title: One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation.
abstract: OBJECTIVE
  Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts.
  
  
  METHODS
  We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31).
  
  
  RESULTS
  In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 % in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p < 0.001) and these patients had higher alanine transaminase values (142 ± 79 vs. 96 ± 46 IU/L, p = 0.024) on postoperative day POD 7. However, the 6-month short-term graft survival rates were 100 % with one-step reconstruction and 83.9 % with direct anastomosis, respectively.
  
  
  CONCLUSIONS
  One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan. tikesurg@yahoo.co.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Shohei
authors.initials: S
authors.lastname: Yoshiya
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Takeo
authors.initials: T
authors.lastname: Toshima
authors.forename: Takashi
authors.initials: T
authors.lastname: Motomura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000637:transplantation; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D014182:Transplantation, Autologous; D014682:Vena Cava, Inferior / Q000637:transplantation