[Some principal surgical techniques for living donor liver transplantation].
OBJECTIVE
To investigate some principal surgical techniques of living donor liver transplantation (LDLT).


METHODS
Eleven patients of LDLT have been performed at our department from January 2001 to March 2002. The left lobe (segments II, III, IV, including the middle hepatic veins) was transplanted in 8 patients, the left lateral lobe (segments II, III) in one and the right lobe (segments V, VI, VII, VIII, not including the middle hepatic veins) in 2. The plane of liver resection was determined on the basis of donor liver volumetry using CT scan and the anatomic analysis of vascular structure of the hepatic vein, portal vein and hepatic artery using intraoperative ultrasound. The hepatic parenchyma was transected using ultrasound aspirator without blood vessel clamping or graft manipulation. The isolated graft was perfused in situ through the portal vein branch. The liver graft was transplanted into the recipients who underwent total hepatectomy with preservation of the inferior vena cava. The hepatic vein reconstruction was performed in end to end fashion or end to side to the vena cava after venoplasty. Arterial anastomoses were performed using microsurgical technique. Biliary reconstruction was made by using duct-to-duct anastomosis and placement of a T tube.


RESULTS
All the 11 donors are uneventfully discharged after operation. In the 11 recipients, an 8-year-old girl needed retransplantation because of hepatic artery thrombosis, one case died of serious chronic rejection on the postoperative day 72. Ten recipients recovered and were discharged from hospital, whose liver function and cuprum oxidase had returned to normal.


CONCLUSIONS
The procedure of LDLT is relatively safe for the donor. Reconstruction of vessels is a key step in the procedure. Comprehending anatomical variation of vessels pre- and intra-operatively and correct surgical management might reduce the incidence of complications.
Wang
Xue-hao
XH
Liver Transplantation Center of Jiangsu Province, Department of Liver Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Li
Xiang-cheng
XC
Zhang
Feng
F
Qian
Jian-min
JM
Li
Guo-qiang
GQ
Kong
Lian-bao
LB
Zhang
Hao
H
Cheng
Feng
F
Sun
Bei-cheng
BC
D000293:Adolescent; D000328:Adult; D001662:Biliary Tract Surgical Procedures; D002648:Child; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology