Simplified standardized technique for living donor liver transplantation using left liver graft plus caudate lobe.
Concomitant resection of the caudate lobe (CL) would increase the liver mass in the left liver graft. We tried to define a simplified standardized technique for adult living donor liver transplantation using the extended left lobe (ELL) plus CL (ELLC) through a prospective study of 27 consecutive ELLC graft cases in 2003. Donor CL was dissected toward the 10 o'clock direction and transected at the midpoint between the trunks of the right hepatic vein (RHV) and the middle hepatic vein (MHV). This orthodox transection was performed in 18 cases, but the transection plane was moved left in 9 cases. Compared with conventional left liver implantation, there was no additional reconstruction except for single revascularization of the largest short hepatic vein of the CL (V1) in 21 cases. On 1-week computed tomography (CT) images, the perfusion states of the CL portion were good in 15 cases, fair in 7 cases, and poor in 5 cases. Regeneration of the CL portion during the 1st week was +43%, +18%, and -10% in the good, fair, and poor perfusion groups, respectively. There were positive correlations among the perfusion state of the CL, the location of the CL transection plane, and the width of the CL portion that was attached to the left liver graft. CL implantation resulted in a mean gain of graft mass by 5.9% in the left liver at the time of operation and by 3.9% after 1 week. There were no donor complications, and 25 recipients (93%) survive to date. In conclusion, this simplified standardized technique was feasible for most of the living donor livers and required only 1 additional reconstruction of the V1.
Hwang
Shin
S
Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Ha
Tae-Yong
TY
Ahn
Chul-Soo
CS
Park
Kwang-Min
KM
Kim
Ki-Hun
KH
Lee
Young-Joo
YJ
Moon
Deok-Bog
DB
Kim
Keon-Kuk
KK
Kim
Yeon-Dae
YD
D000328:Adult; D005260:Female; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology; D016031:Liver Transplantation / Q000379:methods / Q000592:standards*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies