Hepatic venous outflow reconstruction in adult living donor liver transplants without portal hypertension.
Graft congestion is one of the causes of poor graft function in segmental liver transplantation. Three factors are implicated in segmental graft congestion: graft size, hepatic venous outflow and portal inflow. The graft size must be matched to the body weight, which is conventionally done by using graft to body weight ratio. Hepatic blood outflow must be optimized by hepatic vein reconstruction, which can be complicated. High portal blood flow has been shown to be detrimental to small-for-size grafts. These factors are strictly connected to each other. They can all contribute to graft congestion and poor function, while one factor can compensate for the others and decrease congestion. Ideally, all the accessory veins should be reconstructed, if possible, to maximize the outflow. In the absence of portal hypertension and with an adequate sized graft, complex venous reconstruction may not be necessary. We present a case report of an adult living donor liver transplant with the favorable conditions of normal portal pressure and a large sized graft, but complicated by the presence of several accessory hepatic veins. A simple hepatic vein anastomosis was sufficient for adequate outflow and prompt graft function.
Bogetti
Diego
D
Department of Surgery, Division of Transplantation, University of Illinois at Chicago, IL, USA.
Panaro
Fabrizio
F
Jarzembowski
Tomasz
T
Sankary
Howard
H
Benedetti
Enrico
E
Testa
Giuliano
G
D000328:Adult; D000714:Anastomosis, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D009364:Neoplasm Recurrence, Local; D009929:Organ Size; D011169:Portal Vein / Q000601:surgery; D012086:Reoperation; D014682:Vena Cava, Inferior / Q000601:surgery