Outflow reconstruction in right lobe graft adult-adult living donor liver transplantation： a report of 21 cases

Abstract

Objective To investigate technical skills on outflow reconstruction in right lobe graft adult-adult living donor liver transplantation for avoiding of venous congestion. Methods The clinical data of 21 donors and recipients who underwent right lobe living donor liver transplantation were analyzed retrospectively. Donor＇s standard liver volume was between 1150. 1 and 1629. 8 cm3,graft weight was between 585 and 920 g, the ratio of graft volume to recipient＇s estimated standard liver volume （GV/ESLV） was between 43 % and 67 %, graft-recipient weight ratio （GRWR） was between 0. 82 % and 1.59 %, the ratio of remnant liver volume to donor＇s standard liver volume（RLV/SLV） was between 32 % and 55 %, all graft macrosteatosis was less than 10 %. For graftwith middle hepatic vein （MHV）, a triangle large orifice was made by joining MHV to right hepatic vein （RHV）, then anastomosed to recipient＇ s enlarged orifice of RHV. For graft without MHV, if tributary of MHV〉5 mm, autologous or allogenic blood vessel was used as interposition graft to connect to IVC, and if no large MHV tributary, graft RHV was anastomosed to IVC directly. Graft＇s right portal vein was anastomosed to main trunk of recipient＇s portal vein, graft＇s right hepatic artery to recipient＇s hepatic artery, and graft＇s right hepatic duct to recipient＇s right hepatic duct. Results Among the 21 right lobe grafts, 4 right lobe grafts had MHV, 17 right lobe grafts had no MHV.Autologous greater saphenous veins were adopted in 2 cases, cryopreserved iliac arteries were adopted in 5 cases, and RHV was anastomosed directly to IVC in 10 cases. Outflow was all patent in 7 cases having reconstruction of MHV tributaries one month after operation. One-year survival rate was 75 %, 85. 7 % and 70 % respectively in MHV group, MHV tributaries reconstructed group and RHV directly anastomosed to IVC group with the difference being not significance among these three groups （P〉0. 05）. Biliary complications occurred in 7 cases during the follow-up period. One case developed small-for-size syndrome, which was cured by splenic artery embolization. No severe complication occurred in donors. All donors returned to normal life during a follow-up period of 6 to 31 months. Conclusion If outflow tract was reconstructed properly, right lobe graft without MHV has equivalent clinical outcomes to right lobe graft with MHV. Using of autologous or allogenic blood vessel as interposition vessel graft for right lobe graft without MHV is an effective modality to prevent hepatic congestion and secure functional graft volume to meet recipients metabolic demand. Key words: Liver transplantation; Living donor; Right lobe graft; Outflow reconstruction