Simplified technic for human auxiliary liver transplantation

Abstract

A technic for auxiliary transplantation of the liver in man is detailed with a single case report of a patient who died four days after operation because of prolonged postoperative hypotension. The allograft is placed in the right paracolic gutter with the right lobe inferior and the hilum medial. The superior aspect of the allograft inferior vena cava is anastomosed to the recipient infrarenal inferior vena cava. The donor celiac axis is anastomosed to the front of the recipient aorta and the portal vein to the recipient superior mesenteric vein at the level of the duodenum. Biliary drainage is by a Roux-Y anastomosis of jejunum to the gallbladder. Advantages of the technic are that the site for the allograft may be prepared rapidly with decreased ischemic interval, the risk of postoperative respiratory complications and the threat of intra- and postoperative hemorrhage or thrombosis are decreased, and removal of the potentially harmful initial effluent from the ischemic allograft may be accomplished. Revascularization is physiologic in that portal inflow to the allograft is assured in the presence of portal hypertension.