Outflow reconstruction in extended right liver grafts from living donors

Abstract

The risk of outflow obstruction in extended right liver grafts remains a concern. We developed two procedures to minimize torsion in venous anastomosis and to achieve a short warm ischemic time of the graft. When there were no major short hepatic veins in the graft, a square-shaped vein graft was used to make a single orifice using the middle and right hepatic veins in the graft. When reconstruction of multiple short hepatic veins was necessary, a cryopreserved inferior vena cava graft was used, which was anastomosed with the hepatic veins of the graft ex situ. These techniques were applied in 10 patients with good results without torsion of the hepatic venous reconstruction or other complications. Our new techniques might be useful for recipients of extended right liver grafts to secure nontortuous venous reconstructions with a short warm ischemic time of the graft. (Liver Transpl 2003;9: 306-309.)

Venous Outflow Reconstruction in Adult Living Donor Liver Transplant: Outcome of a Policy for Right Lobe Grafts without the Middle Hepatic Vein

“…New strategies for HV reconstruction that would be tolerable to the compression of venous anastomotic sites by the regenerating liver graft were therefore suggested, one by the Tokyo group, using a cryopreserved large vein [24] and one by the Asan group, using an autogenous vein [25]. The Tokyo group introduced the double VC technique, using the cryopreserved VC to create a “common large opening” reconstruction when multiple major SHVs (caliber, ≥5 mm) were present.…”

Refinement of venous reconstruction using cryopreserved veins in right liver grafts

“…When there were major short hepatic veins, including inferior or middle right hepatic veins in the graft, the double vena cava (VC) technique was applied. The method was refined from our previous method 11. A cryopreserved VC graft was prepared for venoplasty in a basin (Fig.…”

Current concept of small-for-size grafts in living donor liver transplantation

“…Eguchi et al 85 modifi ed the triangular technique to reconstruct the co-joined orifi ce between the right hepatic vein and the paraumbilical vein graft for the middle hepatic vein tributaries. Sugawara et al 86,87 used a homologous vein graft as a patch between the right and middle hepatic veins or as a newly formed total venous drainage conduit. Their total venous drainage conduit could achieve the best drainage for right lobe grafts with multiple veins.…”

“…Their total venous drainage conduit could achieve the best drainage for right lobe grafts with multiple veins. 87 It is well recognized that an inferior right hepatic vein exceeding 5 mm in diameter needs reconstruction. 88 Adequate drainage from the middle hepatic tributaries, which drain the anterior segment, is very important to prevent paradoxical SFS graft syndrome even when a large graft is used (Fig.…”