Renoportal anastomosis for dual-graft living donor liver transplantation using an artificial graft and a left renal vein-connected inferior vena cava cuff

Moon, Deok‐Bog; Lee, F.A.C.S. Sung-Gyu; Namkoong, Jung-Man; Hwang, Shin; Kim, Ki‐Hun; Ahn, Curie; Ha, Tae‐Yong; Song, Gi‐Won; Jung, Dong‐Hwan; Park, Gil‐Chun; Park, Yo-Han; Park, Hyung-Woo; Jung, Bo‐Hyun; Kang, Sung-Hwa

doi:10.1002/lt.23795

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…If the patient has a large spontaneous splenorenal collateral, PV flow can be restored by anastomosis between the collateral and Y-shaped interposition grafts. 38 However, adequate alignment of both PVs of the 2 grafts requires special expertise. Therefore, the technical difficulty and operative risk should be discussed after careful examination of the anatomy of the PV and portosystemic collateral.…”

Section: Discussionmentioning

confidence: 99%

Dual-graft Adult Living Donor Liver Transplantation

Song

Lee²,

Moon³

et al. 2017

Annals of Surgery

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Section: Discussionmentioning

confidence: 99%

Dual-graft Adult Living Donor Liver Transplantation

Song

Lee²,

Moon³

et al. 2017

Annals of Surgery

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“…The diameter of artificial grafts is 16 mm, which is preferred. The patency and advantages of artificial grafts have been described previously 10 , 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Our RPA technique has evolved through experience to complement the previous anastomosis technique. The details of the surgical technique have been previously published 9 - 11 .…”

Section: Methodsmentioning

confidence: 99%

“…The Asan Medical Center first performed living donor LT (LDLT) with RPA in October 2005, and in the 15 years following the success of the first case, 14 additional patients have undergone this procedure. In the meantime, our RPA technique has evolved to compensate for the shortcomings of the previous technique 9 - 11 , and the current standardized technique for LDLT with RPA at our centre was established in October 2011. In this study, we aimed to present our current surgical technique and the long-term outcomes of 15 consecutive LDLTs with RPA that used an interposition graft for patients with large spontaneous SRSs accompanied by complete portal venous occlusion.…”

Section: Introductionmentioning

confidence: 99%

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Evolution of the technique of renoportal anastomosis for patients with complete portal venous occlusion in living donor liver transplantation – a retrospective cohort study

Yoon

Moon

Lee

et al. 2023

International Journal of Surgery

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Background: This study aimed to present our surgical technique and the long-term outcomes of living donor liver transplantations with renoportal anastomosis for patients with complete portal venous occlusion. Renoportal anastomosis (RPA) is a promising technique for portal flow reconstruction during liver transplantation in patients with complete occlusion of the portal vein and extensive splanchnic vein thrombosis. However, reports demonstrating living donor liver transplantations (LDLT) with renoportal anastomosis are rarer than those demonstrating deceased donor liver transplantation. Materials and methods: In this single-centre retrospective cohort study, the authors analyzed the medical records of patients who underwent portal flow reconstruction via RPA with end-to-end anastomosis between the interposition graft and LRV-connected inferior vena cava (VC) cuff. The outcomes included postoperative RPA-related morbidity and patient and allograft survival for patients who underwent LDLT with RPA. Results: Fifteen patients underwent LDLT with portal flow reconstruction via RPA from January 2005 to December 2019. The median follow-up period was 80.7 months (range: 27 days–195.2 months). RPA evolved from end-to-end anastomosis in 1 (6.7%) patient to end-to-side anastomoses in the next 6 (40%) patients and finally, to end-to-end anastomoses between the inferior VC cuff connected to the left renal vein and interposing vascular grafts in 8 (53.3%) patients. After standardization of the RPA technique from the eighth case in 2011, the incidence rate of RPA-related complications significantly decreased from 42.9% (3/7) to 12.5% (1/8). At the last follow-up, all 11 surviving patients had normal liver function, and 10 patients had patent anastomoses on imaging examination. Conclusions: This standardized RPA technique using an inferior VC cuff connected to the left renal vein creates a safe end-to-end RPA.

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“…However, these symptoms gradually diminish over a period of months after liver transplantation along with CPHT. In addition, ascites, renal dysfunction, and portal hypertension were also the main complications after RPA ( 13 – 15 ). If the portal vein reconstruction is limited to the portal system blood flow while discounting RPA and IMV reflux collection, hypertension will still persist in the SMV inflow region and the patient will be susceptible to symptoms of intestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

A novel approach for portal system reconstruction in liver transplant patients with grade IV portal vein thrombosis: Case study and literature review

Qu¹,

Zhu²,

Lin³

2022

Front. Transplant.

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BackgroundPortal vein thrombosis is a common problem of end-stage liver disease in patients with portal hypertension and Yerdel grade IV thrombosis may be a contraindication for liver transplantation. Advances in surgical technique have indicated the feasibility of liver transplantation with PVT such as Reno-portal anastomosis, cavo-portal hemitransposition, but low graft portal blood perfusion and regional portal hypertension were the limitations.MethodsWe introduce a new approach for portal system reconstruction in a patient underwent liver transplantation: A 28-year-old male was diagnosed with Budd-Chari syndrome and portal hypertension with grade IV portal vein thrombosis.ResultsThe “Pull-out” technique was applicated for thrombectomy, which can aid in exposing the superior mesenteric vein and portal vein branches and reducing technical difficulties associated with the identification and dissociation of surrounding anatomical structures. To collect sufficient portal vein blood perfusion and avoid regional portal hypertension, the portal vein system was reconstructed through double-approach procedure: reno-portal anastomosis combined with portal-portal anastomosis.ConclusionBased on a precision preoperative evaluation, application of the Pull-out technique and double-approach procedure may be an effective method of thrombectomy especially in cases of grade IV portal vein thrombosis.

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Renoportal anastomosis for dual-graft living donor liver transplantation using an artificial graft and a left renal vein-connected inferior vena cava cuff

Cited by 5 publications

References 4 publications

Dual-graft Adult Living Donor Liver Transplantation

Dual-graft Adult Living Donor Liver Transplantation

Evolution of the technique of renoportal anastomosis for patients with complete portal venous occlusion in living donor liver transplantation – a retrospective cohort study

A novel approach for portal system reconstruction in liver transplant patients with grade IV portal vein thrombosis: Case study and literature review

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