Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein.
BACKGROUND
It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent "chocking" of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV.


METHODS
A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor's right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.


RESULTS
No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepatic vein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1), left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure.


CONCLUSIONS
The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.
Wu
Hong
H
Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Yang
Jia-yin
JY
Yan
Lü-nan
LN
Li
Bo
B
Zeng
Yong
Y
Wen
Tian-fu
TF
Zhao
Ji-chun
JC
Wang
Wen-Tao
WT
Xu
Ming-Qing
MQ
Lu
Qiang
Q
Chen
Zhe-Yu
ZY
Ma
Yu-Kui
YK
Li
Jin
J
D000293:Adolescent; D000328:Adult; D005260:Female; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome