Abstract
Background: In living related liver transplantation (LRLT), reconstruction of the hepatic vein
(HV) by end-to-end anastomosis has been reported to be associated with acute or late
outflow block. Methods: We reviewed 42 patients who underwent LRLT from January 1996 to September 1998. Results: In 7 (27%) of the 26 donor grafts obtained from left lateral segmentectomy or extended
lateral segmentectomy and in 9 (56%) of the 16 grafts obtained from left lobectomy,
venoplasty was required. In the remaining 26 grafts, 1-orifice left HV was obtained.
In addition to the division of the duct of Arantius, the left inferior phrenic vein
was divided routinely in 16 patients, which contributed to reducing the venoplasty
rate from 46% to 25% (P =.1704). In all 42 patients, HV was reconstructed successfully by end-to-end anastomosis.
The median ratio of the diameter of the recipient's HV to that of the graft's HV was
1.2 (range, 0.8-2.1). The grafts were fixed to the abdominal wall by using the falciform
and round ligaments at a site where Doppler ultrasound showed sufficient flow in the
respective vessels. Three patients developed late-onset HV obstruction and required
balloon dilatation either by means of a venous route or a transhepatic route: 1 patient
received a new liver on the 232nd postoperative day, 1 patient died of sepsis without
outflow block, and the last patient is doing well. Conclusions: In LRLT, the division of the duct of Arantius and the left inferior phrenic vein
followed by extensive clamping of the common trunk contributed to obtaining a 1-orifice
HV. This facilitates anastomosis of the HVs of the grafts to the recipients' HVs,
and fixation of the grafts by using the falciform and round ligaments prevents rotation
of the grafts and subsequent acute outflow block. (Surgery 2000;128:48-53)
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Article info
Publication history
Accepted:
February 19,
2000
Footnotes
*Supported by a grant-in-aid for scientific research (08407036) from the Ministries of Health and Welfare and Education, Science and Culture of Japan.
**Reprint requests: Keiichi Kubota, MD, PhD, Professor and Chairman, Second Department of Surgery, Dokkyo University School of Medicine, Mibu, Shimotsuga, Tochigi 321-0293.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
