Morphometric and simulation analyses of right hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts.
The incidence of clinically significant right hepatic vein (RHV) stenosis after adult living donor liver transplantation has been higher than expected. In this study, an assessment of the risk factors for the development of RHV stenosis in this context was undertaken. Hepatic anatomy, surgical techniques, and the incidence of RHV stenosis 1 year after transplantation were evaluated retrospectively in 225 recipients of right lobe grafts. These patients underwent independent RHV reconstruction, which was facilitated by the application of computed tomography morphometry and computational simulation analyses. Three types of preparation of the orifice of the graft RHV and 7 types of preparation for venoplasty of the recipient RHV were used. The frequency of high, middle, and low sites of RHV insertion into the inferior vena cava (IVC) was 56.0%, 36.4%, and 7.6%, respectively, for donors, and 26.7%, 58.7%, and 14.7%, respectively, for recipients. Nine patients (4%) developed RHV stenosis of early onset that required stent insertion during the first 2 postoperative weeks; in 12 patients (5.3%), RHV stenosis of delayed onset occurred. Inappropriate matching of RHV sites of insertion correlated with the incidence of stenosis of early onset (P = 0.039). Technical refinements to avoid adverse consequences of inappropriate ventrodorsal matching of RHV sites of insertion include making the recipient RHV orifice wide and enlarging the recipient IVC by a customized incision and patch venoplasty after anatomical assessment of the RHV and IVC of the graft and recipient.
Hwang
Shin
S
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Ahn
Chul-Soo
CS
Moon
Deok-Bog
DB
Kim
Ki-Hun
KH
Sung
Kyu-Bo
KB
Ko
Gi-Young
GY
Ha
Tae-Yong
TY
Song
Gi-Won
GW
Jung
Dong-Hwan
DH
Gwon
Dong-Il
DI
Kim
Kyoung-Won
KW
Choi
Nam-Kyu
NK
Kim
Kwan-Woo
KW
Yu
Young-Dong
YD
Park
Gil-Chun
GC
D000328:Adult; D000368:Aged; D003198:Computer Simulation; D003251:Constriction, Pathologic; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008102:Liver Circulation / Q000502:physiology; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult