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Simplified standardized technique for living donor liver transplantation using left liver graft plus caudate lobe
Author(s) -
Hwang Shin,
Lee SungGyu,
Ha TaeYong,
Ahn ChulSoo,
Park KwangMin,
Kim KiHun,
Lee YoungJoo,
Moon DeokBog,
Kim KeonKuk,
Kim YeonDae
Publication year - 2004
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20241
Subject(s) - medicine , perfusion , gauche effect , liver transplantation , caudate lobe , living donor liver transplantation , vein , concomitant , transplantation , surgery , revascularization , hepatectomy , resection , radiology , myocardial infarction
Concomitant resection of the caudate lobe (CL) would increase the liver mass in the left liver graft. We tried to define a simplified standardized technique for adult living donor liver transplantation using the extended left lobe (ELL) plus CL (ELLC) through a prospective study of 27 consecutive ELLC graft cases in 2003. Donor CL was dissected toward the 10 o'clock direction and transected at the midpoint between the trunks of the right hepatic vein (RHV) and the middle hepatic vein (MHV). This orthodox transection was performed in 18 cases, but the transection plane was moved left in 9 cases. Compared with conventional left liver implantation, there was no additional reconstruction except for single revascularization of the largest short hepatic vein of the CL (V1) in 21 cases. On 1‐week computed tomography (CT) images, the perfusion states of the CL portion were good in 15 cases, fair in 7 cases, and poor in 5 cases. Regeneration of the CL portion during the 1st week was +43%, +18%, and −10% in the good, fair, and poor perfusion groups, respectively. There were positive correlations among the perfusion state of the CL, the location of the CL transection plane, and the width of the CL portion that was attached to the left liver graft. CL implantation resulted in a mean gain of graft mass by 5.9% in the left liver at the time of operation and by 3.9% after 1 week. There were no donor complications, and 25 recipients (93%) survive to date. In conclusion, this simplified standardized technique was feasible for most of the living donor livers and required only 1 additional reconstruction of the V1. (Liver Transpl 2004;10:1398–1405.)