Refinement of venous reconstruction using cryopreserved veins in right liver grafts

Abstract

Short and direct vein anastomosis is generally performed in living donor liver transplantation using a right liver graft. The graft will regenerate, however, and might thus compress the anastomosis. We formulated a strategy for outflow reconstruction in right liver graft. When reconstruction of multiple short hepatic veins was necessary, a cryopreserved inferior vena cava graft was anastomosed with the hepatic veins of the graft in a basin. When there were no major short hepatic veins in the graft, a rectangular-shaped vein graft was used to make a single orifice using the middle and right hepatic veins in the graft. When there were no tributaries of the middle hepatic vein to be reconstructed, a diamond-shaped vein patch was anastomosed on the anterior wall of the right hepatic vein orifice of the graft. These techniques were satisfactorily applied in 40 patients with no torsion or tension at the anastomotic site of the hepatic venous reconstruction or other complications in outflow. The present strategy seemed to be technically feasible for outflow reconstruction in a right liver graft.

Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation

“…23 The presence of a sizable MRHV or IRHV is also clinically important as they are frequently reconstructed during living donor transplantation using right liver grafts at our institution. 24,25 Although detailed descriptions of the hepatic venous drainage patterns have not previously been reported, the gross venous drainage territories have been reported in several studies. Newmann et al 26 calculated the drainage volume of four major branches of MHV by 3D CT imaging and classified the branching pattern of MHV into three types, with a particular focus on V4 inf and V5.…”

Untitled

“…The duration of surgery was significantly greater with left than right lobe grafts (Table 2), possibly because of greater technical difficulty implanting the left than right lobe. 44 The trimming of the shape and length of the left portal vein may be difficult because the graft may not be located at the intended site. In addition, the vertical course of the left hepatic artery and the short stump may complicate microsurgical reconstruction in a restricted operative space and cause cephalic traction of the graft, graft compression, and early graft dysfunction.…”

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

“…Wide ostium drainage models have been developed to accept the graft's compression. 2,11 Hwang and associates, [12][13][14] who advocated that SVHs should be greater than 5 mm to be integrated into the drainage system, reported in their latest study that they integrated SVHs ≥ 4 mm into the drainage system. Most the integration models aimed at developing a wide ostium anastomosis tolerating compression are made of allogenic grafts or artificial graft materials.…”

“…The most commonly used techniques are unification venoplasty with the right hepatic vein are a separate anastomosis with funneling venoplasty, unification venoplasty with funneling, or quilt venoplasty and large clustered venoplasty with the right hepatic vein. 2,11,13 Figure 3 shows several hepatic venous reconstruction models used in our clinic.…”