Efferent blood supply to the right hepatic lobe regarding its transplantation from a living donor: reconstruction features. Part 2

Abstract

Aim . To present the technical features and results of transplantation of the right hepatic lobe from a living donor with various types of efferent venous anatomy. Materials and methods. 306 liver transplantations from living related donors were performed from 2009 to 2021. Patients with previously described 14 subtypes of efferent vascular anatomy and classified into 3 types, were divided into 4 groups depending on the number of reconstructed vessels. The author analyzed anatomy variants of the right hepatic lobe, duration of surgery and anhepatic period, postoperative morbidity, volume of blood loss, including with allowance for the number of reconstructed vessels, as well as survivability. Results . The study demonstrated the principles and features of the reconstruction of the efferent veins of the graft. Time of surgical intervention, duration of anhepatic period, and postoperative morbidity were greatest with a separate type of blood outflow ( p < 0.05) Blood loss was greatest during reconstruction veins 3 and 4 ( p < 0.05). No difference in blood loss was detected between groups 3 and 4. Survivability within 12, 36, 60 and 120 months accounted for 84%, 83%, 81% and 71%, correspondingly, without any difference between groups. Conclusion . Successful transplantation of the right hepatic lobe requires precision mapping of the venous anatomy of the donor, preserving all potentially important efferent vessels, and commitment to the most complete reconstruction of them, irrespective of the vascular anatomy complexity.