[Technological refinement to reconstruction of liver outflow vein in living donor right liver lobe graft].
OBJECTIVE
To explore the reconstructed pattern of hepatic outflow vein in right lobe without middle hepatic vein (MHV) of adult living donor liver transplantation (LDLT).


METHODS
The retrospective analysis was made on the clinical data of 47 recipients who underwent the operation in LDLT including the outflow vein reconstructed in right liver lobe without MHV. The right hepatic veins (RHV) in transplanted donor liver were anastomosed to a triangular opening in the recipient's inferior vena cava (IVC); the inferior right hepatic veins (IRHV) of significant size that had been preserved were anastomosed directly to the IVC. The great saphenous vein (GSV) as interposition connector was used to reconstruct the significant tributaries (V5,V8) of MHV, the other end of interposition was anastomosed with IVC.


RESULTS
No death occurred in all the donors. Of 47 recipients, complications occurred in 9 recipients including the hepatic vein stricture (1 case), small-for-size liver syndrome (1 case), hepatic artery thrombosis (1 case), intestinal bleeding (1 case), bile leakage (2 cases), left subphrenic abscess (1 case) and pulmonary infection (2 cases). Three cases died of the small-for-size liver syndrome (1 case) and multiple system organ failure (2 cases). The total rate of outflow veins reconstructed for V5, V8 and IRHV was 65. 96% (31/47), the rate of one-vein reconstruction, two-vein reconstruction or three-vein reconstruction was 36.17%, 21. 28% or 8.51% respectively. The successive postoperative investigation for vein grafts were performed by Color Doppler Ultrasound. Four cases experienced GSV graft obstruction or obliteration among the 31 cases in 7-25 days after operation, but extensive collateral circulation has established.


CONCLUSIONS
We used the "multiple-opening vertical anastomosis" to reconstruction of hepatic outflow vein. This technique alleviates the surgical risk on living donors, ensures the excellent venous drainage and prevents from the syndrome in small-for-size livers.
Wu
Hong
H
Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Yang
Jia-yin
JY
Yan
Li-nan
LN
Li
Bo
B
Zeng
Yong
Y
Wen
Tian-fu
TF
Zhao
Ji-chun
JC
Wang
Wen-tao
WT
Xu
Ming-qing
MQ
Ma
Yu-kui
YK
Chen
Zhe-yu
ZY
D000328:Adult; D000368:Aged; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013537:Sutures; D014656:Vascular Surgical Procedures / Q000379:methods*; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult