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World Journal of Surgery

, Volume 35, Issue 2, pp 403–408 | Cite as

Living Donor Right Liver Lobe Transplantation With or Without Inclusion of the Middle Hepatic Vein: Analysis of Complications

  • Jorge Marcelo Padilla Mancero
  • Adriano Miziara Gonzalez
  • Marcelo Augusto Fontenelle RibeiroJr.
  • Gilberto PeronJr.
  • Raul Carlos Wahle
  • Francisco Leôncio Dazzi
  • Adávio de Oliveira e Silva
  • Luiz Augusto Carneiro D’Albuquerque
Article

Abstract

Background

For living-related liver transplantation, harvesting a right hepatic graft that includes the middle hepatic vein (MHV) has been recommended to improve venous drainage of the graft. However, it may result in congestion of the donor’s remaining segment IV, increasing the potential risk to the donor. This study aimed to compare safety levels for liver donors during procedures with or without removal of the MHV.

Methods

A total of 68 living donor liver transplantations were performed from March 2001 to May 2007. In 39 procedures, the MHV was not included in the graft (group A), and in 29 the MHV was included in the graft (group B). The analyzed data included surgical time, use of blood derivatives, length of hospital stay, laboratory analyses, weight of the graft, and clinical complications.

Results

No differences were observed regarding the need for blood derivatives or laboratory parameters. The frequency of postoperative complications was similar in the two groups, with 10 cases (25.6%) in group A and 7 cases (24.1%) in group B (P = 0.887). No deaths were seen. The rate of observed complications was 25% among living donors, most of them being managed without surgical intervention.

Conclusions

The inclusion of the MHV does not add morbidity in living donors in selected cases.

Keywords

Liver Donor Living Donor Liver Transplantation Middle Hepatic Vein Percutaneous Catheter Drainage Multislice Spiral Compute Tomography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Raia S, Nery JR, Mies S (1989) Liver transplantation from live donors. Lancet 2:497. doi: 10.1016/S0140-6736(89)92101-6 CrossRefPubMedGoogle Scholar
  2. 2.
    Hashikura Y, Makuuchi M, Kawasaki S et al (1994) Successful living-related partial liver transplantation to an adult patient. Lancet 343:1233–1234. doi: 10.1016/S0140-6736(94)92450-3 CrossRefPubMedGoogle Scholar
  3. 3.
    Chan SC, Fan ST, Lo CM et al (2007) Toward current standards of donor right hepatectomy for adult-to-adult live donor liver transplantation through the experience of 200 cases. Ann Surg 245:110–117. doi: 10.1097/01.sla.0000225085.82193.08 CrossRefPubMedGoogle Scholar
  4. 4.
    Shah SA, Grant DR, Greig PD et al (2005) Analysis and outcomes of right lobe hepatectomy in 101 consecutive living donors. Am J Transplant 5:2764–2769. doi: 10.1111/j.1600-6143.2005.01094.x CrossRefPubMedGoogle Scholar
  5. 5.
    Suh KS, Kim SH, Kim SB et al (2002) Safety of right lobectomy in living donor liver transplantation. Liver Transpl 8:910–915. doi: 10.1053/jlts.2002.35665 CrossRefPubMedGoogle Scholar
  6. 6.
    Lo CM, Fan ST, Liu CL et al (1997) Adult-to-adult living donor liver transplantation using extended right lobe grafts. Ann Surg 226:261–269. doi: 10.1097/00000658-199709000-00005 CrossRefPubMedGoogle Scholar
  7. 7.
    Yamaoka Y, Washida M, Honda K et al (1994) Liver transplantation using a right lobe graft from a living related donor. Transplantation 57:1127–1141. doi: 10.1097/00007890-199404150-00024 PubMedGoogle Scholar
  8. 8.
    Lee SG, Park KM, Hwang S et al (2001) Congestion of right liver graft in living donor liver transplantation. Transplantation 71:812–814. doi: 10.1097/00007890-200103270-00021 CrossRefPubMedGoogle Scholar
  9. 9.
    Lee SG, Park KM, Hwang S et al (2003) Anterior segment congestion of a right liver lobe graft in living-donor liver transplantation and strategy to prevent congestion. J Hepatobil Pancreat Surg 10:16–25. doi: 10.1007/s10534-002-0789-5 Google Scholar
  10. 10.
    Sugawara Y, Makuuchi M, Sano K et al (2003) Vein reconstruction in modified right liver graft for living donor liver transplantation. Ann Surg 237:180–185. doi: 10.1097/00000658-200302000-00006 CrossRefPubMedGoogle Scholar
  11. 11.
    Couinaud C (1999) Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig Surg 16:459–467. doi: 10.1159/000018770 CrossRefPubMedGoogle Scholar
  12. 12.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. doi: 10.1097/01.sla.0000133083.54934.ae CrossRefPubMedGoogle Scholar
  13. 13.
    Suh KS, Yi NJ, Cho JY et al (2006) Technical refinement preserving segment 4 to donor in extended right hepatectomy. Hepatogastroenterology 53:253–257PubMedGoogle Scholar
  14. 14.
    Scatton O, Plasse M, Dondero F et al (2008) Impact of localized congestion related to venous deprivation after hepatectomy. Surgery 143:483–489. doi: 10.1016/j.surg.2007.11.002 CrossRefPubMedGoogle Scholar
  15. 15.
    Akabayashi A, Slingsby BT, Fujita M (2004) The first donor death after living-related liver transplantation in Japan. Transplantation 77:634. doi: 10.1097/01.TP.0000115342.98226.7C CrossRefPubMedGoogle Scholar
  16. 16.
    Yamamoto K, Takada Y, Fujimoto Y et al (2007) Nonalcoholic steatohepatitis in donors for living donor liver transplantation. Transplantation 83:257–262. doi: 10.1097/01.tp.0000250671.06456.3f CrossRefPubMedGoogle Scholar
  17. 17.
    Hertl M, Cosimi AB (2007) Living donor liver transplantation: how can we better protect the donors? Transplantation 83:263–264. doi: 10.1097/01.tp.0000250671.06456.3f CrossRefPubMedGoogle Scholar
  18. 18.
    Miller C, Florman S, Kim-Schluger L et al (2004) Fulminant and fatal gas gangrene of the stomach in a healthy live liver donor. Liver Transpl 10:1315–1319. doi: 10.1002/lt.20227 CrossRefPubMedGoogle Scholar
  19. 19.
    Barr ML, Belghiti J, Villamil FG et al (2006) A report of the Vancouver Forum on the care of the live organ donor: lung, liver, pancreas, and intestine data and medical guidelines. Transplantation 81:1373–1385. doi: 10.1097/01.tp.0000216825.56841.cd CrossRefPubMedGoogle Scholar
  20. 20.
    Coelho JC, de Freitas AC, Matias JE et al (2007) Donor complications including the report of one death in right-lobe living-donor liver transplantation. Dig Surg 24:191–196. doi: 10.1159/000102898 CrossRefPubMedGoogle Scholar
  21. 21.
    Patel S, Orloff M, Tsoulfas G et al (2007) Living-donor liver transplantation in the United States: identifying donors at risk for perioperative complications. Am J Transplant 7:2344–2349. doi: 10.1111/j.1600-6143.2007.01938.x CrossRefPubMedGoogle Scholar
  22. 22.
    Broering DC, Wilms C, Bok P et al (2004) Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases. Ann Surg 240:1013–1024. doi: 10.1097/01.sla.0000146146.97485.6c CrossRefPubMedGoogle Scholar
  23. 23.
    Birkmeyer JD, Stukel TA, Siewers AE et al (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127. doi: 10.1056/NEJMsa035205 CrossRefPubMedGoogle Scholar
  24. 24.
    Epstein AM (2002) Volume and outcome—it is time to move ahead. N Engl J Med 346:1161–1164. doi: 10.1056/NEJM200204113461512 CrossRefPubMedGoogle Scholar
  25. 25.
    Sano K, Makuuchi M, Miki K et al (2002) Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann Surg 236:241–247. doi: 10.1097/00000658-200208000-00013 CrossRefPubMedGoogle Scholar
  26. 26.
    Ito T, Kiuchi T, Yamamoto H et al (2004) Efficacy of anterior segment drainage reconstruction in right-lobe liver grafts from living donors. Transplantation 77:865–868. doi: 10.1097/01.TP.0000116415.21371.F9 CrossRefPubMedGoogle Scholar
  27. 27.
    Fan ST, Lo CM, Liu CL et al (2003) Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation. Ann Surg 238:137–148. doi: 10.1097/00000658-200307000-00018 CrossRefPubMedGoogle Scholar
  28. 28.
    Beavers KL, Sandler RS, Shrestha R (2002) Donor morbidity associated with right lobectomy for living donor liver transplantation to adult recipients: a systematic review. Liver Transpl 8:110–117. doi: 10.1053/jlts.2002.31315 CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Jorge Marcelo Padilla Mancero
    • 1
  • Adriano Miziara Gonzalez
    • 1
    • 3
  • Marcelo Augusto Fontenelle RibeiroJr.
    • 1
  • Gilberto PeronJr.
    • 1
  • Raul Carlos Wahle
    • 2
  • Francisco Leôncio Dazzi
    • 1
  • Adávio de Oliveira e Silva
    • 2
  • Luiz Augusto Carneiro D’Albuquerque
    • 1
  1. 1.Department of General and Transplantation SurgeryHospital Beneficência PortuguesaSão PauloBrazil
  2. 2.Department of Gastroenterology and HepatologyHospital Beneficência PortuguesaSão PauloBrazil
  3. 3.São PauloBrazil

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