De la Serna Sofía, Llado Laura, Ramos Emilio, Fabregat Joan, Baliellas Carme, Busquets Juli, Secanella Lluis, Pelaez Nuria, Torras Jaume, Rafecas Antoni
Liver Transplantation Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.
Liver Transpl. 2015 Aug;21(8):1051-5. doi: 10.1002/lt.24143.
Venous outflow is critical to the success of liver transplantation (LT). In domino liver transplantation (DLT), the venous cuffs should be shared between the donor and the recipient, and the length can be compromised. The aim of this study was to describe and compare the technical options for outflow reconstruction used at our institution. This was a retrospective analysis of 39 consecutive DLT recipients between January 1997 and May 2013. Twenty-seven men and 12 women (mean age, 61.8 ± 4.3 years) underwent LT and consented to receive a liver from a donor with familial amyloid polyneuropathy (FAP). The main indications were hepatocellular carcinoma and hepatitis C virus cirrhosis. All recipients underwent transplantation by a piggyback technique. Liver procurement in the FAP donors was performed with the classic technique in 22 patients and with the piggyback technique in the last 17. In these latter cases, for vascular outflow reconstruction, a cadaveric venous graft was interposed between the hepatic vein (HV) stump of the FAP liver and the recipient HV in 11 cases (28%). Since 2011, we have employed arterial grafts to be interposed between the vessels stumps: a tailored arterial graft in 5 patients and an aortic graft in 1 case. There was no postoperative mortality. Arterial and portal complications presented in 2 (5.1) and 4 patients (10.3), respectively. Postoperative outflow complications (post-LT subacute Budd-Chiari syndrome) occurred in 4 patients, and all of them had received a venous interposed graft for reconstruction. The incidence of outflow complications tended to be higher among patients with venous grafts than those with arterial graft interposition. Overall patient survival at 1, 3, 5, and 10 years was 97%, 79%, respectively. Arterial grafts constitute a feasible and safe option for vascular outflow reconstruction in DLT because they are associated with a relatively low incidence of complications. The recently proposed Bellvitge arterial graft technique should be added to the current range of available surgical modalities.
肝静脉流出道对于肝移植（LT）的成功至关重要。在多米诺肝移植（DLT）中，静脉袖套应由供体和受体共享，其长度可以适当缩短。本研究的目的是描述和比较我们机构所采用的流出道重建技术方案。这是一项对1997年1月至2013年5月期间连续39例DLT受者的回顾性分析。27例男性和12例女性（平均年龄61.8±4.3岁）接受了肝移植，并同意接受来自患有家族性淀粉样多神经病（FAP）供体的肝脏。主要适应证为肝细胞癌和丙型肝炎病毒肝硬化。所有受者均采用背驮式技术进行移植。22例FAP供体的肝脏获取采用经典技术，最后17例采用背驮式技术。在后者的病例中，对于血管流出道重建，11例（28%）在FAP肝脏的肝静脉（HV）残端与受体HV之间置入了尸体静脉移植物。自2011年以来，我们采用动脉移植物置入血管残端之间：5例采用定制动脉移植物，1例采用主动脉移植物。无术后死亡病例。动脉和门静脉并发症分别出现在2例（5.1%）和4例（10.3%）患者中。术后流出道并发症（肝移植后亚急性布-加综合征）发生在4例患者中，且所有这些患者均接受了静脉置入移植物进行重建。静脉移植物患者的流出道并发症发生率往往高于动脉移植物置入患者。1年、3年、5年和10年的总体患者生存率分别为97%、79%。动脉移植物是DLT中血管流出道重建的一种可行且安全的选择，因为它们的并发症发生率相对较低。最近提出的贝尔维奇动脉移植物技术应添加到当前可用的手术方式范围内。
