Outflow reconstruction in right hepatic live donor liver transplantation

Kinkhabwala, Milan; Guarrera, James V.; Leno, Richard; Brown, Robert S.; Prowda, Joan C.; Kapur, Sandip; Emond, Jean C.

doi:10.1067/msy.2003.18

Cited by 49 publications

(40 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding the possibility of inappropriate venous drainage after LDLT as a potential contributing factor for CHC, our group has had a particular interest in optimizing hepatic venous drainage after LDLT, including the use of venous interposition grafts whenever segments 5 and 8 were not adequately drained by the right hepatic vein; we have reported this approach in detail. 21 In each instance of CHC, hepatic outflow reconstruction was performed in an identical manner as in patients who did not develop CHC. Finally, factors intrinsic to HCV viral infection and potentially associated with more rapid recurrence of HCV after liver transplantation, including viral titer and genotype, were not different when comparing CAD and LDLT.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

Gaglio

Malireddy

Levitt

et al. 2003

Liver Transplantation

125

View full text Add to dashboard Cite

Histologic injury caused by recurrent hepatitis C virus (HCV) has been reported in up to 90% of HCV-infected patients who undergo liver transplantation with a cadaveric graft. However, the natural history of HCV after living donor liver transplantation (LDLT) is not well described. We performed a retrospective analysis of 68 consecutive HCV-infected adult patients: 45 recipients of cadaveric grafts (CAD) were compared with 23 LDLT patients. Elevated serum transaminases, positive HCV RNA, and liver biopsy consistent with histologic evidence of HCV defined recurrence. When comparing CAD with LDLT, both the incidence of HCV recurrence and time to recurrence were not different. The overall incidence of severe sequelae of HCV recurrence, either cholestatic hepatitis, grade III-IV inflammation, and/or HCV-induced graft failure requiring retransplantation, was also not different when comparing CAD with LDLT. However, when comparing CAD versus LDLT, no CAD patient developed cholestatic hepatitis C, compared with 17% of LDLT who developed this complication (P ‫؍‬ .001). Thus, in this patient population, the timing and incidence of HCV recurrence were not different when comparing CAD versus LDLT, but the incidence of cholestatic hepatitis was significantly greater in patients with HCV who underwent LDLT. (Liver Transpl 2003;9:1028-1035.) E nd stage liver disease caused by hepatitis C virus (HCV) is the most common indication for liver transplantation in the United States. However, complications caused by recurrent HCV infection are increasingly being recognized; in patients with active HCV replication before transplantation, reacquisition of viremia after transplantation is universal, and allograft hepatitis caused by HCV occurs in up to 90% of patients followed for 5 years. 1-9 Although histologic injury in the allograft caused by HCV is exceedingly common, disease progression after the development of hepatitis is variable, with some patients experiencing indolent disease and others rapidly progressing to cirrhosis and liver failure. In patents who develop HCV-associated cirrhosis posttransplantation, rapid decompensation is a common occurrence. It has been reported that up to 42% of patients with HCV-associated cirrhosis posttransplantation develop decompensation manifested as ascites, encephalopathy, or hepatic hydrothorax, and fewer than 50% of patients survive more than 1 year after the development of decompensation. 10-12 Thus, both prospective and retrospective data are emerging that indicate that the progression of HCV after orthotopic liver transplantation is accelerated when compared with nontransplantation patients. This has been attributed to multiple factors, including the impact of immunosuppression on viral replication and host defenses. 13 Several lines of anecdotal evidence suggest that HCV recurrence might be more severe in recipients of living donor liver transplantation (LDLT). We hypothesize that postoperative liver regeneration in the partial graft procured from living donors may facilitate HCV repli...

show abstract

Section: Discussionmentioning

confidence: 99%

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

Gaglio

Malireddy

Levitt

et al. 2003

Liver Transplantation

125

View full text Add to dashboard Cite

show abstract

“…Right lobe grafts (segments [5][6][7][8] are most frequently used for adult-to-adult LDLT (1,2). The extent of venous reconstruction required to prevent congestion of the graft is still a main focus of clinical discussion.…”

Section: Introductionmentioning

confidence: 99%

“…The extent of venous reconstruction required to prevent congestion of the graft is still a main focus of clinical discussion. The fate of the MHV and its branches is an important aspect of an ongoing debate (3)(4)(5)(6)(7). Especially the segments 5 and 8 of right hepatic grafts are prone to venous congestion (8,9), which may lead to a loss of functional liver tissue and, as a consequence, possible dysfunction or failure of the graft (10).…”

Section: Introductionmentioning

confidence: 99%

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

Neumann

Thorn

Fischer

et al. 2006

American Journal of Transplantation

View full text Add to dashboard Cite

Full right hepatic grafts are most frequently used for adult-to-adult living donor liver transplantation (LDLT).One of the major problems is venous drainage of segments 5 and 8. Thus, this study was designed to provide information on venous drainage of right liver lobes for operation-planning. Fifty-six CT data sets from routine clinical imaging were evaluated retrospectively using a liver operation-planning system. We defined and analyzed venous drainage segments and the impact of anatomic variations of the middle hepatic vein (MHV) on venous outflow from segments 5 and 8. MHV variations led to significant shifts of segment 5 drainage between the middle and right hepatic vein. In cases with the most frequent MHV branching pattern (n = 33), a virtual hepatectomy closely right to the MHV intersected drainage vessels that provided drainage for 30% of the potential graft, not taking into account potential veno-venous shunts. In individuals with inferior MHV branches that extend far into segments 5 and 6 (n = 10), the overall graft volume at risk of impaired venous drainage increased by 5% (p < 0.001). If this is confirmed in clinical trials and correlated with intraoperative findings, the use of liver operation-planning systems would be beneficial to improve overall outcome after right lobe LDLT.

show abstract

“…As a result of our growing experience in living-donor liver transplantation the importance of an optimal hepatic venous outflow has become more and more evident [15,16,17]. Retrospectively, there is no doubt that at the beginning of living-donor liver transplantation a substantial number of post-transplant liver insufficiencies, especially in critical small grafts, had been caused by venous congestion of the liver.…”

Section: Discussionmentioning

confidence: 99%

Extended left hepatectomy?modified operation planning based on three-dimensional visualization of liver anatomy

Lang

Radtke

Liu

et al. 2003

Langenbecks Arch Surg

View full text Add to dashboard Cite

show abstract

Outflow reconstruction in right hepatic live donor liver transplantation

Cited by 49 publications

References 10 publications

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

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

Extended left hepatectomy?modified operation planning based on three-dimensional visualization of liver anatomy

Contact Info

Product

Resources

About