Difficulty in sustaining hepatic outflow in left lobe but not right lobe living donor liver transplantation

Shirouzu, Yasumasa; Ohya, Yuki; Hayashida, Shintaro; Asonuma, Katsuhiro; Inomata, Yukihiro

doi:10.1111/j.1399-0012.2010.01322.x

Cited by 15 publications

(25 citation statements)

References 28 publications

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“…It has been previously demonstrated that the placement of a wide common channel portion is beneficial for accommodating potential graft remodeling-associated distortion of the hepatic vein anastomosis. [5][6][7] Therefore, when wedged unification is being performed, the depth of the wedging should be adjusted and optimized after the consideration of the relative sizes of the graft and the recipient's hepatic veins. At this point, we emphasize the importance of size matching between the graft hepatic vein orifice and the diameter of the recipient's IVC.…”

Section: Discussionmentioning

confidence: 99%

“…17 To date, we have 3 technical approaches to bench work for hepatic vein orifices of left liver grafts for both adult and pediatric patients, including extended left livers, left livers without the MHV trunk, extended LLSs, LLSs, reduced LLSs, and monosegments. The first approach is unification venoplasty with central wedging/septoplasty to make a wide common channel [5][6][7] ; the second, the placement of a side patch to widen the hepatic vein orifice, 9,18 is a procedure that can be combined with the first approach; and the third is a very unusual combination of the first approach and vein graft interposition. According to our experience, these techniques cover nearly all hepatic vein variations in various types of left liver grafts.…”

Section: Discussionmentioning

confidence: 99%

“…2). [6][7][8] The use of absorbable suture material for pediatric patients is recommended. Occasionally, conventional venoplasty has been used with simple septotomy (not excavating septoplasty) for the unification of small hepatic vein orifices (Fig.…”

Section: Simulation-based Design Of Surgical Techniquesmentioning

confidence: 99%

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Anomalous hepatic vein anatomy of left lateral section grafts and customized unification venoplasty for pediatric living donor liver transplantation

Hwang

Kim

et al. 2013

Liver Transpl

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In liver transplantation, a left lateral section (LLS) graft may have an unusual variant left hepatic vein (LHV) anatomy. This study was designed to analyze the incidence of unusual LHV variants and to determine technical methods for effective reconstruction in infant recipients weighing approximately 10 kg or less. The study comprised 3 parts: an LHV variation analysis, a simulation-based design for the technical modification of graft LHV venoplasty, and its clinical application. The LHV anatomy of 300 potential LLS graft donors was classified into 4 types according to the number and location of the hepatic vein openings: (1) a single opening (n ¼ 218 or 72.7%); (2) 2 large adjacent openings (n ¼ 29 or 9.7%); (3) 2 adjacent openings, 1 large and 1 small (n ¼ 34 or 11.3%); and (4) 2 widely spaced openings (n ¼ 19 or 6.3%). Types 2 and 3 required wedged unification venoplasty, and type 4 required additional vein interposition. In a series of 49 cases using LLS grafts, the graft hepatic vein complication rate was 4.5% at 3 years; stenting was necessary for 1 of the 36 type 1 LHV grafts (2.8%) and for 1 of the 13 type 2-4 LHV grafts (7.7%, P ¼ 0.46). A customized interposition-wedged unification venoplasty technique for coping with type 4 vein variations was developed with a simulation-based approach, and it was successfully applied to a 10-month-old male infant receiving an LLS graft with a type 4 LHV. In conclusion, nearly all LHV variations can be effectively managed with customized unification venoplasty. These venoplasty techniques represent beneficial surgical options as part of graft standardization for hepatic vein reconstruction in pediatric living donor liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anomalous hepatic vein anatomy of left lateral section grafts and customized unification venoplasty for pediatric living donor liver transplantation

Hwang

Kim

et al. 2013

Liver Transpl

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“…This again can cause a horizontal shift in the lie of the MHV and LHV resulting in kinks and outflow issues. 24 In contrast, the right-lobe graft resides comfortably in the limited right subphrenic cavity and regenerates toward the left and anteromedial sides with little positional change of the graft hepatic veins.…”

Section: Disadvantages Of Left-lobe Graftsmentioning

confidence: 99%

Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants

Sudhindran

Ramachandran

Balakrishnan

2012

Journal of Clinical and Experimental Hepatology

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“…Once it occurs, the liver graft is impaired by congestion, which results in jaundice, massive ascites, coagulopathy, and occasionally hepatic failure. Outflow obstructions after liver transplantation are caused by strictures and/or torsion on the anastomosis of the hepatic vein to the inferior vena cava (IVC) 2. The incidence has been reported to be 2% to 7% in living donor liver transplantation (LDLT) 3‐5.…”

mentioning

confidence: 99%

Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation

et al. 2012

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An outflow obstruction of the hepatic vein is a critical complication after living donor liver transplantation (LDLT) and occasionally leads to hepatic failure. Here we introduce a simple method for preventing outflow obstructions by patch plasty in adult LDLT. Between September 2001 and May 2010, 468 adult LDLT procedures were performed at Kyoto University Hospital. We harvested each recipient's portal vein (PV) from the extirpated liver for a patch. We intended to re-form several orifices of the hepatic veins into a single, large orifice. The patch was attached to the anterior wall of the re-formed orifice on the bench. After we put in the liver graft, the procedure for the hepatic vein anastomosis to the inferior vena cava was simple enough that the warm ischemia time was reduced. Three of the 468 cases were diagnosed with an outflow obstruction. All 3 cases underwent hepatic vein reconstruction without patch plasty. In contrast, none of the 159 cases that underwent LDLT with patch plasty suffered from an outflow obstruction, regardless of the liver graft type. The procedure for hepatic vein plasty using a patch from the native PV is simple and elegant and results in excellent outcomes. We propose this as the standard procedure for hepatic vein reconstruction in adult LDLT.

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Difficulty in sustaining hepatic outflow in left lobe but not right lobe living donor liver transplantation

Abstract: The middle and left hepatic veins tend to distort and stretch during graft regeneration. These characteristics seem to be associated with outflow disturbances.

Cited by 15 publications

References 28 publications

Anomalous hepatic vein anatomy of left lateral section grafts and customized unification venoplasty for pediatric living donor liver transplantation

Anomalous hepatic vein anatomy of left lateral section grafts and customized unification venoplasty for pediatric living donor liver transplantation

Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants

Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation

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