Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania.
Department of Surgery, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania.
J Surg Res. 2022 Nov;279:796-802. doi: 10.1016/j.jss.2022.05.026. Epub 2022 Aug 17.
We aimed to describe our procedure for vascular reconstruction and back table bench preparation for the right lobe live donor allograft. Live donor liver transplantation (LDLT) remains an important option for the expansion of the donor pool. The procedure has been widely used, and its success is dependent on a technically perfect operation with appropriate inflow and outflow of the allograft. Adequate preparation of the right lobe (RL) allograft prior to implantation remains a vital part of the procedure.
Our technique of back table vascular reconstruction of the RL allograft has been performed using a hepatic vein patch venoplasty, inferior hepatic vein inclusion, portal vein reconstruction, and segment V and VIII reconstruction for all of our LDLTs.
Between March 2009 and January 2020, 321 consecutive adult LDLTs were performed and underwent back table reconstruction with the techniques described. During that time period, no patients had hepatic insufficiency. There was a single thrombosis of a superior mesenteric vein (SMV) to PV jump conduit.
Our technique of back table reconstruction of the LDLT right lobe graft remains a crucial part of the operative procedure. Our experience with RL grafts without middle hepatic vein (MHV) and our systematic approach for inflow and outflow reconstruction has yielded excellent results with no technical outflow issues and minimal inflow complications.
我们旨在描述用于右叶活体供体肝移植的血管重建和后台准备程序。活体供体肝移植（LDLT）仍然是扩大供体库的重要选择。该手术已被广泛应用，其成功取决于技术上完美的操作以及供体的适当流入和流出。在植入前充分准备右叶（RL）供体仍然是该手术的重要组成部分。
我们的 RL 供体后台血管重建技术已应用于肝静脉补片成形术、下肝静脉包含、门静脉重建以及所有 LDLT 的第 V 和第 VIII 段重建。
2009 年 3 月至 2020 年 1 月，连续进行了 321 例成人 LDLT，并采用描述的技术进行了后台重建。在此期间，没有患者出现肝功能不全。只有一例肠系膜上静脉（SMV）至门静脉跳跃导管血栓形成。
我们的 LDLT 右叶供体后台重建技术仍然是手术过程的关键部分。我们在没有中肝静脉（MHV）的 RL 供体的经验以及我们的流入和流出重建的系统方法取得了出色的结果，没有技术流出问题，流入并发症也很少。
