with drainage (27.2%). Late acute rejection occurring during follow up after transplantation was identified in 28 patients (11.6%). Of these, 1 (14.3%) had anterior sector drainage and 6 (85.7%) were in the patient group without drainage (P = .067). CONCLUSION As a result of this study, for patients with grafts at the volume limit (graft weight to receiver weight ratio <0.8) and with congestion observed in the anterior sector after liver implantation and for patients with outflow problems identified on Doppler ultrasonography, anterior sector veins >5 mm should definitely be drained into the vena cava. Hence, both complication and rejection rates will reduce, and we can lengthen the graft, and thus patient, survival.
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Affiliation(s)
- M Ozbilgin
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
| | - T Unek
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - T Egeli
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - C Agalar
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - S Ozkardeşler
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - C Altay
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - I Astarcioglu
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Miyazawa K, Miyagi S, Nakanishi C, Hara Y, Tokodai K, Nakanishi W, Uematsu S, Shimizu K, Goto M, Kamei T, Unno M. Effect of Middle Hepatic Vein Tributaries Preserving Technique Until Just Before Graft Retrieval on Donors' Surgical Outcomes in Living Donor Liver Transplantation. Transplant Proc 2018; 50:2636-2639. [PMID: 30401365 DOI: 10.1016/j.transproceed.2018.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/02/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The technique of preserving the major tributaries of the middle hepatic vein (MHV) (V5 and V8) until just before graft retrieval is beneficial to minimize congestion time of the graft. However, it remains unclear whether this technique exerts a burden on donors in terms of operative time, blood loss, and postoperative hepatic dysfunction. In this study we investigated adverse effects of the MHV tributaries preserving technique until immediately before graft retrieval on donors' surgical outcomes. METHODS Data from 71 donors who underwent right hepatectomy without MHV for a liver transplantation at our hospital from January 2002 to August 2016 were retrospectively reviewed. Donors were divided into 3 groups as follows: group 1 (n = 12), no MHV tributary reconstruction; group 2 (n = 33), single MHV tributary reconstruction; group 3 (n = 26), 2 or 3 MHV tributaries reconstruction. Donor operation time, blood loss, proportion of the remnant liver, maximum postoperative total bilirubin, aspartate aminotransferase, alanine transaminase, minimum platelets, prothrombin time, albumin level, number of days in hospital from surgery to discharge, and surgical complications were compared. RESULTS Compared with groups 2 and 3, group 1 exhibited shorter average operational time and less average blood loss, but the difference was not significant. Comparisons of all other factors indicated no significant differences. CONCLUSION The technique of preserving the major tributaries of the MHV until just immediately before graft retrieval does not appear to impose an apparent burden on donors.
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Affiliation(s)
- K Miyazawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - S Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - C Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Y Hara
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - K Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - W Nakanishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - S Uematsu
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - K Shimizu
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - M Goto
- Transplantation and Regenerative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - M Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Goja S, Yadav SK, Roy R, Soin AS. A retrospective comparative study of venous vs nonringed expanded polytetrafluoroethylene extension grafts for anterior sector outflow reconstruction in right lobe living donor liver transplantation. Clin Transplant 2018; 32:e13344. [DOI: 10.1111/ctr.13344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/04/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Sanjay Goja
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
| | - Sanjay K. Yadav
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
| | - Rahul Roy
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
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Yang X, Qiu Y, Huang B, Wang W, Shen S, Feng X, Wei Y, Lei J, Zhao J, Li B, Wen T, Yan L. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases. Am J Transplant 2018; 18:1668-1679. [PMID: 29232038 PMCID: PMC6055796 DOI: 10.1111/ajt.14621] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/09/2017] [Accepted: 12/03/2017] [Indexed: 02/05/2023]
Abstract
Ex vivo liver resection combined with autotransplantation is a recently introduced approach to cure end-stage hepatic alveolar echinococcosis (HAE), which is considered unresectable by conventional radical resection due to echinococcal dissemination into the crucial intrahepatic conduits and adjacent structures. This article aims discuss the manipulation details and propose reasonable indications for this promising technique. All patients successfully underwent liver autotransplantation with no intraoperative mortality. The median weight of the autografts was 636 g (360-1300 g), the median operation time was 12.5 hours (9.4-19.5 hours), and the median anhepatic phase was 309 minutes (180- 460 minutes). Intraoperative blood loss averaged 1800 mL (1200-6000 mL). Postoperative complications occurred in 13 patients during hospitalization; 5 patients experienced postoperative complications classified as Clavien-Dindo grade III or higher, and 2 patients died of intraabdominal bleeding and acute cerebral hemorrhage, respectively. Twenty-nine patients were followed for a median of 14.0 months (3-42 months), and no HAE recurrence was detected. The technique requires neither an organ donor nor any postoperative immunosuppressant, and the success of the treatment relies on meticulous preoperative assessments and precise surgical manipulation.
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Affiliation(s)
- Xianwei Yang
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Yiwen Qiu
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Bin Huang
- Department of Vascular SurgeryWest China Hospital of Sichuan UniversityChengduChina
| | - Wentao Wang
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Shu Shen
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Xi Feng
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Yonggang Wei
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Jianyong Lei
- Department of General SurgeryWest China Hospital of Sichuan UniversityChengduChina
| | - Jichun Zhao
- Department of Vascular SurgeryWest China Hospital of Sichuan UniversityChengduChina
| | - Bo Li
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Tianfu Wen
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Lunan Yan
- Department of Liver Surgery & Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina
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Hu H, Huang B, Zhao J, Wang W, Guo Q, Ma Y. Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis. J Surg Res 2016; 210:169-176. [PMID: 28457324 DOI: 10.1016/j.jss.2016.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/31/2016] [Accepted: 11/10/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Alveolar echinococcosis (AE) is characterized by a slow-growing infiltrative neoplasm that is often unresectable by traditional methods because of strong adhesions and invasion to adjacent structures. We present our experience with liver autotransplantation and retrohepatic inferior vena cava (RHIVC) reconstruction using autogenous veins in patients with this end-stage parasitic disease. METHODS Twelve patients with hepatic AE and extensive RHIVC, hepatic vein, and/or hilar invasion underwent ex vivo liver resection and RHIVC reconstruction using autogenous veins followed by autotransplantation in the West China Hospital of Sichuan University from 2013 to 2016. RESULTS The mean weight of the harvested liver graft was 537 g (range: 390-900 g), the mean anhepatic time was 216 min (range, 120-310 min), and the mean operation time was 13.6 h (range, 10.5-19.5 h). The main postoperative complication was bile leakage. The mean postoperative hospital stay was 16.4 d (range, 10.0-37.0 d), and the median follow-up time was 15.5 mo (range, 1.0-32.0 mo). All patients were alive at the latest follow-up. The vascular patency rate was 100%, and no residual disease, recurrence, or metastasis was detected. CONCLUSIONS To our knowledge, liver autotransplantation and RHIVC reconstruction using autogenous veins are rarely performed for patients with end-stage hepatic AE. This technique requires no organ donor, allogeneic, or artificial vessel implantation, postoperative immunosuppressive therapy, or long-term postoperative anticoagulant treatment. These benefits may make the treatment of select end-stage hepatic AE patients more affordable and effective.
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Affiliation(s)
- Hankui Hu
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wentao Wang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qiang Guo
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Ito K, Akamatsu N, Tani K, Ito D, Kaneko J, Arita J, Sakamoto Y, Hasegawa K, Kokudo N. Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: The importance of the inferior right hepatic vein. Liver Transpl 2016; 22:410-9. [PMID: 26684079 DOI: 10.1002/lt.24386] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
Abstract
Special care must be taken in hepatic vein reconstruction to avoid outflow block in living donor liver transplantation (LDLT) with a right liver graft. We have used cryopreserved homologous veins to reconstruct the right hepatic vein (RHV), middle hepatic vein (MHV), MHV tributaries (V5 and V8), and inferior right hepatic vein (IRHV). The reconstruction of V5, V8, and IRHV was based on the estimated congestive volume, calculated by the computed tomography volumetry, to secure the functional graft volume of 40% of the recipient standard liver volume. Among 262 right liver LDLT recipients, the number of reconstructed RHVs, MHVs, V5s, V8s, and IRHVs was 262, 48, 110, 111, and 147, respectively, and the overall patency was 95%, 100%, 36%, 58%, and 86%, respectively. Although the patency of the RHVs and MHVs was satisfactory, that of the V5s, V8s, and IRHVs was suboptimal. Patency of the IRHVs (86%, 126/147) was significantly better than that of both V5s (36%, 40/110) and V8s (58%, 64/111; P < 0.001). In addition, the estimated volume drained by IRHVs was significantly greater than that of V5s and V8s (IRHV, 176 ± 92 mL; V5, 105 ± 49 mL; V8, 127 ± 60 mL; P < 0.001). The patency of IRHV was significantly improved by applying the double inferior vena cava method (93%, 94/101) when compared to the direct anastomosis to vena cava (68%, 25/37; P < 0.001). The IRHV functioned as a main drainage route in cases of an obstructed RHV. In conclusion, reconstruction of the IRHV is recommended, not only to improve the functional reserve of the graft, but also to secure multiple drainage routes of the graft.
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Affiliation(s)
- Kyoji Ito
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Keigo Tani
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Daisuke Ito
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Junichi Kaneko
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Junichi Arita
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
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Yi PS, Zhang M, Xu MQ. Management of the middle hepatic vein in right lobe living donor liver transplantation: A meta-analysis. ACTA ACUST UNITED AC 2015. [PMID: 26223934 DOI: 10.1007/s11596-015-1477-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Living donor liver transplantation (LDLT) is a curative treatment for end stage liver disease. It is advantageous due to the shortage of deceased donors. However, in LDLT, whether the middle hepatic vein (MHV) should be preserved in donors remains controversial. We conducted searches in Pubmed, Embase, Cochrane Library, Web of Science, Ovid, and Google Scholar using the key words "living donor liver transplantation" and "middle hepatic vein". Due to ethical issues, there were no randomized control trails focusing on MHV in LDLT. The majority of reports were retrospective studies. We examined the reference lists to identify related investigations. Google Scholar was then used to obtain full texts. Nine observational studies were analyzed. There were no significant differences in liver function (WMD, -5.51; P=0.12) and complications (RR, 0.98; P=0.89) in donors with or without MHV. However, the liver function in recipients was greatly improved after LDLT with MHV (WMD, -78.32; P=0.01). No definite conclusion was obtained in terms of the liver regeneration indices between LDLT with or without MHV. It was conclude that grafts with MHV in LDLT favor recipient outcomes and do not harm the living donor if a careful preoperative evaluation is performed.
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Affiliation(s)
- Peng-Sheng Yi
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Ming Zhang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ming-Qing Xu
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
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