Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation.
BACKGROUND
The availability of a venous graft is limited in the setting of living donor liver transplantation (LDLT), and the management of the middle hepatic vein middle hepatic vein tributaries in right lobe LDLT still remains controversial.


METHODS
Twenty-three right lobe LDLT grafts, with the reconstruction of middle hepatic vein tributaries using the explanted portal veins from the explanted livers, were evaluated for the patency, postLDLT liver function tests, and graft survival.


RESULTS
The methods of outflow reconstruction were classified into three types: the interposition of the graft to the middle/left hepatic vein (n=12), to the vena cava (n=9), and to the vena cava as a co-orifice with the graft right hepatic vein (n=2). The 1- and 3-year patency rates were 76.7% and 76.7% respectively, with the graft occlusion in five cases. The occluded cases (n=5) had significantly higher aspartate aminotransferase and alanine transaminase levels as compared with those of patent cases (n=18) at 4 weeks after transplantation (P<0.01). However, there was no significant difference in the total bilirubin and prothrombin time in either group during the observation periods. The 1- and 3-year graft survival rates were 91.1% and 91.1%, respectively. In addition, there was no graft loss due to occlusion.


CONCLUSIONS
The use of the recipient's explanted full-length hilar portal vein for the reconstruction of the middle hepatic vein tributaries is thus considered to be a feasible and valuable strategy in the setting of a right lobe LDLT, where appropriate vascular grafts are not always available.
Ikegami
Toru
T
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.tikesurg@yahoo.co.jp
Soejima
Yuji
Y
Taketomi
Akinobu
A
Yoshizumi
Tomoharu
T
Harada
Noboru
N
Uchiyama
Hideaki
H
Shimada
Mitsuo
M
Maehara
Yoshihiko
Y
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy; D006503:Hepatic Veins / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000276:immunology; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011517:Prothrombin Time
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin