Technical options for outflow reconstruction in domino liver transplantation: A single European center experience

Abstract

Venous outflow is critical to the success of liver transplantation (LT). In domino liver transplantation (DLT), the venous cuffs should be shared between the donor and the recipient, and the length can be compromised. The aim of this study was to describe and compare the technical options for outflow reconstruction used at our institution. This was a retrospective analysis of 39 consecutive DLT recipients between January 1997 and May 2013. Twenty-seven men and 12 women (mean age, 61.8 6 4.3 years) underwent LT and consented to receive a liver from a donor with familial amyloid polyneuropathy (FAP). The main indications were hepatocellular carcinoma and hepatitis C virus cirrhosis. All recipients underwent transplantation by a piggyback technique. Liver procurement in the FAP donors was performed with the classic technique in 22 patients and with the piggyback technique in the last 17. In these latter cases, for vascular outflow reconstruction, a cadaveric venous graft was interposed between the hepatic vein (HV) stump of the FAP liver and the recipient HV in 11 cases (28%). Since 2011, we have employed arterial grafts to be interposed between the vessels stumps: a tailored arterial graft in 5 patients and an aortic graft in 1 case. There was no postoperative mortality. Arterial and portal complications presented in 2 (5.1) and 4 patients (10.3), respectively. Postoperative outflow complications (post-LT subacute Budd-Chiari syndrome) occurred in 4 patients, and all of them had received a venous interposed graft for reconstruction. The incidence of outflow complications tended to be higher among patients with venous grafts than those with arterial graft interposition. Overall patient survival at 1, 3, 5, and 10 years was 97%, 79%, respectively. Arterial grafts constitute a feasible and safe option for vascular outflow reconstruction in DLT because they are associated with a relatively low incidence of complications. The recently proposed Bellvitge arterial graft technique should be added to the current range of available surgical modalities.

Living donor domino liver transplantation using a maple syrup urine disease donor: A case series of three children – The first report from Japan

“…By venoplasty at the back table, the RHV, MHV, and LHV were sutured together to create a single cuff. Few reports have discussed the optimal techniques of outflow reconstruction (10)(11)(12)(13)(14)(15). In this case series, we employed the technique described by Chan et al (12), which was venoplasty of the RHV, MHV, and LHV stumps and the single cuff of the HVs anastomosed to the IVC without an interpositional graft or patch.…”

Surgical Outcomes of Domino Liver Transplantation Using Grafts From Living Donors With Familial Amyloid Polyneuropathy

“…Our 5‐year survival rates for LDDLT were similar to those of 49% to 87.5% reported for the DDDLT setting. ( 9,35‐37 ) Furthermore, the difference in survival between LDDLT and LDLT was not significant. Indications for DLT usually include HCC, age >50 or 60 years, and age >40 years with hepatitis C cirrhosis.…”

“…(6) In addition, LDDLT had excellent short-term to mid-term outcomes during a follow-up period of 8 to 40 months in our initial experience. (7) Although several reports have described long-term survival after DLT in which the donor with FAP received a liver graft from a deceased donor, (8)(9)(10) data on the long-term surgical complications of LDDLT are still limited. Because the domino donor receives a liver graft from an LD with shorter vascular and bile duct stumps in LDDLT compared with those in deceased donor DLT (DDDLT), both the domino donor (first recipient) and the domino recipient (second recipient) are potentially at risk of developing vascular and biliary complications.…”

Risk Factors for Hepatic Venous Outflow Obstruction in Piggyback Liver Transplantation: The Role of Recipient’s Pattern of Hepatic Veins Drainage into the Inferior Vena Cava

“…Results of our study and some previous studies are not consistent with regard to the association between HVOO and the hyperplasia and/or fibrotic changes around the anastomoses [ 3 , 7 , 11 , 12 ]. However, we cannot conclude that these pathologic changes were not risk factors for HVOO, due to the retrospective nature of our study and the relatively small sample size of Group C. Although conflicting results were reported on cavo-caval side-to-side or end-to-side anastomosis for outflow reconstruction, it is clear that the best-performing techniques are using the stumps of the 3 major hepatic veins to avoid HVOO in PBLT [ 3 , 13 – 15 ]. In our study, we had the same opinion on the use of the stumps of the 3 major HVs.…”