Maximizing Venous Outflow after Right Hepatic Living Donor Liver Transplantation with a Venous Graft Patch

Mizuno, Shugo; Sanda, Ryo; Hori, Tomohide; Yagi, Shintaro; Iida, Takuya; Usui, Masanobu; Sakurai, Hiroyuki; Tabata, Masami; Isaji, Shuji; Üemoto, Shinji

doi:10.1159/000118033

Cited by 11 publications

(16 citation statements)

References 28 publications

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“…It has been demonstrated that ligation of large MHV tributaries could bring about more remarkable perfusion imbalance between anterior and posterior segments [42]. As a result, the vascular diameter of the MHV tributaries is the mostly recommended criteria for reconstruction and 5 mm is commonly preferred as a demarcation [13,14,16,17,18,19,20,21,23,25,26,28,29,30,32,35], while others have suggested that MHV reconstruction should be based on the clamping test findings [13,17,21,26,29,32,35], graft volume [21,23,43] and the number of the MHV tributaries [23,24,31,33]. The policy of our center for MHV tributaries reconstruction had been described above.…”

Section: Discussionmentioning

confidence: 99%

“…For a modified right lobe there would be technical difficulty as to the additional reconstruction of the MHV tributaries. Firstly, the source of optimal venous grafts for the procedure remains a concern, whether it is cryopreserved or autologous or prosthetic vein grafts [3,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. Secondly, an appropriate reconstruction policy also remains a concern, which could obviate additional procedures and possible outflow problems.…”

Section: Introductionmentioning

confidence: 99%

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Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

et al. 2014

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Aims: To investigate the effectiveness of our technique and policy in reconstructing middle hepatic vein (MHV) tributaries of patients undergoing right-lobe living donor liver transplantation (LDLT). Methods: From January 2001 to December 2010, 186 adult patients underwent right-lobe LDLT without the MHV. Patients were divided into two groups: group A (n = 71) and group B (n = 115) without or with the MHV tributaries reconstruction. We evaluated the serum liver function markers after transplantation and monitored vascular flow in the graft and interpositional vein by Doppler ultrasonography. Results: The cumulative 1-, 3-, 5-year graft and patient survival rates were not significant between group A and group B (p = 0.287 and p = 0.258). Biliary complications appeared to be more frequent in group A than in group B (16.9 vs. 5.2%, p = 0.009). Liver function impairment was found in patients without MHV reconstruction and those with occluded interpositional vessels early after transplantation. The cumulative 1-, 3-, 6- and 12-month patency rate of the interpositional veins was 81.51, 79.60, 74.69 and 72.68%, respectively. Conclusion: The reconstruction technique based on our policy ensures excellent outflow drainage and favorable recipient outcome, while better criteria for MHV reconstruction should be established.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

et al. 2014

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“…In LDLT using a right lobe graft, the use of a venous graft patch has been effective in maximizing venous outflow. 24 This technique involves an end-to-side anastomosis and the use of a venous graft patch attached only to the anterior side of the anastomosis; this might be a feasible procedure for left-sided lobe grafts.…”

Section: Discussionmentioning

confidence: 99%

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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“…Outflow is affected by the construction of the hepatic vein. 5,6 Intrahepatic vascular resistance is related to the size and quality of the graft. 7,8 Hemodynamic status is related to the development of collateral vessels and spleen volume.…”

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confidence: 99%

A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation

et al. 2016

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BackgroundIn adult living donor liver transplantation (ALDLT), graft-to-recipient weight ratio of less than 0.8 is incomplete for predicting portal hypertension (>20 mm Hg) after reperfusion. We aimed to identify preoperative factors contributing to portal venous pressure (PVP) after reperfusion and to predict portal hypertension, focusing on spleen volume-to-graft volume ratio (SVGVR).MethodsIn 73 recipients with ALDLT between 2002 and 2013, first we analyzed survival according to PVP of 20 mm Hg as the threshold, evaluating the efficacy of splenectomy. Second, we evaluated various preoperative factors contributing to portal hypertension after reperfusion.ResultsAll of the recipients with PVP greater than 20 mm Hg (n = 19) underwent PVP modulation by splenectomy, and their overall survival was favorable compared with 54 recipients who did not need splenectomy (PVP ≤ 20 mm Hg). Graft-to-recipient weight ratio had no correlation with PVP.Multivariate analysis revealed that estimated graft and spleen volume were significant factors contributing to PVP after reperfusion (P < 0.0001 and P < 0.0001, respectively). Furthermore, estimated SVGVR showed a significant negative correlation to PVP after reperfusion (R = 0.652), and the best cutoff value for portal hypertension was 0.95.ConclusionsIn ALDLT, preoperative assessment of SVGVR is a good predictor of portal hypertension after reperfusion can be used to indicate the need for splenectomy before reperfusion.

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Maximizing Venous Outflow after Right Hepatic Living Donor Liver Transplantation with a Venous Graft Patch

Cited by 11 publications

References 28 publications

Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

Reconstructing Middle Hepatic Vein Tributaries in Right-Lobe Living Donor Liver Transplantation

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

A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation

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