New technologies of the reconstruction of venous inflow and outflow in the liver transplantation

Abstract

Objectives: To study the immediate and long-term results of the liver transplantation. Materials and methods: 142 Living donor liver transplantations (LDLT) and 21 liver transplantations from cadaveric donors (including adult split LT and reLT) have been performed from June 2010 to September 2015. “Difficult” reconstructions of portal venous inflow and/or outflow from the cava vein from liver graft was required in 96 cases (67.6%) because of the donors' vascular anatomy abnormalities and lesions of the cava gate of the recipients' liver. Saving the middle hepatic vein in the donor's liver was a prerequisite. Isolated venous outflow from 5 to 8 or 6 or 8 segments of the liver, trifurcation of the portal vein, a short stump of the right portal vein, thrombosis of the portal vein, complete fibrous obliteration of the portal vein, damage of the inferior vena cava and total damage of the cava vein by Echinococcus multilocularis were an indications for difficult vascular reconstructions of the venous inflow and outflow. Results: Hospital mortality among recipients was 3.1% (2.8% after LDLT), morbidity was 24.7% (26.6% after LDLT). Vascular complications were 3.1% (all complications were after LDLT - 3.5%). Frequency of the biliary complications (grade A, B (ISGLS)) was 19.8% (20.6% after LDLT). The long-term survival in recipients was 98.2% in the 1 year, 97.5% in the 2 year and 93.8% in the 3 year. Morbidity among donors was 9.9%. Mortality among living donors was absent. Mean postoperative hospital stay was 23 (19–34) days for recipients and 12 (10–19) days for donors.