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Single Orifice Outflow Reconstruction: Refining the Venous Outflow in Modified Right Lobe Live Donor Liver Transplantation

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

MHV reconstruction is essential to avoid anterior sector congestion in adult live donor liver transplantation (LDLT) using a modified right lobe graft.

Aims

The objective of this study is to evaluate the graft and patient outcomes with single orifice outflow reconstruction technique (SORT) (RHV + neo-MHV combined reconstruction on IVC) vs. dual outflow reconstruction technique (DORT) (RHV and neo-MHV separately reconstructed on IVC) in a modified right lobe LDLT.

Methods

Prospectively collected data of consecutive patients undergoing LDLT from June 2011 to August 2018 were analyzed. The patients were divided into two groups: SORT (n = 207) and DORT (n = 108). The perioperative morbidity and mortality were compared between two groups.

Results

The two groups were comparable in baseline preoperative characteristics. Intraoperatively, warm ischemia time (27 vs. 45 min, p < 0.001), anhepatic phase (132 vs. 159 min, p < 0.001), and operative time (680 vs. 840 min, p < 0.001) were significantly shorter in SORT group. SORT group also had significantly lower GRWR (0.92 vs. 1.06, p < 0.001) and higher portal flow (2.4 vs. 2.7 L/min, p = 0.02). Postoperatively, SORT group had lower peak AST (177 vs. 209 IU/L, p < 0.001), ALT (163 vs. 189 IU/L, p = 0.004), creatinine levels (0.98 vs. 1.10, p = 0.01), rate of severe sepsis (13.7% vs. 22.9%, p = 0.03), major morbidity (50.7% vs. 62.6%, p = 0.03), shorter ICU (9 vs. 14 days, p < 0.001), and hospital stay (21 vs. 26 days, p = 0.03). Overall survival rates were comparable.

Conclusion

A SORT leads to improved early graft function and perioperative morbidity in modified right lobe LDLT in spite of having lower GRWR and higher portal flow.

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Abbreviations

AST:

Aspartate transaminase

ALT:

Alanine transaminase

DORT:

Dual outflow reconstruction technique

CDC:

Clavein-Dindo classification

EGD:

Early graft dysfunction

GRWR:

Graft to recipient weight ratio

HTK:

Histidine-tryptophan-ketoglutarate

IHV:

Inferior hepatic vein

IVC:

Inferior vena cava

ICU:

Intensive care unit

LDLT:

Live donor liver transplantation

LHA:

Left hepatic artery

MHV:

Middle hepatic vein

MELD:

Model for end stage liver disease

PTFE:

Polytetrafluoroethylene

PDS:

Polydioxanone

RHV:

Right hepatic vein

RHA:

Right hepatic artery

SORT:

Single orifice outflow reconstruction technique

WIT:

Warm ischemia time

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Authors and Affiliations

  1. Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver& Biliary Sciences, Vasant Kunj-D2, New Delhi, 110070, India

    Viniyendra Pamecha, Bramhadatta Pattnaik, Piyush Kumar Sinha, Nilesh Sadashiv Patil, Nihar Mohapatra, Shridhar Vasantrao Sasturkar & Venkatesh Balaraman Sundararajan

  2. Department of Radiology, Institute of Liver & Biliary Sciences, New Delhi, India

    Shalini Thapar

  3. Department of Anesthesia, Institute of Liver & Biliary Sciences, New Delhi, India

    Gaurav Sindwani & Mahesh Kumar Arora

Authors
  1. Viniyendra Pamecha
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  2. Bramhadatta Pattnaik
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  3. Piyush Kumar Sinha
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Contributions

Study concept and Design: Viniyendra Pamecha. Data collection: Bramhadatta Pattnaik, Piyush Kumar Sinha, Shridhar Vasantrao Sasturkar, Nihar Mohapatra, Gaurav Sindwani, and Shalini Thapar. Analysis and interpretation of data: Bramhadatta Pattnaik, Piyush Kumar Sinha, and Viniyendra Pamecha. Manuscript drafting: Bramhatta Pattnaik, Nilesh Patil, and Viniyendra Pamecha. Critical revision of the manuscript for important intellectual content: Viniyendra Pamecha, Nilesh Patil, and Mahesh Kumar Arora. Video clip of SORT: Venkatesh Balaraman Sundararajan and Viniyendra Pamecha.

Corresponding author

Correspondence to Viniyendra Pamecha.

Ethics declarations

The study was approved by the institutional scientific and ethics committee (no.: IEC/2017/48/MA10) and conducted in accordance with the Helsinki declaration 1975.

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The authors declare that they have no conflict of interest.

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Pamecha, V., Pattnaik, B., Sinha, P.K. et al. Single Orifice Outflow Reconstruction: Refining the Venous Outflow in Modified Right Lobe Live Donor Liver Transplantation. J Gastrointest Surg 25, 1962–1972 (2021). https://doi.org/10.1007/s11605-020-04776-3

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