title: All-in-one sleeve patch graft venoplasty for multiple hepatic vein reconstruction in living donor liver transplantation.
abstract: OBJECTIVE
  This paper presents an innovative technique to address complex multiple hepatic vein (HV) reconstruction in right lobe graft living donor liver transplantation (RL-LDLT).
  
  
  METHODS
  A patient with hepatitis C virus-related cirrhosis underwent RL-LDLT. The graft had seven HVs, including: the right HV (17 mm); one segment VII HV (11 mm); two segment VI HVs (6 mm and 16 mm), and three segment V HVs. The graft weighed 663 g (53% of standard liver volume; ratio of graft weight to recipient body weight: 0.96). Each HV had significant drainage territory requiring reconstruction. A cryopreserved iliac vein graft was used to create a sleeve patch to incorporate the HV openings. The holes were anastomosed to their corresponding HV tributaries using continuous 6-0 polydioxanone (PDS) sutures. Two of the three segment V HVs were combined using a smaller iliac vein patch, which was anastomosed in an end-to-side fashion to a previously harvested recipient umbilical vein interposition graft. The other end of the umbilical vein graft was anastomosed to the larger iliac vein sleeve patch.
  
  
  RESULTS
  Overall, six HV openings were incorporated in one sleeve patch to allow a single wide anastomosis with the recipient inferior vena cava. Doppler ultrasound after reconstruction showed adequate flow patterns in all the HVs.
  
  
  CONCLUSIONS
  All-in-one sleeve patch graft venoplasty simplifies the reconstruction of multiple HVs and reduces warm ischaemia time in RL-LDLT with excellent outcomes.
authors.affiliation: Liver Transplantation Programme, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. clchen@cgmh.org.tw
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Anthony Q
authors.initials: AQ
authors.lastname: Yap
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Liu
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D015925:Cryopreservation; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation*; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D013536:Suture Techniques; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014471:Umbilical Veins / Q000637:transplantation; D058017:Vascular Grafting