One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living donor liver transplantation
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- Ikegami, T., Shirabe, K., Yoshiya, S. et al. Surg Today (2013) 43: 769. doi:10.1007/s00595-012-0449-5
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Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts.
We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31).
In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 % in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p < 0.001) and these patients had higher alanine transaminase values (142 ± 79 vs. 96 ± 46 IU/L, p = 0.024) on postoperative day POD 7. However, the 6-month short-term graft survival rates were 100 % with one-step reconstruction and 83.9 % with direct anastomosis, respectively.
One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.
KeywordsLiving donor liver transplantation Short hepatic vein Right inferior hepatic vein Right lobe Venous reconstruction
Explanted portal vein
Internal jugular vein
Inferior vena cava
Living donor liver transplantation
Model for end-stage liver disease
Middle hepatic vein
Prothrombin time international normalized ratio
Right hepatic vein
Right inferior hepatic vein
Standard liver volume
Segment 5 vein
Segment 8 vein