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Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation
Author(s) -
Mori Akira,
Kaido Toshimi,
Ogura Yasuhiro,
Ogawa Kohei,
Hata Koichiro,
Yagi Shintaro,
Yoshizawa Atsushi,
Isoda Hiroyoshi,
Shibata Toshiya,
Uemoto Shinji
Publication year - 2012
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.23387
Subject(s) - medicine , liver transplantation , vein , surgery , anastomosis , living donor liver transplantation , inferior vena cava , transplantation
An outflow obstruction of the hepatic vein is a critical complication after living donor liver transplantation (LDLT) and occasionally leads to hepatic failure. Here we introduce a simple method for preventing outflow obstructions by patch plasty in adult LDLT. Between September 2001 and May 2010, 468 adult LDLT procedures were performed at Kyoto University Hospital. We harvested each recipient's portal vein (PV) from the extirpated liver for a patch. We intended to re‐form several orifices of the hepatic veins into a single, large orifice. The patch was attached to the anterior wall of the re‐formed orifice on the bench. After we put in the liver graft, the procedure for the hepatic vein anastomosis to the inferior vena cava was simple enough that the warm ischemia time was reduced. Three of the 468 cases were diagnosed with an outflow obstruction. All 3 cases underwent hepatic vein reconstruction without patch plasty. In contrast, none of the 159 cases that underwent LDLT with patch plasty suffered from an outflow obstruction, regardless of the liver graft type. The procedure for hepatic vein plasty using a patch from the native PV is simple and elegant and results in excellent outcomes. We propose this as the standard procedure for hepatic vein reconstruction in adult LDLT. Liver Transpl, 2012. © 2012 AASLD.