title: Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation.
abstract: An outflow obstruction of the hepatic vein is a critical complication after living donor liver transplantation (LDLT) and occasionally leads to hepatic failure. Here we introduce a simple method for preventing outflow obstructions by patch plasty in adult LDLT. Between September 2001 and May 2010, 468 adult LDLT procedures were performed at Kyoto University Hospital. We harvested each recipient's portal vein (PV) from the extirpated liver for a patch. We intended to re-form several orifices of the hepatic veins into a single, large orifice. The patch was attached to the anterior wall of the re-formed orifice on the bench. After we put in the liver graft, the procedure for the hepatic vein anastomosis to the inferior vena cava was simple enough that the warm ischemia time was reduced. Three of the 468 cases were diagnosed with an outflow obstruction. All 3 cases underwent hepatic vein reconstruction without patch plasty. In contrast, none of the 159 cases that underwent LDLT with patch plasty suffered from an outflow obstruction, regardless of the liver graft type. The procedure for hepatic vein plasty using a patch from the native PV is simple and elegant and results in excellent outcomes. We propose this as the standard procedure for hepatic vein reconstruction in adult LDLT.
authors.affiliation: Department of Surgery (Division of Hepato-Biliary-Pancreatic Surgery and Transplantation)Graduate School of Medicine, Kyoto University, Kyoto, Japan. akr@kuhp.kyoto-u.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Mori
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Hata
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Isoda
authors.forename: Toshiya
authors.initials: T
authors.lastname: Shibata
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery