title: Evolution of anterior segment reconstruction after live donor adult liver transplantation: a single-center experience.
abstract: Controversy exists regarding the best method for venous outflow reconstruction after live donor liver transplantation using right lobe grafts. Some authors advocate routine inclusion of the middle hepatic vein with the graft, whereas others favor a more selective approach. In this report, we examine the evolution of our decision making and technique of selective anterior venous segment reconstruction during live donor adult liver transplantation performed in 226 recipients. We have developed a simplified back-bench procedure using sequential-composite anastomosis using various vascular conduits with syndactylization to the right hepatic vein creating a single large-outflow anastomosis in the recipient. Conduits used include iliac artery or vein allograft, recanalized umbilical vein, cryopreserved iliac artery allograft, and 6-mm synthetic expanded polytetrafluoroethylene vascular graft. This technique can be performed quickly, safely, and under cold storage conditions and results in excellent outcome while minimizing donor risk.
authors: Department of Transplantation, Lahey Clinic Medical Center, Burlington, MA 01805, USA. james.j.pomposelli@lahey.org
authors: James J
authors: JJ
authors: Pomposelli
authors: Mohamed
authors: M
authors: Akoad
authors: Khalid
authors: K
authors: Khwaja
authors: W D
authors: WD
authors: Lewis
authors: Yee L
authors: YL
authors: Cheah
authors: Jennifer
authors: J
authors: Verbesey
authors: Roger L
authors: RL
authors: Jenkins
authors: Elizabeth A
authors: EA
authors: Pomfret
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000401:mortality*; D015996:Survival Rate; D014184:Transplantation, Homologous; D014656:Vascular Surgical Procedures / Q000401:mortality*