Outflow Tract Reconstruction in Living Donor Liver Transplantation1

Villa, Vanessa H. de; Chen, Chao‐Long; Chen, Yaw‐Sen; Wang, Chih‐Chi; Wang, Shih-Hor; Chiang, Yuan‐Cheng; Cheng, Yu‐Fan; Huang, Tung‐Liang; Jawan, Bruno; Cheung, H.K

doi:10.1097/00007890-200012150-00011

Cited by 63 publications

(61 citation statements)

References 7 publications

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“…The disease indications for transplantation included hepatitis B virus with or without hepatocellular carcinoma (HCC; 92), hepatitis C virus infection with or without HCC (25), primary biliary cirrhosis (12), alcoholic cirrhosis (8), hepatitis B virus and hepatitis C virus with or without HCC (6), Wilson's disease (4), and other (5).…”

Section: Resultsmentioning

confidence: 99%

“…4 Our techniques for donor graft hepatectomy and recipient total hepatectomy in LDLT have been described in detail previously. 3,5,6 The anesthesia management followed the protocol of the Department of Anesthesiology. 7,8 Red blood cell transfusions were not given to patients with hemoglobin levels > 8.0 g/ dL and as long as the intravascular volume was sufficient to maintain normal hemodynamics.…”

Section: Methodsmentioning

confidence: 99%

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Solitary pulmonary nodule in the liver transplant candidate: Importance of diagnosis and treatment

et al. 2010

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Our objectives were to define the incidence and etiology of solitary pulmonary nodules (SPNs) in patients undergoing living donor liver transplantation (LDLT), describe a diagnostic approach to the management of SPNs in LDLT, and define the impact of SPNs on the overall survival of adult LDLT recipients. Nine patients (9/152, 5.9%) were diagnosed with an SPN on the basis of chest radiography findings during the pretransplant survey. All were male. The mean age was 52 years. All the patients had hepatitis B virus-related cirrhosis with hepatocellular carcinoma. All were asymptomatic for the lung lesion. All underwent contrast-enhanced chest computed tomography (CT) to verify the presence and possible etiology of the SPNs. In 3 cases, CT was used to definitely determine that there was no pulmonary nodule; in 2, CT led to a definite diagnosis of pulmonary tuberculosis. In 4, CT led to a definite identification of an SPN but not to an etiological diagnosis. Two patients underwent outright thoracoscopy and biopsy of their SPNs. Biopsy showed cryptococcosis in both patients. One received a therapeutic trial of an antituberculosis treatment, and repeat CT after 1 month showed a regression in the size of the SPN. A diagnosis of tuberculosis was made. One patient had an inconclusive whole body positron emission tomography scan and subsequently underwent thoracoscopy where biopsy showed tuberculosis. A concomitant malignancy, either primary lung cancer or metastasis from the liver tumor, was not identified. All patients were surviving with their original grafts and were lung infection-free. The overall mean posttransplant follow-up was 54 months (range ¼ 33-96 months). Patients undergoing transplantation require a thorough clinical evaluation to exclude overt and occult malignancies that would preclude the planned procedure. This is important because routine immunosuppression use after transplantation may often result in the body's loss of immunoregulatory functions and thus in a myriad of problems, including oncological and infectious processes. Occult infections may manifest as fulminant, life-threatening sepsis after transplantation.Indeterminate pulmonary nodules in transplant candidates pose both diagnostic and therapeutic

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Solitary pulmonary nodule in the liver transplant candidate: Importance of diagnosis and treatment

et al. 2010

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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%

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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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Cryopreserved arterial grafts as a conduit in outflow reconstruction in living donor liver transplantation

Ali

Yong

Eng

et al. 2015

J Hepato Biliary Pancreat

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Outflow Tract Reconstruction in Living Donor Liver Transplantation1

Abstract: A triple recipient venoplasty with a matching venoplasty of multiple graft hepatic veins to create a single wide outflow orifice is recommended in living donor liver transplantation using left side grafts.

Cited by 63 publications

References 7 publications

Solitary pulmonary nodule in the liver transplant candidate: Importance of diagnosis and treatment

Solitary pulmonary nodule in the liver transplant candidate: Importance of diagnosis and treatment

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

Cryopreserved arterial grafts as a conduit in outflow reconstruction in living donor liver transplantation

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