VASCULAR RECONSTRUCTION FOR RIGHT HEPATIC LOBE GRAFT IMPLANTATION

Abstract

P492 Aims: Right hepatic lobe graft from living donor being very convenient for teenagers and adults has some special features which are important to obtain the success. Variants of arterial and portal blood supply and hepatic outflow of this graft require special vascular reconstruction to optimise the revascularization. Methods: 73 living related liver transplantations were performed using the right hepatic lobe . The details of hepatic blood supply and outflow in living donor were evaluated by ultrasonography and CT-scan with 3D-reconstruction preoperatively. All variants of right hepatic lobe arterial blood supply were appropriate. Results: The right hepatic lobe in 8 donors was supplied by 2 arteries (from celiac artery and from mesenteric artery). Only in 1 of these cases the celiac branch was significant and demanded arterial reconstruction before implantation. Bifurcation of portal vein with at least short trunk of the right portal branch was preferable in donor according to convenience of graft perfusion for cooling and conservation. In 5 cases of 2 separate right portal branches the preliminary portal reconstruction was successfully performed on the back-table using portal bifurcation removed during hepatectomy in recipient. In 58 living related liver donors when the single large right hepatic vein was observed all additional small hepatic veins from the right lobe were considered to be of no significance and ligated. The hepatico-caval anastomosis was being performed almost side-to-side between the artificially performed wide opening in the right caval wall and widely dilated opening of hepatic vein of the graft. In 11 cases of 2 equal right hepatic veins of the graft the inferior right hepatic vein was implanted with end-to-side technique after the upper anastomosis had been performed. In 4 other cases 3 hepatico-caval anastomosis were performed with the same technique. In all cases good function of grafts was obtained. No vascular complications were observed. The survival of grafts and recipients is 97.3 percent. Conclusions: The variants of vascular reconstruction in recipient allow to use right hepatic lobe from living donor in all cases without technical contra-indications.