Liver transplantationDonor procedureEffect of Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation Using Right Lobe
Section snippets
Materials and methods
From January 1999 to September 2005, we performed 211 cases of adult LDLT using the right lobe. Patient ages ranged from 34 to 62 years, most of whom were in the fifth or sixth decade. Male subjects were predominant. The operative methods consisted of right-to-right anastomosis of the hepatic vein, portal vein, and hepatic artery after total removal of diseased liver. All grafts did not include the MHV. Biliary reconstructions were mainly end-to-end anastomoses without a T-tube insertion. The
Results
Our criteria for reconstruction of that MHV were that the vessel was more than 5 mm in diameter in the segment 5 or segment 8 vein. Among 211 cases, 182 (86.3%) were reconstructed with interpositional MHV grafts. Among them, 95 cases (52.2%) were patent at 1 week postoperatively. There was no significant difference in the patency rate of MHV reconstruction according to material used for the vascular graft, such as saphenous vein or portal vein, or the site of reconstruction, such as segment 5,
Discussion
There is controversy about reconstruction of the MHV in right lobe LDLT. Lee et al1 reported that several cases without MHV reconstruction patients suffered severe congestion in the anterior segment, followed by prolonged massive ascites and liver dysfunction, eventually dying due to sepsis. They recommended reconstruction of the MHV. There are several theories on the pathogenesis of the problems in LDLT without MHV reconstruction. Kaneko et al3 suggested that ligation of contributaries of the
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Cited by (26)
Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival
2019, Hepatobiliary and Pancreatic Diseases InternationalCitation Excerpt :However, a previous study [23] demonstrated that serious congestion of the right anterior segment in some right lobe grafts may occur after transplantation and may influence graft regeneration and increase graft injury and loss. Kim et al. [9] advocated for the selective reconstruction of MHV tributaries in patients with small-for-size grafts of GRWR <0.8% but not for all grafts. Lee et al. [24] recommended that the reconstruction of MHV drainage from the anterior segment was necessary when the V5 or V8 were larger than 5 mm in diameter during donor hepatectomy.
Outflow modulation to target liver regeneration: Something old, something new
2014, European Journal of Surgical OncologyCitation Excerpt :A series of papers have shown the effects of congestion on hypertrophy of the liver. Indeed, the causal relationship between congestion and liver regeneration has been consistently reported after living donor transplantation.8,9 Patients submitted to right liver resection with middle hepatic vein harvesting have a smaller regeneration rate of segments I and IV, compensated by an increased regeneration rate of segments II and III.10
Cryopreserved aortic quilt plasty for one-step reconstruction of multiple hepatic venous drainage in right lobe living donor liver transplantation
2011, Transplantation ProceedingsCitation Excerpt :The first week of the posttransplantation period is crucial to establish the venous drainage, because most graft regeneration occurs during this time. Therefore, early posttransplant venous outflow has to be uncomplicated for graft viability.4 If discoloration of the anterior segment occurs during temporary and simultaneous clamping of the segment 5 and 8 veins and the right hepatic artery, drainage of the segment 5 and 8 is needed.
Segment IV preserving middle hepatic vein retrieval in right lobe living donor liver transplantation
2011, Journal of the American College of SurgeonsCitation Excerpt :In a standard RLG, congestion can reduce as collaterals open up,25-28 but this can take up to 3 months.21,29 Venous drainage in a modified RLG is partial because few venous tributaries are reconstructed, and inconsistent because of frequent thrombosis of the small-caliber, low-flow venous conduits.30-33 Modified RLGs were found to have congestion scores similar to standard RLG, intraoperatively and at 1 month after transplantation, despite patent interposition grafts.34