title: Technical refinement of hepatic vein reconstruction in living donor liver transplantation using left liver graft.
abstract: BACKGROUND
  In adult living donor liver transplantation (LDLT), left liver graft is generally safer for the donor. The aim of this study was to demonstrate a technical refinement for achieving sufficient outflow using left liver graft.
  
  
  METHODS
  Forty-seven cases using left liver were divided into 2 groups according to the procedures of hepatic vein reconstruction: the side-clamp group (21 cases), and the cross-clamp group (26 cases), to sufficiently enlarge the diameter of the hepatic vein with excising the inferior vena cava (IVC).
  
  
  RESULTS
  The liver function tests at 7 days after LDLT were not significantly different between the 2 groups, but the median amount of ascites was significantly greater in the side-clamp group (1250 ml; range, 484-3690) than in the cross-clamp group (582 ml; 190-2785). When we selected the patients with the ratio of graft weight to recipient standard liver volume less than 30%, the 1-year patient survival after transplantation was significantly better in the cross-clamp group than in the side-clamp group (90% in cross-clamp group vs. 71% in side-clamp group, P<0.05).
  
  
  CONCLUSIONS
  In conclusion, hepatic vein reconstruction with cross-clamping of the IVC can secure a sufficient outflow in LDLT using left liver graft.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Soyama
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Kinoshita
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Zhassulan
authors.initials: Z
authors.lastname: Baimakhanov
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Tota
authors.initials: T
authors.lastname: Kugiyama
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Adachi
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Amane
authors.initials: A
authors.lastname: Kitasasto
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult