Complex hepatic outflow reconstruction in domino liver transplantation.
Domino liver transplantation has been accepted as a safe procedure to further expand the organ donor pool. The most important technical challenge of the procedure resides in restoring a proper hepatic venous allograft outflow in the familial amyloidotic polyneuropathy-liver recipient. To overcome this issue, combined techniques were used to perform an innovative outflow reconstruction. A domino liver transplantation was successfully performed with reconstruction of complex venous outflow. The inferior vena cava sparing hepatectomy technique in the familial amyloidotic polyneuropathy-donor was used to cut the hepatic vein to the liver parenchyma. To overcome this issue the venous outflow tract was reconstructed using a longitudinally opened iliac vein graft from a post-mortem donor to create a new outflow tract using a diamond patch between the right and middle/left hepatic veins.
Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc,Universite catholique Louvain UCL Brussels, Belgium. rsnpinheiro@gmail.com.
Rafael S
RS
Pinheiro
Quirino
Q
Lai
Carola
C
Dahrenmoller
Jan
J
Lerut
D028227:Amyloid Neuropathies, Familial / Q000473:pathology; D005260:Female; D006503:Hepatic Veins / Q000502:physiology* / Q000601:surgery*; D006801:Humans; D007084:Iliac Vein / Q000601:surgery / Q000637:transplantation; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology*; D014019:Tissue Donors; D066027:Transplant Recipients; D016896:Treatment Outcome; D058017:Vascular Grafting