title: Outflow reconstruction for right liver allograft with multiple hepatic veins: "V-plasty" of hepatic veins to form a common outflow channel versus 2 or more hepatic vein-to-inferior vena cava anastomoses in limited retrohepatic space.
abstract: Outflow reconstruction in living donor liver transplantation (LDLT) is certainly difficult in limited retrohepatic space with using right liver grafts with venous anomalies. Venoplasty of the inferior right hepatic veins (IRHVs) and middle hepatic vein (MHV) reconstruction using synthetic grafts to form a common outflow channel or a second venocaval anastomosis are available options. We aim to compare outcomes of LDLT recipients who underwent outflow reconstruction with a "V-Plasty" technique and outcomes of patients who underwent a second venocaval anastomosis. Out of 325 recipients who underwent LDLT from March 2011 to September 2014, 45 received right liver allografts that were devoid of MHV with multiple draining IRHVs (2 or more). Group A (n = 16) comprised the recipients with outflow reconstruction with a V-Plasty, and group B (n = 29) included the recipients with a second venocaval anastomosis. Group A recipients (male:female, 10:6; median age, 50.5 years) had a mean Model for End-Stage Liver Disease score of 14.7, whereas for group B recipients (male:female, 20:9; median age, 52.0 years) it was 17.2. The mean IRHV diameter for group A and B grafts was 8.3 mm each. Mean warm ischemia time for group A was significantly lower (25.2 minutes) as compared to group B recipients (34.6 minutes) with P < 0.001. The 2-month patency rates of vascular grafts were 100% for group A recipients with no evidence of thrombosis. In conclusion, the V-Plasty technique of MHV and IRHV reconstruction to form a common outflow is a new concept that proves to be a safe and feasible alternative for second venocaval anastomosis.
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Thorat
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.|Departments of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.|Departments of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Horng-Ren
authors.initials: HR
authors.lastname: Yang
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.|Departments of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ping-Chun
authors.initials: PC
authors.lastname: Li
authors.affiliation: Departments of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ming-Li
authors.initials: ML
authors.lastname: Li
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.|Departments of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.|Departments of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Te-Hung
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.|Departments of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Chao
authors.initials: SC
authors.lastname: Hsu
authors.affiliation: Departments of Anaesthesiology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Kin-Shing
authors.initials: KS
authors.lastname: Poon
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001807:Blood Vessel Prosthesis; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007511:Ischemia; D008099:Liver / Q000098:blood supply / Q000601:surgery; D008102:Liver Circulation; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013927:Thrombosis / Q000150:complications; D016896:Treatment Outcome