title: Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: The importance of the inferior right hepatic vein.
abstract: Special care must be taken in hepatic vein reconstruction to avoid outflow block in living donor liver transplantation (LDLT) with a right liver graft. We have used cryopreserved homologous veins to reconstruct the right hepatic vein (RHV), middle hepatic vein (MHV), MHV tributaries (V5 and V8), and inferior right hepatic vein (IRHV). The reconstruction of V5, V8, and IRHV was based on the estimated congestive volume, calculated by the computed tomography volumetry, to secure the functional graft volume of 40% of the recipient standard liver volume. Among 262 right liver LDLT recipients, the number of reconstructed RHVs, MHVs, V5s, V8s, and IRHVs was 262, 48, 110, 111, and 147, respectively, and the overall patency was 95%, 100%, 36%, 58%, and 86%, respectively. Although the patency of the RHVs and MHVs was satisfactory, that of the V5s, V8s, and IRHVs was suboptimal. Patency of the IRHVs (86%, 126/147) was significantly better than that of both V5s (36%, 40/110) and V8s (58%, 64/111; P < 0.001). In addition, the estimated volume drained by IRHVs was significantly greater than that of V5s and V8s (IRHV, 176 ± 92 mL; V5, 105 ± 49 mL; V8, 127 ± 60 mL; P < 0.001). The patency of IRHV was significantly improved by applying the double inferior vena cava method (93%, 94/101) when compared to the direct anastomosis to vena cava (68%, 25/37; P < 0.001). The IRHV functioned as a main drainage route in cases of an obstructed RHV. In conclusion, reconstruction of the IRHV is recommended, not only to improve the functional reserve of the graft, but also to secure multiple drainage routes of the graft.
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Kyoji
authors.initials: K
authors.lastname: Ito
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Tani
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ito
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Arita
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult