title: Standardization of modified right lobe grafts to minimize vascular outflow complications for adult living donor liver transplantation.
abstract: BACKGROUND
  After >2000 adult living donor liver transplants (LDLTs), we observed minimization of the complication rate using case-by-case modification of venous outflow reconstruction in right liver graft (RLG), standardization seeking intend to provide a hemodynamic- based, regeneration-compliant hepatic outflow reconstruction.
  
  
  METHODS
  We retrospectively examined 100 consecutive adult LDLT using modified RLG before and after application of RLG standardization to compare the 6-month incidences of vascular outflow complications.
  
  
  RESULTS
  The right hepatic vein stenting rate for first 6 months was 5% in the customized group and 1% in the standardized group (P=.212). The middle hepatic vein stenting rate for first 6 months was 9% in the customized group and 4% in the standardized group (P=.373). The inferior right hepatic vein stenting rate for first 6 months was 12.8% in the customized group and 7.1% in the standardized group (P=.472). The overall 6-month patient survival rate was 94% in the customized group and 95% in the standardized group (P=.867). The overall incidence of significant RLG venous outflow complications was 19% in the customized group and 8% in the standardized group (P=.023).
  
  
  CONCLUSIONS
  Standardization as a universal graft model seemed to be more effective and feasible than conventional graft customization requiring individualized case-by-case modification.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: C S
authors.initials: CS
authors.lastname: Ahn
authors.forename: K H
authors.initials: KH
authors.lastname: Kim
authors.forename: D B
authors.initials: DB
authors.lastname: Moon
authors.forename: T Y
authors.initials: TY
authors.lastname: Ha
authors.forename: G W
authors.initials: GW
authors.lastname: Song
authors.forename: D H
authors.initials: DH
authors.lastname: Jung
authors.forename: G C
authors.initials: GC
authors.lastname: Park
authors.forename: J M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: S Y
authors.initials: SY
authors.lastname: Yoon
authors.forename: S W
authors.initials: SW
authors.lastname: Jung
authors.forename: S G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D006503:Hepatic Veins / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D012039:Regional Blood Flow; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000628:therapy; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery