Effect of Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation Using Right Lobe

Kim, D.G.; Moon, In Sung; Kim, S.J.; Lee, Y.J.; Lee, M.D.

doi:10.1016/j.transproceed.2006.06.005

Cited by 22 publications

(21 citation statements)

References 8 publications

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“…It has been demonstrated that ligation of large MHV tributaries could bring about more remarkable perfusion imbalance between anterior and posterior segments [42]. As a result, the vascular diameter of the MHV tributaries is the mostly recommended criteria for reconstruction and 5 mm is commonly preferred as a demarcation [13,14,16,17,18,19,20,21,23,25,26,28,29,30,32,35], while others have suggested that MHV reconstruction should be based on the clamping test findings [13,17,21,26,29,32,35], graft volume [21,23,43] and the number of the MHV tributaries [23,24,31,33]. The policy of our center for MHV tributaries reconstruction had been described above.…”

Section: Discussionmentioning

confidence: 99%

“…For a modified right lobe there would be technical difficulty as to the additional reconstruction of the MHV tributaries. Firstly, the source of optimal venous grafts for the procedure remains a concern, whether it is cryopreserved or autologous or prosthetic vein grafts [3,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. Secondly, an appropriate reconstruction policy also remains a concern, which could obviate additional procedures and possible outflow problems.…”

Section: Introductionmentioning

confidence: 99%

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Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

et al. 2014

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Aims: To investigate the effectiveness of our technique and policy in reconstructing middle hepatic vein (MHV) tributaries of patients undergoing right-lobe living donor liver transplantation (LDLT). Methods: From January 2001 to December 2010, 186 adult patients underwent right-lobe LDLT without the MHV. Patients were divided into two groups: group A (n = 71) and group B (n = 115) without or with the MHV tributaries reconstruction. We evaluated the serum liver function markers after transplantation and monitored vascular flow in the graft and interpositional vein by Doppler ultrasonography. Results: The cumulative 1-, 3-, 5-year graft and patient survival rates were not significant between group A and group B (p = 0.287 and p = 0.258). Biliary complications appeared to be more frequent in group A than in group B (16.9 vs. 5.2%, p = 0.009). Liver function impairment was found in patients without MHV reconstruction and those with occluded interpositional vessels early after transplantation. The cumulative 1-, 3-, 6- and 12-month patency rate of the interpositional veins was 81.51, 79.60, 74.69 and 72.68%, respectively. Conclusion: The reconstruction technique based on our policy ensures excellent outflow drainage and favorable recipient outcome, while better criteria for MHV reconstruction should be established.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

et al. 2014

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“…The reported patency of the native MHV in the ERGs is approximately 90% . The reported patency of the reconstructed MHV is highly variable (52%‐90%) . Hence, it was taken as 65% in our study, allowing an equivalence margin of 25%.…”

Section: Methodsmentioning

confidence: 99%

“…In fact, magnetic resonance imaging–based studies have reported congestion of the right anterior sector in 62% of right lobe grafts even after reconstruction of segment V and VIII drainage . Furthermore, questions regarding the patency of the reconstructed veins as well as the impact of MHV harvest on donor morbidity warrant further clarification …”

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confidence: 99%

Randomized trial on extended versus modified right lobe grafts in living donor liver transplantation

et al. 2018

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Despite advances in the practice of living donor liver transplantation (LDLT), the optimum surgical approach with respect to the middle hepatic vein (MHV) in right lobe LDLT remains undefined. We designed a randomized trial to compare the early postoperative outcomes in recipients and donors between extended right lobe grafts (ERGs; transection plane was maintained to the left of MHV and division of MHV performed beyond the segment VIII vein) and modified right lobe grafts (MRGs; transection plane was maintained to the right of MHV; the segment V and VIII drainage was reconstructed using a conduit of recipient portal vein). Eligible patients (n = 86) were prospectively randomized into the ERG arm (n = 43) and the MRG arm (n = 43) at the beginning of donor hepatectomy. The primary endpoint considered in this equivalence trial was patency of the MHV or the reconstructed "neo-MHV" in the recipient. The secondary endpoints included biochemical parameters, postoperative complications, mortality in recipients as well as donors and volume regeneration of remnant liver in donors, measured at 2 months. The patency of the MHV was comparable in the ERG and MRG arms (90.7% versus 81.4%; difference, 9.3%; 95% confidence interval [CI], -5.8 to 24.4; z score, 1.245; P = 0.21). Volume regeneration of the remnant liver in donors was significantly better in the MRG arm (111.3% versus 87.3%; mean difference, 24%; 95% CI, 14.6-33.3; P < 0.001). The remaining secondary endpoints in donors and recipients were similar between the 2 arms. To conclude, MRG with reconstructed neo-MHV has comparable patency to native MHV in ERG and confers equivalent graft outflow in the recipient. Furthermore, it allows better remnant liver regeneration in the donor at 2 months. Liver Transplantation 24 888-896 2018 AASLD.

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“…Whether MHV tributaries should be reconstructed in the hemiliver without the MHV is another crucial problem, since a congested area in the right liver graft is reported to result in poor liver function , followed by atrophy, unless venous reconstruction is performed. [2] As venous drainage of the liver graft is just as important as hepatic inflow for the integrity of graft function, drainage should be reconstructed where an area of more than 10% of congestion is anticipated. [3] Sacrificing the donor's middle hepatic vein can cause congestion of the liver parenchyma drained by it, which can cause inadequate liver function in some donors.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of the middle hepatic vein in live donor liver transplantation: will it improve donor liver function?

Liyanage

2014

Sri Lanka j Surg

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Abstract:Right liver graft with the middle hepatic vein sometimes induces postoperative liver failure in donors due to insufficient functional remnant liver volume. Venous drainage of the graft is important for prevention of congestion and proper function of the graft. Therefore right hepatic veins and the tributaries of the middle hepatic vein need reconstruction.The unique technique of reconstructing the middle hepatic vein, the right hepatic vein and the short hepatic veins using allografts and artificial grafts are discussed.Patients who had right hepatic and middle hepatic vein reconstructions had good graft functions and less hepatic congestion. This technique will be useful for preserving liver function in right liver lobe donors in Sri Lanka where more than 31% of the general population has fatty liver disease. Introduction:

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Effect of Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation Using Right Lobe

Cited by 22 publications

References 8 publications

Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

Randomized trial on extended versus modified right lobe grafts in living donor liver transplantation

Reconstruction of the middle hepatic vein in live donor liver transplantation: will it improve donor liver function?

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