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

Abstract

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.

Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: The importance of the inferior right hepatic vein

“…The patency of the hepatic vein tributaries, however, was suboptimal. Previous reports, including ours, have indicated a high incidence of occlusion of the MHV tributaries, V5 and V8, over the longterm period . In contrast, the present study revealed a significantly better patency rate of the IRHV compared with V5 and V8.…”

Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

“…Preoperative US of the GSV was adopted to determine whether autologous vein grafts could be used for vascular reconstruction. The most important advantage of an autologous graft over an artificial one is better biocompatibility, which greatly reduces the risk of graft rejection while reducing the postoperative anticoagulant therapy, thus reducing the possibility of postoperative bleeding 40, 41. In addition, the GSVs are easy to harvest, and their removal does not cause many adverse effects; all the preceding reasons make the GSV the ideal material for vascular reconstruction 26, 32, 35…”

“…In our study, the ratio of RLV to ing. 40,41 In addition, the GSVs are easy to harvest, and their removal does not cause many adverse effects; all the preceding reasons make the GSV the ideal material for vascular reconstruction. 26,32,35 The management of the anhepatic phase is another key issue for maintaining an uneventful intraoperative course.…”

A retrospective comparative study of venous vs nonringed expanded polytetrafluoroethylene extension grafts for anterior sector outflow reconstruction in right lobe living donor liver transplantation

“…The homologous vein can be from the same donor besides liver graft (internal jugular vein, ovarian, or inferior mesenteric vein), cryopreserved vessels from group‐matched deceased donor (eg, iliac vessels), or another recipient portal vein. Synthetic vascular grafts can be ePTFE or Dacron …”