Successful hepatic vein reconstruction in 42 consecutive living related liver transplantations

Abstract

Background: In living related liver transplantation (LRLT), reconstruction of the hepatic vein (HV) by end-to-end anastomosis has been reported to be associated with acute or late outflow block. Methods: We reviewed 42 patients who underwent LRLT from January 1996 to September 1998. Results: In 7 (27%) of the 26 donor grafts obtained from left lateral segmentectomy or extended lateral segmentectomy and in 9 (56%) of the 16 grafts obtained from left lobectomy, venoplasty was required. In the remaining 26 grafts, 1-orifice left HV was obtained. In addition to the division of the duct of Arantius, the left inferior phrenic vein was divided routinely in 16 patients, which contributed to reducing the venoplasty rate from 46% to 25% (P =.1704). In all 42 patients, HV was reconstructed successfully by end-to-end anastomosis. The median ratio of the diameter of the recipient's HV to that of the graft's HV was 1.2 (range, 0.8-2.1). The grafts were fixed to the abdominal wall by using the falciform and round ligaments at a site where Doppler ultrasound showed sufficient flow in the respective vessels. Three patients developed late-onset HV obstruction and required balloon dilatation either by means of a venous route or a transhepatic route: 1 patient received a new liver on the 232nd postoperative day, 1 patient died of sepsis without outflow block, and the last patient is doing well. Conclusions: In LRLT, the division of the duct of Arantius and the left inferior phrenic vein followed by extensive clamping of the common trunk contributed to obtaining a 1-orifice HV. This facilitates anastomosis of the HVs of the grafts to the recipients' HVs, and fixation of the grafts by using the falciform and round ligaments prevents rotation of the grafts and subsequent acute outflow block. (Surgery 2000;128:48-53)