Could the use of interposition grafts for arterial reconstruction be avoided by more caudate graft placement in living donor liver transplantation?
One of the major challenges in living donor liver transplantation (LDLT) is short and small vessels (particularly the hepatic artery), particularly in segmental liver grafts from living donors. In the present study we report an alternative surgical technique that avoids interpositional vessel grafts or tension on the connection by anastomizing the allograft hepatic vein to the recipient inferior vena cava in a more caudate location. From March 2000 to January 2003, 28 patients (11 women/17 men) underwent 28 LDLT. Until June 2001, the preferred technique for hepatic vein anastomosis was end-to-end anastomosis between the allograft hepatic vein and the recipient hepatic vein (HV-HV) (n = 10). Thereafter an end-to-side anastomosis was performed between allograft hepatic vein and recipient inferior vena cava (HV-IVC) (n = 18). The level of venotomy on the recipient vena cava was decided according to the pre-anastomotic placement of the allograft in the recipient hepatectomy site with sufficient width to have an hepatic artery anastomosis without tension or need for an interposition graft during hepatic artery and portal vein anastomoses. Except the right lobe allograft with anterior and posterior portal branches, all portal and hepatic artery anastomoses were constructed without an interposition graft or tension in the HV-IVC group. Only one hepatic artery thrombosis developed in the HV-IVC group. As a result, this technique may avoid both hepatic artery thrombosis and the use of interposition grafts in living donor liver transplantation.
Ersöz
S
S
University of Ankara, School of Medicine, Department of Surgery, Ankara, Turkey.
Tüzüner
A
A
Hazinedaroğlu
S
S
Karayalçin
K
K
Yerdel
M A
MA
Anadol
E
E
D000714:Anastomosis, Surgical; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*