Hepatic vein reconstruction in 152 living-related donor liver transplantation patients

Egawa, Hiroto; Inomata, Yukihiro; Üemoto, Shinji; Asonuma, Katsuhiro; Kiuchi, Tetsuya; Okajima, Hideaki; Yamaoka, Yoshio; Tanaka, Kōichi

doi:10.1016/s0039-6060(97)90353-6

Cited by 140 publications

(136 citation statements)

References 8 publications

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“…One of the causes of HVOO, especially in late-onset pediatric cases, is the dislocation of the graft due to the regeneration of the liver parenchyma or the accommodation of the graft in the abdominal cavity. 6,8,23 An end-to-end anastomosis might be affected to a greater extent than an end-to-side anastomosis by the dislocation of the regenerated graft. Thus, the technique proposed by the Tokyo group may be more appropriate in larger children with leftsided lobe grafts.…”

Section: Discussionmentioning

confidence: 99%

“…1 The anastomotic orifice was prepared according to the number of graft hepatic veins, the shape of the graft, and the anatomy of the recipient IVC. 6,10 The standard type of recipient orifice on the IVC is shown in the first column of Fig. 1.…”

Section: Methodsmentioning

confidence: 99%

“…Doppler ultrasound findings suggesting HVOO were the disappearance of the pulsatile hepatic venous flow and the flattening of the hepatic venous wave. 6 Liver biopsy findings suggesting HVOO included congestion, hemorrhaging, and necrosis around the central veins. 12 Common abnormal laboratory findings included hypoalbuminemia and hyperbilirubinemia.…”

Section: Methodsmentioning

confidence: 99%

“…5 Hepatic vein reconstruction is one of the most crucial factors in recipient surgery, and the creation of a wide outflow orifice is a key point for preventing HVOO. 6 The triangulation technique recommended by Emond et al 7 has led to a decrease in the incidence of this complication. A previous report documented the early experience with HVOO and introduced a new technique for hepatic vein reconstruction involving an incision on the inferior vena cava (IVC).…”

mentioning

confidence: 99%

“…A previous report documented the early experience with HVOO and introduced a new technique for hepatic vein reconstruction involving an incision on the inferior vena cava (IVC). 6 This modified technique for hepatic vein reconstruction has been applied for more than 10 years in our hospital, and it is important to evaluate how this technique has contributed to the prevention of HVOO.…”

mentioning

confidence: 99%

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Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Sakamoto¹,

Egawa²,

Kanazawa³

et al. 2010

Liver Transpl

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The goals of this study were to evaluate the incidence of hepatic venous outflow obstruction (HVOO) in pediatric patients after living donor liver transplantation (LDLT) using left-sided lobe grafts and to assess the therapeutic modalities used for the treatment of this complication at a single center. Four hundred thirteen primary LDLT procedures were performed with left-sided lobe grafts between 1996 and 2006. All transplants identified with HVOO from a cohort of 380 grafts with survival greater than 90 days were evaluated with respect to the patient demographics, therapeutic intervention, recurrence, and outcome. Seventeen cases (4.5%) were identified with HVOO. Eight patients experienced recurrence after the initial balloon venoplasty. Two patients finally required stent placement after they experienced recurrence shortly after the initial balloon venoplasty. A univariate analysis revealed that a smaller recipient-to-donor body weight ratio and the use of reduced grafts were statistically significant risk factors. The cases with grafts with multiple hepatic veins had a higher incidence of HVOO. In conclusion, the necessity of repeated balloon venoplasty and stent placement was related to poor graft survival. Therefore, the prevention of HVOO should be a high priority in LDLT. When grafts with multiple hepatic veins and/or significant donor-recipient size mismatching are encountered, the use of a patch graft is recommended. Stent placement should be carefully considered because of the absence of data on the long-term patency of stents and stent-related complications. New stenting devices, such as drug-eluting and biodegradable stents, may be promising for the management of HVOO. Liver Transpl 16:1207-1214, 2010. V C 2010 AASLD.Received April 5, 2010; accepted July 2, 2010.Techniques for reduced size liver transplantation, split liver transplantation, and living donor liver transplantation (LDLT) have been developed to address the shortage of organs and the size discrepancy between donors and recipients. 1,2 These types of liver transplantation are technically demanding because of the use of short vascular pedicles, which are more likely to cause postoperative vascular complications. Hepatic venous outflow obstruction (HVOO) is a rare vascular complication; however, it may lead to graft dysfunction without appropriate management. 3,4 The causes of HVOO include technical problems, subsequent fibrosis with inflammatory processes, and compression or twisting of the anastomosis caused by Abbreviations: BA, biliary atresia; GRWR, graft-to-recipient weight ratio; HVOO, hepatic venous outflow obstruction; IVC, inferior vena cava; LDLT, living donor liver transplantation; LL, left lobe; LLS, left lateral segment; r-LLS, reduced left lateral segment; SD, standard deviation; WD, Wilson's disease.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Sakamoto¹,

Egawa²,

Kanazawa³

et al. 2010

Liver Transpl

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Living‐Related Liver Transplantation

Lacaille,

Sokal

2001

J. pediatr. gastroenterol. nutr.

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Small‐for‐size graft, small‐for‐size syndrome and inflow modulation in living donor liver transplantation

Ikegami

Onda

Furukawa

et al. 2020

J Hepato Biliary Pancreat

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The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching called "small-for-size syndrome (SFSS)." The initial trials to resolve this problem involved increasing the procured graft size, from left to right, and even extending to include a right lobe graft. Clinical cases of living right lobe donations have been reported since then, drawing attention to the risks of increasing the liver volume procured from a living donor. However, not only other modes of increasing graft volume (GV) such as auxiliary or dual liver transplantation, but also control of the increased portal pressure caused by a small-for-size graft (SFSG), such as a porto-systemic shunt or splenectomy and optimal outflow reconstruction, have been trialed with some positive results. To establish an effective strategy for transplanting SFSG and preventing SFSS, it is essential to have precise knowledge and tactics to evaluate graft quality and GV, when performing these LDLTs with portal pressure control and good venous outflow. Thus, we reviewed the updated literature on the pathogenesis of and strategies for using SFSG.

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Hepatic vein reconstruction in 152 living-related donor liver transplantation patients

Cited by 140 publications

References 8 publications

Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Living‐Related Liver Transplantation

Small‐for‐size graft, small‐for‐size syndrome and inflow modulation in living donor liver transplantation

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