[Modifications of surgical technique in adult-to-adult living donor liver transplantation].
OBJECTIVE
To report the authors' experience with adult-to-adult living donor liver transplantation using right lobe liver grafts performed by a modified technique.


METHODS
From March to June 2005, 13 patients underwent living donor liver transplantation using right lobe grafts. Among these, one patient received two left lobes from his two elder sisters, one received a right lobe from his mother and a left lobe from a cadaveric donor. All patient underwent a modification designed to improve the reconstruction of right hepatic vein, the reconstruction the tributaries of the middle hepatic vein by interpositioning a vein grafts, and the anastomosis of the hepatic arteries and bile ducts.


RESULTS
There were no severe complications and deaths found in donors. Four complications occurred in recipients including hepatic artery thrombosis (n = 1), bile leakage (n = 1), left subphrenic abscess (n = 1) and pulmonary infection (n = 1). The patient with pulmonary infection died of multiple organ failure (MOF). All patients underwent direct anastomosis of right hepatic vein and inferior vena cava (IVC), 5 cases plus the reconstructions of right inferior hepatic vein, and the other 5 cases plus the reconstruction of the tributaries of the middle hepatic vein by interpositioning a vein graft to provide sufficient venous outflow. The graft and recipient weight ratio (GRWR) were between 0.72% and 1.24%, among these, 9 cases < 1.0% and 2 cases < 0.8%, and there was no "small-for-size syndrome" occurred.


CONCLUSIONS
With modifications of surgical technique, especially the reconstruction of hepatic vein to provide sufficient venous outflow, living donor liver transplantation in adults using right lobe liver grafts can become a relatively safe procedure and prevent the "small-for-size syndrome".
Yan
Lü-nan
LN
Liver Transplantation Division, Department of Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. yanlunan688@163.com
Li
Bo
B
Zeng
Yong
Y
Wen
Tian-fu
TF
Zhao
Ji-chun
JC
Wang
Wen-tao
WT
Yang
Jia-yin
JY
Xu
Ming-qing
MQ
Ma
Yu-kui
YK
Chen
Zhe-yu
ZY
Liu
Jiang-wen
JW
Wu
Hong
H
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D014184:Transplantation, Homologous