Whole-Liver Graft Without the Retrohepatic Inferior Vena Cava for Sequential (Domino) Living Donor Liver Transplantation

Inomata, Yukihiro; Zeledón, Manuel; Asonuma, Katsuhiro; Okajima, Hideaki; Takeichi, Takayuki; Ishiko, Takatoshi; Ando, Yumiko

doi:10.1111/j.1600-6143.2007.01828.x

Cited by 20 publications

(20 citation statements)

References 7 publications

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“…On the other hand, the preservation of the retrohepatic vena cava is an alternative strategy to veno-venous bypass (40)(41)(42)(43)(44)(45). In order to use (implant) the FAP graft obtained As mentioned earlier, from a technical point of view, arterial, biliary, portal and outflow complications occurred with similar frequency in both groups (p = 0.6, 1.0, 0.2 and 1.0 respectively).…”

Section: Study Of Fap Liver Donors Versus Fap Nonliver Donorsmentioning

confidence: 95%

Operative Risks of Domino Liver Transplantation for the Familial Amyloid Polyneuropathy Liver Donor and Recipient: A Double Analysis

Tincani

Hoti

Andreani

et al. 2011

American Journal of Transplantation

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Section: Study Of Fap Liver Donors Versus Fap Nonliver Donorsmentioning

confidence: 95%

Operative Risks of Domino Liver Transplantation for the Familial Amyloid Polyneuropathy Liver Donor and Recipient: A Double Analysis

Tincani

Hoti

Andreani

et al. 2011

American Journal of Transplantation

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“…Apart from the genetic defect resulting in the production of variant transthyretin, a protein whose accumulation eventually leads to polyneuropathy, the liver of a patient undergoing transplantation for FAP is normal. Transplant candidates with FAP are frequently younger than 50 years, and these patients' native livers, when excised at the time of transplant, have been used as allografts for other recipients 96–98. Indeed, optimal results can be expected in domino transplantation as the CIT can be minimized.…”

Section: Domino Transplantation In the Context Of Familial Amyloid Pomentioning

confidence: 99%

“…Although procuring the FAP patient's liver most often requires preservation of the inferior vena cava, which may increase technical difficulties in implanting these livers into the second recipient, domino grafts from patients with FAP can be considered reference grafts rather than extended criteria allografts, particularly for candidates whose life expectancy is less than the time needed to develop amyloid disease, such as older candidates. In addition, novel methods of reconstruction may allow the transplantation of whole grafts without the retrohepatic inferior vena cava 98. However, FAP is a rare disease, and domino transplantation is a modest contribution to the expansion of the donor pool.…”

Section: Domino Transplantation In the Context Of Familial Amyloid Pomentioning

confidence: 99%

Report of the Paris consensus meeting on expanded criteria donors in liver transplantation

Durand¹,

Renz²,

Alkofer³

et al. 2008

Liver Transpl

279

239

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Because of organ shortage and a constant imbalance between available organs and candidates for liver transplantation, expanded criteria donors are needed. Experience shows that there are wide variations in the definitions, selection criteria, and use of expanded criteria donors according to different geographic areas and different centers. Overall, selection criteria for donors have tended to be relaxed in recent years. Consensus recommendations are needed. This article reports the conclusions of a consensus meeting held in Paris in March 2007 with the contribution of experts from Europe, the United States, and Asia. Definitions of expanded criteria donors with respect to donor variables (including age, liver function tests, steatosis, infections, malignancies, and heart-beating versus non-heart-beating, among others) are proposed. It is emphasized that donor quality represents a continuum of risk rather than "good or bad." A distinction is made between donor factors that generate increased risk of graft failure and factors independent of graft function, such as transmissible infectious disease or donor-derived malignancy, that may preclude a good outcome. Updated data concerning the risks associated with different donor variables in different recipient populations are given. Recommendations on how to safely expand donor selection criteria are proposed.

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“…The MHV/LHV common trunk is implanted to the common trunk of the AHA recipient followed by the RHV to its corresponding RHV stump or in the opposite order. Technical difficulties in these anastomoses were noted by Inomata et al10 The MHV/LHV common trunk and the RHV were joined to each limb of a deceased donor's iliac venous graft, which contained a portion of the IVC. This provided more length to work with and a single caval cuff for anastomosis 11.…”

Section: Discussionmentioning

confidence: 99%

Simplifying hepatic venous outflow reconstruction in sequential living donor liver transplantation

Chan

et al. 2009

Liver Transpl

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The native liver of a familial amyloidotic polyneuropathy recipient who undergoes living donor liver transplantation used as a graft for sequential liver transplantation does not include the inferior vena cava. Implantation of this whole liver graft to a second recipient could be simplified by borrowing the experience from right liver living donor liver transplantation. With careful release of the hepatic vein from its surrounding adventitia mainly by sharp dissections, adequate lengths of these veins could be attained without compromising the native inferior vena cava. Following venoplasty of the right and middle/left hepatic vein stumps, the single cuff of the hepatic veins is anastomosed to the inferior vena cava without interpositional venous graft or patch. Satisfactory venous outflow is reliably achieved because this is the most direct outflow tract. Liver Transpl 15: 1514Transpl 15: -1518Transpl 15: , 2009 Sequential liver transplantation using a deceased donor liver graft for familial amyloidotic polyneuropathy (FAP) is well described.1 Classically, the liver explanted from a patient with FAP, or an amyloid hepatic allograft (AHA), is transplanted to a second recipient (AHA recipient). The latter is usually greater than 60 years old, because the AHA will continue to produce variant transthyretin, resulting in neuropathy years later. In deceased donor sequential liver transplantation, the inferior vena cava (IVC) is included in the deceased donor liver graft and also in the AHA. Therefore, graft implantation is by end-to-end IVC anastomosis for both recipients. Total hepatectomy of the patient with FAP is similar to standard deceased donor liver transplantation, except that the suprahepatic and infrahepatic IVC of a just adequate length are included in the AHA for implantation in the AHA recipient. It is important to note that the FAP patient should not be considered at a disadvantage for being a living liver donor in the recipient total hepatectomy. A way to maintain the IVC flow during the anhepatic phase and without venovenous bypass is application of the piggyback technique.2 This has been applied to patients with FAP who had side-toside cava-caval anastomosis and closure of the suprahepatic and infrahepatic cava. 3In the case of living donor sequential liver transplantation, however, the IVC of the FAP patient has to be preserved in all cases and is not included in the AHA explanted from the FAP patient. This AHA, which is a whole graft and devoid of the IVC for implantation to the AHA recipient, also requires unimpeded venous outflow. The procedure, though akin to the piggyback technique, is different because the length of the hepatic veins in the AHA graft is limited. FIRST RECIPIENTThe patient with FAP was 42 years old. Her main symptoms were peripheral, and autonomic polyneuropathy manifested as numbness of the limbs and constipation. She also had weight loss of 7 kg over a 1-year period. Antral biopsy by upper endoscopy revealed Congo redstained amyloid deposits in the muscularis mucosae. E...

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Whole-Liver Graft Without the Retrohepatic Inferior Vena Cava for Sequential (Domino) Living Donor Liver Transplantation

Cited by 20 publications

References 7 publications

Operative Risks of Domino Liver Transplantation for the Familial Amyloid Polyneuropathy Liver Donor and Recipient: A Double Analysis

Operative Risks of Domino Liver Transplantation for the Familial Amyloid Polyneuropathy Liver Donor and Recipient: A Double Analysis

Report of the Paris consensus meeting on expanded criteria donors in liver transplantation

Simplifying hepatic venous outflow reconstruction in sequential living donor liver transplantation

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