These authors contributed equally to this work.
Reconstruction of inferior right hepatic veins in living donor liver transplantation using right liver grafts†
Article first published online: 25 JAN 2012
Copyright © 2011 American Association for the Study of Liver Diseases
Volume 18, Issue 2, pages 238–247, February 2012
How to Cite
Hwang, S., Ha, T.-Y., Ahn, C.-S., Moon, D.-B., Kim, K.-H., Song, G.-W., Jung, D.-H., Park, G.-C., Namgoong, J.-M., Jung, S.-W., Yoon, S.-Y., Sung, K.-B., Ko, G.-Y., Cho, B., Kim, K. W. and Lee, S.-G. (2012), Reconstruction of inferior right hepatic veins in living donor liver transplantation using right liver grafts. Liver Transpl, 18: 238–247. doi: 10.1002/lt.22465
This study was supported by the Asan Medical Center Organ Transplantation Center Research Fund.
- Issue published online: 25 JAN 2012
- Article first published online: 25 JAN 2012
- Accepted manuscript online: 5 DEC 2011 02:49AM EST
- Manuscript Accepted: 24 OCT 2011
- Manuscript Received: 13 JUL 2011
- Asan Medical Center Organ Transplantation Center Research Fund
Because revascularization of the inferior right hepatic vein (IRHV) is a major component of right liver graft (RLG) reconstruction, we assessed the surgical techniques and clinical outcomes of IRHV reconstruction so that we could formulate practical guidelines for standardized procedures. From July 2004 to February 2010, we performed separate IRHV reconstructions in 487 of 1142 adult RLG recipients (42.7%). These recipients included 364 patients with a natural single IRHV and 123 patients with multiple IRHVs; in the latter group, the IRHVs were unified by venoplasty, which enabled a single anastomosis. The 1-year stenosis rates for the single-vein and venoplasty groups were 23% and 18.9%, respectively, and the early stent insertion rates were 7.1% and 9.8%, respectively (P = 0.09). Late IRHV occlusion did not lead to graft dysfunction, and all large major IRHVs were patent. A morphometric analysis showed that IRHV stenosis was associated with IRHV stretching and an anastomotic level discrepancy. This led to refinements of the surgical techniques: IRHV orifices were shaped into funnels, and the IRHV anastomosis was accurately placed at the recipient inferior vena cava (IVC). In an ongoing prospective study of 35 patients, our funneling unification venoplasty resulted in only 1 episode (2.9%) of early IRHV stenosis requiring stenting at a median follow-up of 8 months. The final configurations of the reconstructed IRHVs after funneling unification venoplasty and extensive IVC dissection were very similar to those of the native donor liver. In conclusion, we suggest that in combination with extensive recipient IVC dissection, funneling and unification venoplasty techniques are useful for securely reconstructing single or multiple IRHVs during the implantation of RLGs. Liver Transpl 18:238–247, 2012. © 2011 AASLD.