Hepatic venous outflow reconstruction in right live donor liver transplantation.
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.
Malago
Massimo
M
Department of Surgery, University of Essen-Duisburg, Essen, Germany. massimo.malago@uni-essen.de
Molmenti
Ernesto P
EP
Paul
Andreas
A
Nadalin
Silvio
S
Lang
Hauke
H
Radtke
Arnold
A
Liu
Chao
C
Frilling
Andrea
A
Biglarnia
Reza
R
Broelsch
Christoph E
CE
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*