Lee Doo-Ho, Park Yeon Ho, Choi Sang Tae, Kim Joo Seop, Kim Doojin
Department of Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.
Department of Surgery, Kangdong Sungsim Hospital, Hallym University School of Medicine, Seoul, Korea.
Transplant Proc. 2020 Jul-Aug;52(6):1821-1824. doi: 10.1016/j.transproceed.2020.01.146. Epub 2020 May 21.
Hepatic vein reconstruction is very important in living donor liver transplantation to prevent outflow obstruction and maintain the graft function. In right liver grafts, reconstruction of the tributary of the middle hepatic vein (MHV) or inferior hepatic vein (IHV) is mandatory, and several options are recommended. Recently, it has been reported that a single, wide orifice is an important perquisite for adequate outflow in liver transplantation. This can be achieved by various venoplasty techniques in back table procedures using the recipient's saphenous vein, a cryopreserved vascular graft, or a synthetic vascular graft.
Due to the insufficiency of an actual graft, we used a simple back table technique with the polyethylene terephthalate Y-graft in 3 cases of right liver grafting between October 2015 and September 2019 in Gil Medical Center. We used both arms of the Y-graft for anastomosis of the 2 largest branches of both tributaries. The main trunk of the Y-graft was then joined to the right hepatic vein (RHV). We analyzed these patients' outcomes retrospectively and the study was approved by institutional review board in Gachon University Gil Medical Center. This study strictly complies with the Helsinki Congress and the Istanbul Declaration regarding donor source and informed consent was obtained from all patients.
All 3 patients had good tributary patency and allograft function at discharge. The patency of the graft was maintained over a period ranging from 2 months to 2 years, without any anticoagulant administration. Regardless of the tributary patency, all patients survived with good outflow of the grafts.
Although we had little prior experience in synthetic venous grafts, these cases indicate some interesting findings, with a simple and intuitive procedure. We believe our technique is a practical method for manipulating various venous tributaries in a right liver graft.
肝静脉重建在活体肝移植中对于预防流出道梗阻和维持移植物功能非常重要。在右肝移植物中，肝中静脉（MHV）或肝下静脉（IHV）分支的重建是必不可少的，并且推荐了几种选择。最近，有报道称单一、宽大的吻合口是肝移植中足够流出道的重要前提条件。这可以通过在后台操作中使用受者的大隐静脉、冷冻保存的血管移植物或合成血管移植物的各种静脉成形术技术来实现。
由于实际移植物不足，我们于2015年10月至2019年9月在吉尔医疗中心对3例右肝移植病例使用了聚对苯二甲酸乙二醇酯Y型移植物的简单后台技术。我们将Y型移植物的双臂用于两条分支中两个最大分支的吻合。然后将Y型移植物的主干与右肝静脉（RHV）相连。我们对这些患者的结局进行了回顾性分析，该研究获得了加川大学吉尔医疗中心机构审查委员会的批准。本研究严格遵守赫尔辛基大会的规定，关于供体来源的伊斯坦布尔宣言，并获得了所有患者的知情同意。
所有3例患者出院时均有良好的分支通畅和同种异体移植物功能。移植物的通畅在2个月至2年的时间内得以维持，无需任何抗凝治疗。无论分支是否通畅，所有患者均存活，移植物流出良好。
尽管我们之前在合成静脉移植物方面经验很少，但这些病例显示了一些有趣的发现，手术简单直观。我们相信我们的技术是一种在右肝移植物中处理各种静脉分支的实用方法。
