title: Outflow reconstruction in right hepatic live donor liver transplantation.
abstract: BACKGROUND
  Inconstant venous anatomy increases the risk of outflow complications in right hepatic live donor liver transplantation (RH-LDT), but no consensus has emerged guiding optimal reconstruction for venous outflow.
  
  
  METHODS
  We retrospectively analyzed surgical venous reconstruction using a flexible approach to anterior accessory veins in 48 RH-LDTs performed between April, 1998 and July, 2002.
  
  
  RESULTS
  Actuarial recipient graft and patient survival was 79% and 85%, respectively. Single hepatic venous anastomosis was performed in 74% of the patients. Twelve patients underwent reconstruction of 20 accessory veins, including 7 posterior segment veins and 13 anterior segment veins. Anterior vein reconstruction techniques included end-to-end anastomosis to the middle hepatic vein, interposition conduit, venoplasty, or a combination of techniques. Documented complications related to the venous anastomosis occurred in only 1 patient (2%), with no patient having a documented venous thrombosis of either the main RHV or a reconstructed accessory vein. There were no differences in outcome based on single versus multiple venous reconstruction. Anteromedial congestion was noted in 3 patients in the absence of anatomic venous anastomotic complication, but the clinical significance of this finding is unclear.
  
  
  CONCLUSIONS
  Despite variations in segmental venous drainage and a propensity for anteromedial congestion in right hepatic grafts, RH-LDT can be performed without outflow obstruction with close attention to a wide RHV anastomosis. In addition, anterior accessory vein reconstruction can be reserved for grafts of marginal size or quality where early postoperative venous congestion may impair early graft function. Routine extended hepatectomy incorporating the MHV with the graft is unnecessary.
authors.affiliation: Center for Liver Disease and Transplantation, Department of Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons and Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Milan M
authors.initials: MM
authors.lastname: Kinkhabwala
authors.forename: James V
authors.initials: JV
authors.lastname: Guarrera
authors.forename: Richard
authors.initials: R
authors.lastname: Leno
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: Joan
authors.initials: J
authors.lastname: Prowda
authors.forename: Sandip
authors.initials: S
authors.lastname: Kapur
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*