Is large orifice the only solution to prevent venous outflow disturbance in right lobe living donor liver transplantation? New simplified one-orifice venoplasty

Abstract

Introduction: Most transplant surgeons have focused recently on creating large and wide orifice to secure venous outflow in living donor liver transplantation (LDLT). The aim of this report was to introduce our middle hepatic vein (MHV) reconstruction techniques and excellent outcomes of new simplified one-orifice venoplasty. Methods: We compared clinical outcomes with three reconstruction techniques through retrospective review of 200 LDLTs using right lobe grafts at our institution from January 2010 to June 2015; group I (n = 60) received one-orifice technique that create wider outflow with patchwork including central patch, group II (n = 106) received one-orifice technique using patch venoplasty without central patch, and group III (n = 34) received more simplified one-orifice technique that invaginate reconstructed MHV into right hepatic vein without patch venoplasty. Results: The early patency rates of MHV were similar in the three groups; 96.7%, 98.1% and 100% on postoperative day 7 and 95.0%, 94.3% and 94.1% on postoperative day 14, respectively (p > 0.05). Overall complication rates in group III was significantly lower than those in group I and II and cold ischemic time and operation time in group II and III were significantly lower than those in group I, respectively (p = 0.000). Especially, MHV stent insertion did not occur in group III during follow-up period. Conclusion: Our new simplified one-orifice technique could be an effective method of overcoming technical difficulties and the outflow disturbance in right lobe LDLT without complex bench work to create large outflow.