Living-Donor Liver Transplant Using the Right Hepatic Lobe Without the Right Hepatic Vein: Solving the Drainage Problem

Akbulut, Sami; Yılmaz, Mehmet; Eris, Cengiz; Kutlu, Ramazan; Yılmaz, Sezai

doi:10.6002/ect.2012.0060

Cited by 9 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These techniques include reduced-size DDLT, split-size DDLT, segmental LDLT (right, left, and left lateral segment), and monosegment LDLT. 1,2,5 In parallel to the introduction of these alternative techniques aimed at expanding the donor organ pool for LT, the incidence rates of formerly relatively rare vascular and biliary complications have increased in cases of segmental liver transplant. According to previous reports, most post-LDLT complications are caused by limited graft volume (graft-to-recipient weight ratio of < 0.8), bile duct variations (eg, multiple bile ducts and narrow bile ducts), complex venous drainage pattern (eg, V5, V8, right inferior hepatic veins and middle hepatic vein), short and narrow venous structures, abnormal portal vein patterns (duplex or triplex portal vein), and hepatic artery variations (eg, multiple arteries, short artery, and narrow artery).…”

Section: Discussionmentioning

confidence: 99%

Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience

Koç

Akbulut²,

Soyer³

et al. 2021

Exp Clin Transplant

Self Cite

View full text Add to dashboard Cite

Objectives: In this study, we share our approach for care of patients with hepatic venous outlet obstruction after living-donor liver transplant. Results: Patients ranged in age from 1 to 61 years (24 adults and 11 children). All adult patients had undergone right lobe living-donor liver transplant. In the pediatric group, 8 had undergone left lateral segment and 3 had undergone left lobe living-donor liver transplant. Nineteen adult patients and all 11 pediatric patients underwent hepatic venous reconstruction, with all procedures based on common large-opening drainage models using various vascular graft materials. Development of hepatic venous outlet obstruction occurred at mean posttransplant day 233 ± 298.5 in the adult patients and mean posttransplant day 139 ± 97.8 in the pediatric patients. After development of obstruction, the patients underwent 1-6 sessions (1.5 ± 1.1 sessions) of balloon angioplasty. After the first balloon angioplasty procedure, 25% of the adults and 36.3% of the pediatric patients developed recurrence. The early-onset and late-onset subgroups showed statistically significant differences in serum albumin (P = .01), underlying causes (P < .001), time from transplant to obstruction (P = .02), and time from transplant to last visit (P = .02). The survivor and nonsurvivor subgroups showed statistically significant differences in total bilirubin (P = .03) and time from transplant to last visit (P = .03). Conclusions: Common large-opening reconstruction minimizes hepatic venous outlet obstruction development after living-donor liver transplant. Balloon angioplasty and/or stenting is almost always the first option in the care of this complication. Materials and Methods Key words: Balloon angioplasty, Venous outflow, Venous reconstruction models IntroductionSince the time of the first successful liver transplant in humans (performed by Starzl and colleagues in 1967), liver transplant has emerged as the standard treatment option for a wide array of liver disorders and mainly those related to chronic liver diseases. [1][2][3][4] Although deceased-donor liver transplant (DDLT) constitutes a large percentage of liver transplant procedures performed in Western countries, most liver transplant procedures performed in many of the Asian countries (including Turkey) use organs obtained from living donors (that is, living-donor liver transplant; LDLT). 1 The surgical techniques of DDLT and LDLT differ, as do the posttransplant liver functions resulting from each.One of the most notable differences in the techniques is the reconstruction approach for venous outflow, which is necessary to ensure proper and adequate hepatic drainage. 3 In DDLT, various wide anastomoses are reconstructed between the donor's inferior vena cava (IVC) and the recipient's retrohepatic IVC; this approach lowers the rate of postoperative drainage complications to acceptable levels. In contrast, for LDLT, the reconstruction approach is complicated by the presence of multiple venous orifices in the liver grafts, as well as...

show abstract

Section: Discussionmentioning

confidence: 99%

Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience

Koç

Akbulut²,

Soyer³

et al. 2021

Exp Clin Transplant

Self Cite

View full text Add to dashboard Cite

show abstract

“…Since the first successful liver transplantation (LT) performed in 1967, LT has become the gold standard treatment for many liver diseases in adult and pediatric patients[ 1 ]. In socioculturally developed western countries, most of the liver graft requirements are provided from the cadaveric organ pool, while in Asian and Middle Eastern countries, a significant portion of the organ requirements are provided from the living donor pool[ 1 , 2 ]. In deceased donor liver transplantation, whole size liver graft is harvested with the inferior vena cava (IVC) and then venous anastomosis can be performed easily between the IVC of the liver graft and IVC of the recipient using conventional, piggyback, or modified piggyback techniques[ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…In socioculturally developed western countries, most of the liver graft requirements are provided from the cadaveric organ pool, while in Asian and Middle Eastern countries, a significant portion of the organ requirements are provided from the living donor pool[ 1 , 2 ]. In deceased donor liver transplantation, whole size liver graft is harvested with the inferior vena cava (IVC) and then venous anastomosis can be performed easily between the IVC of the liver graft and IVC of the recipient using conventional, piggyback, or modified piggyback techniques[ 1 , 2 ]. In contrast, variations in the vascular structure of the liver graft obtained from a living liver donor (LLD) cause difficulties during vascular reconstruction in LDLT, especially hepatic venous reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…To evaluate the hepatic vascular structures of LLD candidates, Doppler ultrasonography (US), multidetector computed tomography (MDCT) and, if necessary, conventional hepatic angiography are the most commonly used techniques[ 2 ]. Variations detected in the liver vascular anatomy of the potential LLD candidates either result in rejecting the candidate or the surgical team considers alternative surgical techniques such as various venous drainage models.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?

Demyati

Akbulut

Çiçek

et al. 2020

WJH

Self Cite

View full text Add to dashboard Cite

BACKGROUND Since the first living donor liver transplantation (LDLT) was performed by Raia and colleagues in December 1988, LDLT has become the gold standard treatment in countries where cadaveric organ donation is not sufficient. Adequate hepatic venous outflow reconstruction in LDLT is essential to prevent graft congestion and its complications including graft loss. However, this can be complex and technically demanding especially in the presence of complex variations and congenital anomalies in the graft hepatic veins. CASE SUMMARY Herein, we aimed to present two cases who underwent successful right lobe LDLT using a right lobe liver graft with rudimentary or congenital absence of the right hepatic vein and describe the utility of a common large opening drainage model in such complex cases. CONCLUSION Thanks to this venous reconstruction model, none of the patients developed postoperative complications related to venous drainage. Our experience with venous drainage reconstruction models shows that congenital variations in the hepatic venous structure of living liver donors are not absolute contraindications for LDLT.

show abstract

“…Again, size discrepancy between the anastomosed vessels is a predisposing factor. Post transplant regeneration of the graft can compresses short and narrow venous anastomoses leading to graft congestion and dysfunction [41] . Various graft materials have been used to create hepatic venous reconstructions allowing for wide ostium anastomoses that can then withstand compression during regeneration [42] .…”

Section: Hepatic Venous Systemmentioning

confidence: 99%

Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

Hennedige

Gopinathan

Madhavan

2014

WJR

View full text Add to dashboard Cite

Core tip: Living donor liver transplantation (LDLT) has evolved to a widely accepted therapeutic option. As a radiologist, knowledge of the various anatomical variations and pathological states in both the donor and recipient are imperative to generating a meaningful report in pre-operative evaluation. This paper provides a brief overview of the common surgical concepts of LDLT and gives a detailed description of the minimum that a radiologist is expected to seek and report in computed tomography and magnetic resonance scans performed for LDLT related evaluation.

show abstract

Living-Donor Liver Transplant Using the Right Hepatic Lobe Without the Right Hepatic Vein: Solving the Drainage Problem

Cited by 9 publications

References 15 publications

Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience

Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience

Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?

Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

Contact Info

Product

Resources

About