Raising-flap technique for outflow reconstruction in living donor liver transplantation

Jeng, Long‐Bin; Thorat, Ashok; Li, Ping-Chun; Li, Mingli; Yang, Horng Ren; Yeh, Chun-Chieh; Chen, Te-Hung; Hsu, Chia‐Hao; Hsu, Sandy Huey-Jen; Poon, Kin Shing

doi:10.1002/lt.23810

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…However, anatomical variations of hepatic veins in LLS is common and two wide HV orifices account for 2-4% of all LLS grafts (5,6). Adequate hepatic venous outflow is essential for survival of graft and patients (7)(8)(9). For LLS grafts with two wide hepatic vein orifices, it is technically challenging if it occurs (10).…”

Section: Introductionmentioning

confidence: 99%

Modified Dual Hepatic Vein Anastomosis in Pediatric Living-Donor Liver Transplantation Using Left Lateral Segment Grafts With Two Wide Orifices

et al. 2021

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Background: The anatomic variation of hepatic vein in the left lateral segment (LLS) increases the risk of outflow complication in pediatric living liver transplantation (LDLT). Here, we share a modified method for dual hepatic vein reconstruction in pediatric LDLT using LLS with two wide orifices.Methods: From Sep 2018 to Dec 2019, 434 pediatric LDLTs using LLS were performed in our center. Hepatic veins of grafts were classified into three types with emphasis on the number, size, and location of orifices at the cut surface: a single opening (type I, n = 341, 78.57%); two adjacent orifices (type II, n = 66, 15.21%); two wide orifices with orifices distances <20 mm (type IIIa, n = 15, 3.46%); and two wide orifices with orifices distances >20 mm (type IIIb, n = 12, 2.76%). Rv was defined as the ratio of diameter of V2 and V3 (refer to hepatic vein drained segments II and III). We developed a modified dual hepatic vein anastomosis to reconstruct outflow for type IIIb grafts with Rv ≤1. Briefly, the hepatic vein of segment II was anastomosed to the common stump of middle hepatic vein (MHV) and left hepatic vein (LHV), followed by unification of V3 and the longitudinal incision orifice in inferior venous cave (IVC).Results: During median follow-up of 15.6 months (7.5–22.9 months), no hepatic vein complications occurred.Conclusion: This novel modified dual hepatic vein anastomosis could serve as a feasible surgical option for type IIIb LLS grafts with Rv ≤1 in pediatric LDLT.

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Section: Introductionmentioning

confidence: 99%

Modified Dual Hepatic Vein Anastomosis in Pediatric Living-Donor Liver Transplantation Using Left Lateral Segment Grafts With Two Wide Orifices

et al. 2021

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“…Because of deceased donor scarcity, LDLT is a major source of liver allografts in Asia, and the exclusion of a donor on account of presence of venous anomalies of liver may further decrease the chance of receiving the liver transplantation for a patient with end‐stage liver disease (ESLD). Recent studies have emphasized the pivotal role of an adequate outflow for proper functioning of liver allografts in LDLT, the modifications of the outflow reconstruction techniques in the presence of venous variations to prevent hepatic venous congestion, and for making right liver allografts fully functional …”

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confidence: 99%

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

et al. 2016

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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 5 16) comprised the recipients with outflow reconstruction with a V-Plasty, and group B (n 5 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.

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Fibrinolysis after reperfusion of liver graft

Poon

Chen

Thorat

et al. 2015

Acta Anaesthesiologica Taiwanica

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From September 2012 to March 2013, a total of 63 adult-to-adult living donor liver transplantations were performed at our institution. All the patients were monitored for their coagulation functions using rotation thromboelastometry (ROTEM, Tem Innovations GmbH) during the procedure at the following points: preoperative baseline, 5 minutes, 30 minutes, and 120 minutes, respectively, after reperfusion of the liver graft. A total of 84.13% of cases (n = 53) revealed fibrinolysis after reperfusion of the graft and the condition was reversed after 30 minutes without any need for additional treatment. No significant coagulopathy was observed during this period in all of the cases. The result of the ROTEM finding must correlate with the clinical situation before instituting any management to avoid the risk of thrombosis of the hepatic artery.

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Raising-flap technique for outflow reconstruction in living donor liver transplantation

Cited by 6 publications

References 8 publications

Modified Dual Hepatic Vein Anastomosis in Pediatric Living-Donor Liver Transplantation Using Left Lateral Segment Grafts With Two Wide Orifices

Modified Dual Hepatic Vein Anastomosis in Pediatric Living-Donor Liver Transplantation Using Left Lateral Segment Grafts With Two Wide Orifices

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

Fibrinolysis after reperfusion of liver graft

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