Elsevier

Transplantation Proceedings

Volume 38, Issue 7, September 2006, Pages 2099-2101
Transplantation Proceedings

Liver transplantation
Donor procedure
Effect of Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation Using Right Lobe

https://doi.org/10.1016/j.transproceed.2006.06.005Get rights and content

Abstract

Background

This study reviewed the impact of middle hepatic vein (MHV) reconstruction on right lobe graft with regard to functional recovery and graft regeneration at 1 week after transplantation.

Materials and methods

From January 1999 to September 2005. 211 adult living donor liver transplantations were performed using the right lobe. The reconstruction of hepatic venous tributaries from segment 5 or segment 8 or both was performed in every cases of sufficient size. The patency of graft vessels was evaluated with computed tomography (CT) angiography on postoperative day 7. We analyzed liver enzymes (aspartate transferase [AST], alanine transferase [ALT] and bilirubin) at 1 week postoperatively and evaluated regeneration activity by CT volumetry at 1 week postoperatively.

Results

Among 211 cases, 182 (86.3%) were reconstructed with interpositional MHV grafts. Among them, 51 cases (51.9%) were patent at 1 week postoperatively. The levels of AST and ALT in patent cases of all patients and small-for-size grafts were lower than among the occlusion cases, albeit not significantly. The mean graft regeneration at 1 week postoperatively among patent cases was 1.75 ± 0.39 versus 1.64 ± 0.24 in the occluded cases (P = .111), but among small-for-size grafts, there was a significant difference in graft regeneration between patent versus occluded cases (2.05 ± 0.50 vs 1.66 ± 0.17, P = .037).

Conclusion

Functional recovery and graft regeneration in small-for-size grafts showed a beneficial effect in patent cases, compared with occluded cases. Our selection criteria for MHV reconstruction must include cases of small-for-size grafts not all cases.

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

References (10)

  • D.G. Kim et al.

    Donor safety in living donor liver transplantation using the right lobe

    Transplant Proc

    (2003)
  • S. Lee et al.

    Congestion of right liver graft in living donor liver transplantation

    Transplantation

    (2001)
  • T. Ito et al.

    Effect of anterior segmental drainage reconstruction in right lobe grafts from living donors

    Transplantation

    (2004)
  • T. Kaneko et al.

    Intrahepatic anastomosis formation between the hepatic vein in the graft liver of the living related liver transplantation: observation by Doppler ultrasonography

    Transplantation

    (2000)
  • K. Sano et al.

    Evaluation of the hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction

    Ann Surg

    (2002)
There are more references available in the full text version of this article.

Cited by (26)

  • Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival

    2019, Hepatobiliary and Pancreatic Diseases International
    Citation 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 Oncology
    Citation 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 Proceedings
    Citation 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 Surgeons
    Citation 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

View all citing articles on Scopus
View full text