title: Donor graft outflow venoplasty in living donor liver transplantation.
abstract: Hepatic venous outflow reconstruction is a key to successful living donor liver transplantation (LDLT) because its obstruction leads to graft dysfunction and eventual loss. Inclusion or reconstruction of most draining veins is ideal to ensure graft venous drainage and avoids acute congestion in the donor graft. We developed donor graft hepatic venoplasty techniques for multiple hepatic veins that can be used in either right- or left-lobe liver transplantation. In left-lobe grafts, venoplasty consisting of the left hepatic vein and adjacent veins such as the left superior vein, middle hepatic vein, or segment 3 vein is performed to create a single, wide orifice without compromising outflow for anastomosis with the recipient's vena cava. In right lobe graft where a right hepatic vein (RHV) is adjacent with a significantly-sized segment 8 vein, accessory RHV, and/or inferior RHV, venoplasty of the RHV with the accessory RHV, inferior RHV, and/or segment 8 vein is performed to create a single orifice for single outflow reconstruction with the recipient's RHV or vena cava. Of 35 venoplasties, 2 developed hepatic venous stenoses which were promptly managed with percutaneous interventional radiologic procedures. No graft was lost due to hepatic venous stenosis. In conclusion, these techniques avoid interposition grafts, are easily performed at the back table, simplify graft-to-recipient cava anastomosis, and avoid venous outflow narrowing.
authors.affiliation: Department of Surgery, Liver Transplantation Program, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao-Sung, Kaohsiung, Taiwan.
authors.forename: Allan
authors.initials: A
authors.lastname: Concejero
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Yeuh-Wei
authors.initials: YW
authors.lastname: Liu
authors.forename: Chin-Hsiang
authors.initials: CH
authors.lastname: Yang
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
authors.forename: Salleh
authors.initials: S
authors.lastname: Ibrahim
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Tung-Liang
authors.initials: TL
authors.lastname: Huang
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006503:Hepatic Veins / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures / Q000379:methods*