title: Hemodynamics-compliant reconstruction of the right hepatic vein for adult living donor liver transplantation with a right liver graft.
abstract: Secure reconstruction of the right hepatic vein (RHV) is essential for the successful implantation of a right liver graft during living donor liver transplantation (LDLT). To develop reliable surgical techniques for RHV reconstruction, we performed 3 concurrent studies: a simulation study using a fluid dynamics experimental model and a computational simulation model; an observational study analyzing the hemodynamic changes during radiological interventions for RHV stenosis; and a prospective clinical study establishing hemodynamics-compliant surgical techniques. The simplified fluid dynamics experimental model revealed that actually measured outflow volumes were very similar to theoretical values derived from a fluid dynamics formula. The computational simulation model showed that outflow decreases were nearly linearly correlated with the degree of stenosis when it exceeded 50%. The clinical observational study revealed that mild (≤50%), moderate (50%-75%), and severe RHV stenoses (≥75%) had mean pressure gradients of 2.5 ± 1.0, 6.6 ± 2.3, and 9.6 ± 2.8 mm Hg, respectively. The prospective clinical study was performed for patients who underwent RHV reconstruction with RHV angle blunting and inferior vena cava enlargement (n = 274); a historical control group of patients who underwent reconstruction by other methods (n = 225) was also used. RHV stenting within 2 weeks and 1 year was necessary for 1 patient (0.4%) and 5 patients (1.8%) in the study group, respectively, and for 9 patients (4.0%) and 21 patients (9.1%) in the control group, respectively (P < 0.01). The mean cephalocaudal length of patulous RHV anastomoses was greater in the study group versus the control group (P < 0.001). In conclusion, our modified RHV reconstruction technique significantly reduces the risk of RHV stenosis. We thus suggest the routine or selective use of this technique as a part of graft standardization for LDLT using a right liver graft.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, 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: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Kyoung Won
authors.initials: KW
authors.lastname: Kim
authors.forename: Byungchul
authors.initials: B
authors.lastname: Cho
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: Chun-Soo
authors.initials: CS
authors.lastname: Park
authors.forename: Yo-Han
authors.initials: YH
authors.lastname: Park
authors.forename: Hyeong-Woo
authors.initials: HW
authors.lastname: Park
authors.forename: Hyo-Jun
authors.initials: HJ
authors.lastname: Lee
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D003198:Computer Simulation; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D006085:Graft Survival; D006439:Hemodynamics; D006503:Hepatic Veins / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods