title: Living-donor liver transplantation using the left liver, with special reference to vein reconstruction.
abstract: The authors describe their techniques for hepatic vein reconstruction, devised for safe living-donor liver transplantation using a left liver graft. End-to-end anastomosis of the hepatic veins is performed to prevent an outflow occlusion. To ensure adequate hepatic venous flow, it is necessary to obtain a wide ostium and sufficient length of the hepatic vein for anastomosis, which should be secured by venoplasty of the hepatic veins of the graft and the recipient. A left liver with a caudate lobe graft is useful for overcoming the problem of a small graft. Reconstruction of the short hepatic vein of the caudate lobe may allow this portion to regenerate at the same rate as the left liver. In a left liver graft without the trunk of the middle hepatic vein, reconstruction of a tributary of this vein might be necessary to prevent graft congestion in segment IV. Color Doppler ultrasonography or a hepatic arterial clamping test should be performed in donor hepatectomy to evaluate the need for middle hepatic vein reconstruction.
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. makuuchi-tky@umin.ac.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
mesh_terms: D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D014656:Vascular Surgical Procedures