Surgery Today

, Volume 43, Issue 7, pp 769–776

One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living donor liver transplantation

  • Toru Ikegami
  • Ken Shirabe
  • Shohei Yoshiya
  • Yuji Soejima
  • Tomoharu Yoshizumi
  • Hideaki Uchiyama
  • Takeo Toshima
  • Takashi Motomura
  • Yoshihiko Maehara
Original Article

DOI: 10.1007/s00595-012-0449-5

Cite this article as:
Ikegami, T., Shirabe, K., Yoshiya, S. et al. Surg Today (2013) 43: 769. doi:10.1007/s00595-012-0449-5

Abstract

Purposes

Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts.

Methods

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).

Results

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.

Conclusion

One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.

Keywords

Living donor liver transplantation Short hepatic vein Right inferior hepatic vein Right lobe Venous reconstruction 

Abbreviations

ALT

Alanine transaminase

AST

Aspartate aminotransferase

EPV

Explanted portal vein

GV

Graft volume

IJV

Internal jugular vein

IVC

Inferior vena cava

LDLT

Living donor liver transplantation

MELD

Model for end-stage liver disease

MHV

Middle hepatic vein

POD

Postoperative day

PT-INR

Prothrombin time international normalized ratio

RHV

Right hepatic vein

RIHV

Right inferior hepatic vein

SLV

Standard liver volume

V5

Segment 5 vein

V8

Segment 8 vein

Copyright information

© Springer Japan 2012

Authors and Affiliations

  • Toru Ikegami
    • 1
  • Ken Shirabe
    • 1
  • Shohei Yoshiya
    • 1
  • Yuji Soejima
    • 1
  • Tomoharu Yoshizumi
    • 1
  • Hideaki Uchiyama
    • 1
  • Takeo Toshima
    • 1
  • Takashi Motomura
    • 1
  • Yoshihiko Maehara
    • 1
  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

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