title: Hepatic vein reconstruction in 152 living-related donor liver transplantation patients.
abstract: BACKGROUND
  Hepatic vein (HV) reconstruction is crucial in partial liver transplantation in which the inferior vena cava (IVC) is preserved.
  
  
  METHODS
  We reviewed the medical records of 152 living-related donor liver transplantations (LRDLTs) in 150 children (45 left lobe grafts, 106 lateral segment grafts, and 1 right lobe graft) monitored for 12 months or longer.
  
  
  RESULTS
  A standard technique was a wide end-to-side anastomosis between the donor HV and cuffs, consisting of the recipient middle and left HV and an incision to the IVC. In 15 of 22 partial grafts with two separated HVs the two vessels were reformed by back table surgery to have a common anastomotic orifice, and two separate anastomoses of the individual vessels were made for the remaining seven grafts. Four patients with an absence of infrahepatic IVCs and two with completely obstructed IVCs had end-to-end anastomoses with recipient IVCs. Four patients with stenotic IVCs had end-to-side anastomoses with new orifices on the IVCs. Two patients had acute HV obstruction caused by twisting of the HV that required laparotomy, and six had late-onset HV obstruction that required radiologic intervention. A tissue expander was placed prophylactically in the right subphrenic space in 10 patients to prevent the dislocation of the graft into the right subphrenic space.
  
  
  CONCLUSIONS
  It is important in HV reconstruction in partial liver transplantation to make wide orifices and to adapt each graft to its orthotopic place, taking into consideration graft shape, size of the abdominal cavity of the recipient, and anatomic variations in vessels.
authors.affiliation: Department of Transplantation Immunology, Faculty of Medicine, Kyoto University, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Egawa
authors.forename: Y
authors.initials: Y
authors.lastname: Inomata
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
authors.forename: K
authors.initials: K
authors.lastname: Asonuma
authors.forename: T
authors.initials: T
authors.lastname: Kiuchi
authors.forename: H
authors.initials: H
authors.lastname: Okajima
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaoka
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006503:Hepatic Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008099:Liver / Q000098:blood supply / Q000601:surgery; D016031:Liver Transplantation / Q000000981:diagnostic imaging / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D019736:Prostheses and Implants; D015625:Tissue Expansion Devices; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography