Complex hepatic outflow reconstruction in domino liver transplantation

Pinheiro, Rafael Soares; Lai, Quirino; Dahrenmoller, Carola; Lerut, Jan

doi:10.1016/s1499-3872(14)60014-x

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…It is of note that eight patients presented a venous outflow obstruction and that six patients needed to be re-transplanted [16]. The fact that 16 more technical modifications have been reported during the period 2001-2019 indicates the need for further standardization and simplification of the technique [8,28,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. The venous outflow reconstruction of the domino-graft, such as described here, is in line with this.…”

Section: Discussionsupporting

confidence: 67%

“…Depending on the anatomical variation, LHV and MHV are together or separated. Venoplasty (if close to each other) or use of a small venous patch (if too far from each other) allow one single orifice to be created [28]. The easiest way to reconstruct correctly the supra-hepatic outflow tract of the graft is to anastomose the orifices of RHV and of the M-LHV cuff of the domino-graft to a modified free iliaco-caval vein graft (originating, if possible, from the same post-mortem donor).…”

Section: The Domino-back-table Operation (Figs 1 2a-d)mentioning

confidence: 99%

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Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

et al. 2020

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Domino-liver transplantation represents a rare chance to expand the donor liver pool. Fear of putting both donor and recipient at disadvantage has meant that the procedure has not been applied universally. A modification of the original technique which allows both safe procurement of the graft as well as safe implantation of the reconstructed graft in the domino-graft recipient using a 180° rotated, adequately trimmed, free iliaco-caval venous graft is described in detail.

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Section: Discussionsupporting

confidence: 67%

Section: The Domino-back-table Operation (Figs 1 2a-d)mentioning

confidence: 99%

Domino-liver transplantation: toward a safer and simpler technique in both donor and recipient

et al. 2020

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“…Direct end‐to‐end anastomosis between the HV stumps is technically difficult, and venoplasties are usually performed . The use of vascular grafts is also highly recommended, and several venous graft options have been proposed, including the use of a cadaveric Y‐shaped IVC‐iliac or portal vein bifurcation, a longitudinally opened iliac vein, or an autologous portal vein or umbilical vein . Cescon et al 15 have even described a cadaveric IVC patch that is sutured to each venous opening in the FAP graft to create a circular stump that can be anastomosed to the recipient's IVC.…”

Section: Discussionmentioning

confidence: 99%

“…To overcome the problem of short cuffs, interposed grafts are often required to obtain a suitable operative field for the reconstruction, for which several venous graft options have been proposed in the literature . To this end, our group has recently proposed a novel technique using arterial grafts to create a tailored patch that can be anastomosed between the HV stumps of the FAP graft and the recipient …”

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confidence: 99%

Technical options for outflow reconstruction in domino liver transplantation: A single European center experience

et al. 2015

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Venous outflow is critical to the success of liver transplantation (LT). In domino liver transplantation (DLT), the venous cuffs should be shared between the donor and the recipient, and the length can be compromised. The aim of this study was to describe and compare the technical options for outflow reconstruction used at our institution. This was a retrospective analysis of 39 consecutive DLT recipients between January 1997 and May 2013. Twenty-seven men and 12 women (mean age, 61.8 6 4.3 years) underwent LT and consented to receive a liver from a donor with familial amyloid polyneuropathy (FAP). The main indications were hepatocellular carcinoma and hepatitis C virus cirrhosis. All recipients underwent transplantation by a piggyback technique. Liver procurement in the FAP donors was performed with the classic technique in 22 patients and with the piggyback technique in the last 17. In these latter cases, for vascular outflow reconstruction, a cadaveric venous graft was interposed between the hepatic vein (HV) stump of the FAP liver and the recipient HV in 11 cases (28%). Since 2011, we have employed arterial grafts to be interposed between the vessels stumps: a tailored arterial graft in 5 patients and an aortic graft in 1 case. There was no postoperative mortality. Arterial and portal complications presented in 2 (5.1) and 4 patients (10.3), respectively. Postoperative outflow complications (post-LT subacute Budd-Chiari syndrome) occurred in 4 patients, and all of them had received a venous interposed graft for reconstruction. The incidence of outflow complications tended to be higher among patients with venous grafts than those with arterial graft interposition. Overall patient survival at 1, 3, 5, and 10 years was 97%, 79%, respectively. Arterial grafts constitute a feasible and safe option for vascular outflow reconstruction in DLT because they are associated with a relatively low incidence of complications. The recently proposed Bellvitge arterial graft technique should be added to the current range of available surgical modalities.

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“…If this is the case, then HV reconstruction is mandatory. Many different technical resources have been described, from a classic technique with cava resection and venousvenous bypass, to reconstruction with a cava patch, (1) an iliac bifurcation graft, (2) venoplasty with a venous patch (3) or arterial patch, (4) or performing a neocaval segment using both common iliac veins, (5) among others.…”

Section: To the Editormentioning

confidence: 99%