title: Reconstruction of the Outflow Tract in Cross-Auxiliary Double-Domino Donor Liver Transplantation.
abstract: BACKGROUND
  Auxiliary liver transplantation is accepted as an effective manner to expand the liver donor pool. A difficult surgical technical challenge of the procedure is hepatic vein reconstruction of the graft.
  
  
  METHODS
  To resolve this problem, complex techniques are used to perform an innovative outflow tract reconstruction in the world's first cross-auxiliary double-domino donor liver transplantation with two whole liver grafts. The inferior vena cava-sparing hepatectomy technique was applied at harvest in the two domino liver donors. For each donor, the three major hepatic veins (right, middle, and left) were joined together to create one single orifice, but there was no sufficient tissue to perform a direct anastomosis.
  
  
  RESULTS
  The hepatic vein was reconstructed with the use of a longitudinally opened iliac vein graft from a cadaveric donor to prolong the outflow tract for the piggyback suturing.
  
  
  CONCLUSIONS
  This new technique might provide an innovative surgical approach for reconstructing the complex outflow tract of domino transplantation.
authors: Liver Transplant Section, General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors: W
authors: W
authors: Qu
authors: Liver Transplant Section, General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China. Electronic address: fchzhuzhijun@hotmail.com.
authors: Z-J
authors: ZJ
authors: Zhu
authors: Liver Transplant Section, General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors: L
authors: L
authors: Wei
authors: Liver Transplant Section, General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors: L-Y
authors: LY
authors: Sun
authors: Liver Transplant Section, General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors: Y
authors: Y
authors: Liu
authors: Liver Transplant Section, General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors: Z-G
authors: ZG
authors: Zeng
mesh_terms: D000328:Adult; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D019737:Transplants / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*