Intrahepatic Anastomosis Formation Between the Hepatic Veins in the Graft Liver of the Living Related Liver Transplantation: Observation by Doppler Ultrasonography

Abstract

In living related liver transplantation, the right lobe has come to be used as a graft to meet the metabolic demands of adult or adolescent recipients. In harvesting the right lobe as a graft, however, there is controversy as to whether or not the middle hepatic vein (MHV) should be included and reconstructed. Anatomical intrahepatic anastomosis between the right hepatic vein (RHV) and MHV is considered to exist, but the formation process of this functional anastomosis has not been demonstrated by Doppler ultrasonography (US). In our case, a right lobe including a right branch of the MHV was used as a graft. In implanting, the RHV was anastomosed to the inferior vena cava and the right branch of the MHV was ligated. Using Doppler US, we checked the blood flow in the hepatic vein after transplantation. Within 3 days of surgery, no flow was detected in the right branch of the MHV. A flow around the right branch of the MHV was observed at postoperative day 6. At postoperative day 9, a reverse flow was detected in which the right branch of the MHV drained into the RHV via the anastomosis between them. Based on our results, it appears that a functional intrahepatic anastomosis between hepatic veins formed gradually within 10 days of ligation of an afferent branch, during which time the graft function did not deteriorate.

Changes in portal vein flow after adult living-donor liver transplantation: Does it influence postoperative liver function?

“…To do that, we have used, when necessary, cryopreserved iliac artery grafts. In our experience, this has proven to be effective not only during the early postoperative period, which is the most important time for the graft to adapt, 24 but also in the long term. Immediate postoperative liver function, as well as the flow shown by the imaging study during the early postoperative period, showed an uneventful recovery of all the grafts and patients (we did not lose grafts for technical reasons).…”

Branching Patterns and Drainage Territories of the Middle Hepatic Vein in Computer-Simulated Right Living-Donor Hepatectomies

“…In reality, the elevated pressure in the outflow path seems to gradually open the existing shunts between the liver veins that are not detectable by our methods. The existence of these anastomoses has been demonstrated in studies and case reports (11,12,44,45). Another compensatory mechanism is the reversal of flow in the portal vein (46,47).…”

Adult-to-adult living donor liver transplantation using right-lobe grafts: Results and lessons learned from a single-center experience

“…It has been our experience and also recently reported that postoperative ultrasound examination of the graft drainage shows reversal of flow in the right middle hepatic vein branch ultimately emptying into the right hepatic vein system. 15 Since moving our transection plane in this manner, we have not experienced outflow problems causing graft dysfunction. Another venous drainage issue is that of accessory hepatic veins draining into the vena cava.…”