title: Impact of graft hepatic vein inferior vena cava reconstruction with graft venoplasty and inferior vena cava cavoplasty in living donor adult liver transplantation using a left lobe graft.
abstract: BACKGROUND
  Hepatic venous reconstruction is critical in living donor adult liver transplantation (LDALT) because outflow obstruction in small for size graft may lead to graft dysfunction or loss. We describe the usefulness of venoplasties of the graft hepatic vein (HV) and graft HV-recipient inferior vena cava (IVC) reconstruction in LDALT using a left lobe graft.
  
  
  METHODS
  Sixty patients who underwent LDALT were studied. We divided the patients into following two groups: venoplasty group (n=30) and control group (n=30). For the patients with venoplasty group, venoplasty of the graft and recipient IVC cavoplasty was made to widen the orifice. Comparison examination of a background factors and postoperative bilirubin and the ascites was carried out.
  
  
  RESULTS
  The mean graft volume standard liver volume ratio (GV/SLV) did not have the difference at 41.7% of venoplasty group, and 42.1% of control group (p=NS). The diameter of the hepatic vein in control and venoplasty group before and after venoplasty is 26.9+/-5.5, 28.2+/-2.9, and 34.1+/-3.9 mm, respectively. The diameter of the hepatic vein after venoplasty is larger than that of before venoplasty and of control (P<0.05). Mean total bilirubin level on postoperative day (POD) 7 is 13.8+/-9.3 mg/dl in control group and 7.0+/-3.3 mg/dl in venoplasty group (P<0.05). Mean amount of ascites on POD 7 and 14 are 1576+/-1113 and 1397+/-1661 cc in control group, and 736+/-416 and 550+/-385 cc in venoplasty group, respectively (P<0.05). Two-year survival rate is 75.2 % in control group and 86.6 % in venoplasty group (P<0.05).
  
  
  CONCLUSIONS
  We conclude that in LDALT using left lobe graft, HV-IVC reconstruction with graft venoplasty and IVC cavoplasty is useful not only to prevent outflow block but also to improve graft function.
authors.affiliation: Department of General Surgical Science, and the 21st Century COE Program, Graduate School of Medicine, Gunma University, Maebashi, Japan. tsuehiro@med.gunma-u.ac.jp
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Suehiro
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Keiji
authors.initials: K
authors.lastname: Kishikawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Shimura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Kohji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Mochida
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000601:surgery*