title: Reconstruction of inferior right hepatic veins in living donor liver transplantation using right liver grafts.
abstract: Because revascularization of the inferior right hepatic vein (IRHV) is a major component of right liver graft (RLG) reconstruction, we assessed the surgical techniques and clinical outcomes of IRHV reconstruction so that we could formulate practical guidelines for standardized procedures. From July 2004 to February 2010, we performed separate IRHV reconstructions in 487 of 1142 adult RLG recipients (42.7%). These recipients included 364 patients with a natural single IRHV and 123 patients with multiple IRHVs; in the latter group, the IRHVs were unified by venoplasty, which enabled a single anastomosis. The 1-year stenosis rates for the single-vein and venoplasty groups were 23% and 18.9%, respectively, and the early stent insertion rates were 7.1% and 9.8%, respectively (P = 0.09). Late IRHV occlusion did not lead to graft dysfunction, and all large major IRHVs were patent. A morphometric analysis showed that IRHV stenosis was associated with IRHV stretching and an anastomotic level discrepancy. This led to refinements of the surgical techniques: IRHV orifices were shaped into funnels, and the IRHV anastomosis was accurately placed at the recipient inferior vena cava (IVC). In an ongoing prospective study of 35 patients, our funneling unification venoplasty resulted in only 1 episode (2.9%) of early IRHV stenosis requiring stenting at a median follow-up of 8 months. The final configurations of the reconstructed IRHVs after funneling unification venoplasty and extensive IVC dissection were very similar to those of the native donor liver. In conclusion, we suggest that in combination with extensive recipient IVC dissection, funneling and unification venoplasty techniques are useful for securely reconstructing single or multiple IRHVs during the implantation of RLGs.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Jung-Man
authors.initials: JM
authors.lastname: Namgoong
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jung
authors.forename: Sam-Youl
authors.initials: SY
authors.lastname: Yoon
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Byungchul
authors.initials: B
authors.lastname: Cho
authors.forename: Kyoung Won
authors.initials: KW
authors.lastname: Kim
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006503:Hepatic Veins / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014682:Vena Cava, Inferior / Q000601:surgery; D055815:Young Adult