[Technological refinement to reconstruction of liver outflow vein in living donor right liver lobe graft].

OBJECTIVE

To explore the reconstructed pattern of hepatic outflow vein in right lobe without middle hepatic vein (MHV) of adult living donor liver transplantation (LDLT).

METHODS

The retrospective analysis was made on the clinical data of 47 recipients who underwent the operation in LDLT including the outflow vein reconstructed in right liver lobe without MHV. The right hepatic veins (RHV) in transplanted donor liver were anastomosed to a triangular opening in the recipient's inferior vena cava (IVC); the inferior right hepatic veins (IRHV) of significant size that had been preserved were anastomosed directly to the IVC. The great saphenous vein (GSV) as interposition connector was used to reconstruct the significant tributaries (V5,V8) of MHV, the other end of interposition was anastomosed with IVC.

RESULTS

No death occurred in all the donors. Of 47 recipients, complications occurred in 9 recipients including the hepatic vein stricture (1 case), small-for-size liver syndrome (1 case), hepatic artery thrombosis (1 case), intestinal bleeding (1 case), bile leakage (2 cases), left subphrenic abscess (1 case) and pulmonary infection (2 cases). Three cases died of the small-for-size liver syndrome (1 case) and multiple system organ failure (2 cases). The total rate of outflow veins reconstructed for V5, V8 and IRHV was 65. 96% (31/47), the rate of one-vein reconstruction, two-vein reconstruction or three-vein reconstruction was 36.17%, 21. 28% or 8.51% respectively. The successive postoperative investigation for vein grafts were performed by Color Doppler Ultrasound. Four cases experienced GSV graft obstruction or obliteration among the 31 cases in 7-25 days after operation, but extensive collateral circulation has established.

CONCLUSION

We used the "multiple-opening vertical anastomosis" to reconstruction of hepatic outflow vein. This technique alleviates the surgical risk on living donors, ensures the excellent venous drainage and prevents from the syndrome in small-for-size livers.