Variations of the left and middle hepatic veins: Application in living related hepatic transplantation

Cheng, Ya-Min; Huang, Tung‐Liang; Chen, Chao‐Long; Chen, Tai-Yi; Huang, Chung‐Cheng; Ko, Sheung‐Fat; Lee, Tze‐Yu

doi:10.1002/jcu.1996.1870240103

Cited by 65 publications

(71 citation statements)

References 5 publications

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“…The midhepatic vein and left hepatic vein have an intimate anatomic relationship and frequently form a common trunk before joining the inferior vena cava. 98 Donor right lobectomy is usually performed in one of two ways. Either the lobe is resected with both the right and midhepatic veins or with only the right hepatic vein.…”

Section: Right Lobe Living Donor Liver Transplantationmentioning

confidence: 99%

Right lobe living donor liver transplantation: A review

Marcos

2000

Liver Transpl

157

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The continuing shortage of organs for adult transplant recipients has generated enthusiasm for adult-to-adult living donor liver transplantation (LDLT). The major concern has been the ability to resect a graft of adequate size without subjecting the donor to undue risk. The right hepatic lobe is generally large enough for adult recipients, but because of the real and perceived risks of right lobe (RL) resection, surgeons have been hesitant to offer this option to their patients. The first series of RL resections that included a significant number of patients was reported in 1999, and the results were encouraging. Only minor complications occurred in donors, and the recipients fared quite well. Enthusiasm for these donor resections is growing, and more centers are beginning to perform them. There is a good deal of global experience with pediatric LDLT but little with adults, and there are unique considerations in this population. This review examines donor selection criteria for adult recipients, highlights technical points critical for good outcome, and examines the early results and complications in both donors and recipients. If the preliminary results continue to be reproduced, RL LDLT could have significant impact on the worsening organ shortage.

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Section: Right Lobe Living Donor Liver Transplantationmentioning

confidence: 99%

Right lobe living donor liver transplantation: A review

Marcos

2000

Liver Transpl

157

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“…Missed biliary radicle has seldom been mentioned as a complication of the donor or recipient operation in living related liver transplantation [14]. In our experience, unusual routes of intrahepatic bile duct ramification complicated the surgical procedures in living related graft retrieval and bilio-enteric reconstruction in the recipient [3,4]. Despite detection of all anatomical variations of the biliary tree by 3-dimensional computed tomographic cholangiography and confirmation by intraoperative cholangiography, a biliary radicle was still missed in this particular case.…”

Section: Discussionmentioning

confidence: 99%

Interventional radiologic procedures in liver transplantation

Cheng

Chen

Huang

et al. 2001

Transplant International

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Postoperative biliary and vascular complications contribute significantly to morbidity and mortality in liver transplantation. Interventional radiologists are an integral part of the multidisciplinary team necessary for optimizing the management of these complications. During a 15-year period, 39 cadaveric and 25 living related liver transplantations were performed at the Chang Gung Memorial hospital, Taiwan. Of 64 liver transplant recipients, 9 (3 adult and 6 pediatric) underwent 13 interventional radiological procedures for the treatment of biliary sludge-casts (n = 2), bile duct occlusion or stenosis ( n = 2), hepatic veins thrombosis (n = l), hepatic veins stenosis ( n = l), portal vein stenosis with splenorenal shunting (n = l), biloma (n = l), and infected fluid collection or ascites (n = 4). Antegrade or retrograde interventional approach was used to successfully treat all biliary complications, and all percutaneous drainage procedures were effective in the control of intra-abdominal fluid collections. Portal vein stenosis was treated by balloon dilatation, and the associated splenorenal shunt was closed by metallic coil embolization via transhepatic catheterization of the portal vein. Hepatic vein stenosis was effectively treated by balloon dilatation and expandable metallic stent deployment via transfemoral and jugular venous approaches, respectively. Hepatic vein thrombosis was only partially lysed by transvenous streptokinase administration, and surgical thrombectomy was needed to achieve complete recanalization. The total success rate of the interventional procedures was 92 % with no procedure-related complications. The overall survival rate in this series is 89 %, and all patients who underwent living related liver transplantation maintain to date a 100 YO survival rate. We can conclude that interventional radiological procedures are very useful for managing biliary and vascular complications after liver transplantation. These techniques provide a cure in most situations, thus obviating the need for further surgical intervention or re-transplantation.

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“…One donor of A-A RL-LDLT with type III APVB according to the types proposed by Cheng et al 8 underwent a right hepatic lobectomy on August 2006 in West China Hospital. This donor had independent posterior sectoral branching from the main PV trunk.…”

mentioning

confidence: 99%

“…The recipient with the diagnosis of advanced liver failure secondary to chronic hepatitis B had type I (normal) PV branches. 8 The donor right hepatic lobectomy was performed as described. 9 After the parenchymal transection was finished, the right hepatic duct, right hepatic artery, right PV branching, and right hepatic vein were transected approximately 2-3 mm from the confluence.…”

mentioning

confidence: 99%