Vascular Reconstruction and Outcomes of Adult-to-Adult Right Lobe Living Donor Liver Transplantations: A Single Center Experience in Viet Nam

Abstract

Introduction: Outflow and inflow reconstruction of the liver graft is a key to successful results of living donor liver transplantation (LDLT) using right lobe graft. Methods: We prospectively analyzed the data on all right lobe LT adult patients, consecutively performed from January 2019 to December 2020 in Central Military Hospital 108. When the remnant and total liver volume ratio (RLV/ TFLV) less than 35%, we used modified right lobe (MRL) graft. In the case using extended right lobe (ERL) graft (RLV/ TFLVgreater than 35%), we conjoined MHV and RHV. Reconstruction of the portal vein (PV) was done by end-to-end anastomosis by using continuous sutures. Reconstruction of the hepatic artery was done by end-to-end anastomosis by using continuous sutures and surgical loupes. Results: A total of 52 cases of adult-to-adult LDLT using right lobe graft were collected. For hepatic vein reconstruction, there were 10 cases using MRL and 42 cases of ERL. The intervention rate for outflow stenosis was 0/52 case (0%) of a mean follow- up of 11.4±6.5 months (range, 1-28 months). PV stenosis were detected in 2 patients (3,8%) whom were successfully treated with stent placement. No hepatic artery thrombosis and hepatic artery stenosis were found after LDLTs. Conclusion: The single orifice hepatic vein reconstruction in LDLT using right lobe graft is a simple and feasible surgical technique and it can prevent effectively RHV stenosis. PV stent placement was technically and clinically effective technique in managing PV stenosis after LDLT.