title: Hepatic venous outflow reconstruction in right live donor liver transplantation.
abstract: The increasing experience with live donor liver transplantation has allowed for the identification of potential morbidities associated with technical considerations. Technical graft failure can be associated with both inflow and outflow vascular compromise. Although the latter has not always been given the relevance of the former, evidence pointing to its pivotal role continues to mount. We believe that impaired venous outflow was a cause of previously unexplained graft failures during our initial experience. Based on this observation, we developed a technique to prevent the "choking" of the graft at the outflow anastomosis with the inferior vena cava (IVC). The enhanced outflow via a cloaca maximum is achieved by reconstructing the graft vessels with preserved veins or arteries (usually iliac vessels are used) from a blood-group-identical or blood-group-compatible deceased organ donor. Alternatively, hepatic vein or portal vein obtained from the resected native liver can be used. The reconstructed common outflow is anastomosed to a triangular opening of the IVC. Such enhanced outflow provides optimal venous drainage, especially during the early phase of growth of the graft.
authors.affiliation: Department of Surgery, University of Essen-Duisburg, Essen, Germany. massimo.malago@uni-essen.de
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Chao
authors.initials: C
authors.lastname: Liu
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
authors.forename: Reza
authors.initials: R
authors.lastname: Biglarnia
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000714:Anastomosis, Surgical; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D019651:Plastic Surgery Procedures / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*