Modified right liver graft from a living donor to prevent congestion1

Lee, Sung Gyu; Park, Kwang Min; Hwang, Shin; Kim, Ki Hun; Choi, Dong Nak; Joo, Sun Hyung; Anh, Chul Soo; Nah, Yang Won; Jeon, Jang Yong; Park, Sang Hoon; Koh, Kyoung Hwan; Han, Sang Hoon; Choi, Kyu Taek; Hwang, Kyu Sam; Sugawara, Yasuhiko; Makuuchi, Masatoshi; Min, Pyung Chul

doi:10.1097/00007890-200207150-00010

Cited by 164 publications

(56 citation statements)

References 17 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%

“…Cryoperserved cadaveric iliac vein and artery have been proved to effectively solve drainage problems of the paramedian portion of the right lobe [10,18,19]. The initial vessel material for MHV reconstruction was recipient GSV [13], which was preferred for interposition during the early period at our center, and then it was taken over by CIAs because we found that it was easier to obtain a large-sized outflow orifice when CIAs were used for reconstruction.…”

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: Discussionmentioning

confidence: 99%

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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“…Modified right lobe graft [7] was used in 10 patients. Extended right lobe graft [8] and right lobe graft without middle hepatic vein reconstruction were used in 4 and 2 cases respectively.…”

Section: Resultsmentioning

confidence: 99%

Balanced approach can help initial outcomes: analysis of initial 50 cases of a new liver transplantation program in East Asia

Kim

Jung

et al. 2014

Ann Surg Treat Res

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PurposeTo evaluate patient triage pattern and outcomes according to types of liver transplantation as part of a new liver transplant program developed in an East Asian country with a limited number of deceased donors.MethodsMedical records of initial 50 liver transplantations were reviewed retrospectively.ResultsTwenty-nine patients underwent deceased donor liver transplantation (DDLT) and 21 patients underwent living donor liver transplantation (LDLT). Mean model for end-stage liver disease scores of recipients of DDLT and LDLT were 24.9 ± 11.6 and 13.1 ± 5.4, respectively (P < 0.0001). Twenty-eight patients had HCCs and 17 of them (60.7%) underwent LDLT, which was 80.9% of LDLTs. There were 2 cases of perioperative mortality; each was from DDLT and LDLT, respectively. Median follow-up was 18 months. Overall patient and graft survival rates at 6 months, 1 and 2 years were 95.7%, 93.4%, and 89.8%, respectively. There was no significant difference in survival between DDLT and LDLT. Overall recurrence-free survival rates of hepatocellular carcinoma (HCC) patients at 6 month, 1, and 2 years were 96.3%, 96.3%, and 90.3%, respectively. There was no significant difference in recurrence-free survival between DDLT and LDLT.ConclusionAs a new liver transplant program with limited resource and waiting list, patients with critical condition could undergo DDLT whereas relatively stable patients with HCCs were mostly directed to LDLT. We recommend a balanced approach between DDLT and LDLT for initiating liver transplant programs.

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“…However, the late obstructions of these ePTFE graft were all asymptomatic and had no impact on postoperative liver congestion, liver regeneration, or patient survival. With respect to the duration of graft patency, one to two weeks is considered to be enough to maintain adequate liver graft function because intrahepatic venous collateral can be expected to develop within one week of the operation [20]. Another report has described the conversion of the portal tract to an outflow channel within one hour, and intrahepatic venous collateral formation within two weeks when the hepatic vein was occluded [21].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of artificial vascular graft for venous reconstruction in liver surgery

et al. 2014

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BackgroundThe purpose of this study was to evaluate the results of hepatectomy with inferior vena cava or hepatic vein resection, followed by vessel reconstruction with an artificial vascular graft.MethodsFrom 2000 to 2011, 1,434 patients underwent several types of hepatectomy at our institution. Of these, we reviewed the cases of eight patients (0.56%) who underwent hepatectomy with inferior vena cava or hepatic vein resection and subsequent reconstruction using an expanded polytetrafluoroethylene (PTFE) graft.ResultsWe resected the inferior vena cava in six patients and the hepatic vein in two patients. All eight patients underwent subsequent reconstruction using an expanded PTFE graft. The median operative time was 443 minutes and the median blood loss was 2,017 mL. The median postoperative hospital stay period was 18.5 days and the in-hospital mortality rate was 0%. Complications occurred in four patients: two patients experienced bile leakage, one experienced a wound infection, and one experienced pleural effusion. The two patients who experienced bile leakage had undergone reoperation on postoperative day 1. No complication with the artificial vascular graft occurred in these eight cases. Histological invasion to the replaced inferior vena cava or hepatic vein was confirmed in four cases. All artificial vascular grafts remained patent during the observation period.ConclusionsHepatectomy combined with inferior vena cava or hepatic vein resection, followed by reconstruction with an expanded PTFE graft can be performed safely in selected patients.

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Modified right liver graft from a living donor to prevent congestion1

Cited by 164 publications

References 17 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

Balanced approach can help initial outcomes: analysis of initial 50 cases of a new liver transplantation program in East Asia

Usefulness of artificial vascular graft for venous reconstruction in liver surgery

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