Feasibility of Left Lobe Living Donor Liver Transplantation Between Adults: An 8-Year, Single-Center Experience of 107 Cases

Soejima, Yuji; Taketomi, Akinobu; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Harada, Noboru; Ijichi, Hideki; Yonemura, Yutaka; Shimada, Mitsuo; Maehara, Yoshihiko

doi:10.1111/j.1600-6143.2006.01284.x

Cited by 147 publications

(162 citation statements)

References 35 publications

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“…Despite the greater difficulty of hepatic artery reconstruction when selecting left hepatic grafts with multiple hepatic arteries, we prefer to use a left hepatic graft because it increases donor's safety (Nishizaki et al, 2001;Soejima et al, 2006;Taketomi et al, 2009). Table 1.…”

Section: Preparation Of Recipient Hepatic Arteries For Hepatic Arterymentioning

confidence: 99%

Microvascular Hepatic Artery Reconstruction in Living Donor Liver Transplantation

Uchiyama¹,

Shirabe²,

Taketomi³

et al. 2012

Liver Transplantation - Technical Issues and Complications

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Section: Preparation Of Recipient Hepatic Arteries For Hepatic Arterymentioning

confidence: 99%

Microvascular Hepatic Artery Reconstruction in Living Donor Liver Transplantation

Uchiyama¹,

Shirabe²,

Taketomi³

et al. 2012

Liver Transplantation - Technical Issues and Complications

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“…A simple way is to increase the graft volume by the application of right-lobe LDLT or auxiliary LDLT. 2,3 Another way is decompression of the excessive portal pressure and flow into a small graft. This includes the formation of a portocaval shunt or performing splenectomy or splenic artery ligation.…”

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confidence: 99%

“…As we previously reported, our key GV/SLV value for the choice of graft is 35%. 2 If the GV/SLV is less than 35% in the left-lobe graft, the right-lobe graft is chosen. However, several cases in our series eventually had GV/SLV Ͻ 30% with a 1-year graft survival of 80%.…”

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confidence: 99%

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Transient portocaval shunt for a small-for-size graft in living donor liver transplantation

Ikegami¹,

Imura²,

Arakawa³

et al. 2008

Liver Transpl

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TO THE EDITORS:We read with interest the article by Taniguchi et al. from Hokkaido University. 1 They proposed the usefulness of transient portocaval shunt, closed with an endoloop, for the management of small-for-size graft syndrome in living donor liver transplantation (LDLT). Although we appreciated their tactful technique for shunt closure without laparotomy, we do not, however, agree with its universal application in LDLT using small grafts.There have been several concepts reported for the management of small-for-size graft syndrome in LDLT. A simple way is to increase the graft volume by the application of right-lobe LDLT or auxiliary LDLT. 2,3 Another way is decompression of the excessive portal pressure and flow into a small graft. This includes the formation of a portocaval shunt or performing splenectomy or splenic artery ligation. 1,4 As described in their report, the dilemma in the application of a portacaval shunt is that it itself may jeopardize the graft regeneration. 1 The systemic venous pressure is always lower than the portal system pressure, and graft regeneration would still increase the intragraft portal pressure. It may possibly cause graft nonfunction caused through the decreased graft portal flow by a stealing mechanism.As we have previously reported, splenectomy or splenic artery ligation is a simple concept for decompression of portal hypertension. With these maneuvers, portal pressure can always be pulled down to around 20 cm H 2 O. 4 The hemodynamic status over the recipient's posttransplant time course and the graft is much simpler in splenectomy or splenic artery ligation than in a portacaval shunt, which might need manual closure in association with graft regeneration. 1 The positive points of a splenectomy include not only the decompression of portal hypertension but also increased leukocyte and platelet counts. 4 Moreover, the surgical techniques for splenectomy have improved dramatically with the recent introduction of a vessel sealing system. 5 Our indication for establishing a portocaval shunt is limited only by portal system pressure greater than 20 mm Hg after the performance of splenectomy or splenic artery ligation.Moreover, the graft volume/standard liver volume (GV/SLV) ratio described in the report by Taniguchi et al. 1 is 35.8%. As we previously reported, our key GV/SLV value for the choice of graft is 35%. 2 If the GV/SLV is less than 35% in the left-lobe graft, the right-lobe graft is chosen. However, several cases in our series eventually had GV/SLV Ͻ 30% with a 1-year graft survival of 80%. 2 Thus, we question why they needed to perform temporary portacaval shunt for that case. Indeed, what are the details of their indication of temporary portacaval shunt? We would have just performed splenectomy for that GV/ SLV ϭ 35.6% case and might have undertaken a portacaval shunt if the portal pressure after splenectomy had been greater than 20 mm Hg.

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“…As is well known, the chance of receiving a liver graft from a deceased donor is almost zero in Japan. [7][8][9] The estimated autograft volume after ECHR was 590 g, representing a graft volume/standard liver volume ratio of 49.6% (Fig. 2).…”

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Extracorporeal hepatic resection for unresectable giant hepatic hemangiomas

et al. 2007

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In order to perform surgical treatment for tumors unresectable for anatomical reasons, there are two approaches: one is liver transplantation, and the other is extracorporeal hepatic resection (ECHR). [1][2][3][4][5][6][7] The benefit of liver transplantation is its simple surgical concept, and the benefits of ECHR are that it is immunosuppression-free and that organ donors are unnecessary. [1][2][3][4][5][6] The patient was a 39-year-old female referred to our hospital for possible living donor liver transplantation for her huge and multiple unresectable hemangiomas of the liver. Although she had undergone transcatheter arterial embolization 6 months previously, they showed an increase in size. At the time of referral, she demonstrated abdominal distention with shortness of breath. Her laboratory testing showed normal liver function tests, including a total bilirubin level of 1.3 mg/dL, an albumin level of 4.3 g/dL, and a prothrombin time of 13.6 seconds. A computed tomography scan of the abdomen showed 4 huge tumors (Fig. 1). This location of the tumors and their benign origin led us to choose ECHR rather than living donor liver transplantation after detailed informed consent was obtained. As is well known, the chance of receiving a liver graft from a deceased donor is almost zero in Japan. [7][8][9] The estimated autograft volume after ECHR was 590 g, representing a graft volume/standard liver volume ratio of 49.6% (Fig. 2).The patient was taken to the operating room, and laparotomy was performed (Fig. 3). The liver was severely enlarged, but the nontumor portion looked like normal hepatic parenchyma. After the dissection of the hilar structures at the mid-hilum, the portosystemic venovenous bypass, using reinforced venous cannulas (Edwards Life Sciences, Inc., Irvine, CA), was established from the inferior mesenteric vein with 16Fr and from the left saphenous vein with 15Fr to the left axillary vein with 14Fr. The patient was started on the bypass at the rate of 4 L/min with a stable circulatory condition. After the division of the proper hepatic artery, the total liver was mobilized from the diaphragm. The common hepatic duct was divided, the vascular clamps were applied and followed by division on the portal vein and suprahepatic and infrahepatic vena cava, and then the total hepatectomy was performed. The explanted liver was flushed with 3 L of normal saline followed by 3 L of University of Wisconsin solution. Intraoperative ultrasound was done on the backtable for the determination of the exact cutting line. After dissection of the vena cava from the dorsal liver with ligation of the short hepatic veins, the huge hemangiomas in segment 1, segment 2 to 3, caudal segment 4, and segment 6 to 7 were resected with a Cavitron ultrasonic surgical aspirator (Valleylab, Inc., Boulder, CO; Fig. 2). After resection, vascular and biliary leakage tests using an injection of University of Wisconsin solution were performed, and the leakage points were repaired with fine sutures. The actual weight of the whole explanted...

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Feasibility of Left Lobe Living Donor Liver Transplantation Between Adults: An 8-Year, Single-Center Experience of 107 Cases

Cited by 147 publications

References 35 publications

Microvascular Hepatic Artery Reconstruction in Living Donor Liver Transplantation

Microvascular Hepatic Artery Reconstruction in Living Donor Liver Transplantation

Transient portocaval shunt for a small-for-size graft in living donor liver transplantation

Extracorporeal hepatic resection for unresectable giant hepatic hemangiomas

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