Donor graft outflow venoplasty in living donor liver transplantation.

Hepatic venous outflow reconstruction is a key to successful living donor liver transplantation (LDLT) because its obstruction leads to graft dysfunction and eventual loss. Inclusion or reconstruction of most draining veins is ideal to ensure graft venous drainage and avoids acute congestion in the donor graft. We developed donor graft hepatic venoplasty techniques for multiple hepatic veins that can be used in either right- or left-lobe liver transplantation. In left-lobe grafts, venoplasty consisting of the left hepatic vein and adjacent veins such as the left superior vein, middle hepatic vein, or segment 3 vein is performed to create a single, wide orifice without compromising outflow for anastomosis with the recipient's vena cava. In right lobe graft where a right hepatic vein (RHV) is adjacent with a significantly-sized segment 8 vein, accessory RHV, and/or inferior RHV, venoplasty of the RHV with the accessory RHV, inferior RHV, and/or segment 8 vein is performed to create a single orifice for single outflow reconstruction with the recipient's RHV or vena cava. Of 35 venoplasties, 2 developed hepatic venous stenoses which were promptly managed with percutaneous interventional radiologic procedures. No graft was lost due to hepatic venous stenosis. In conclusion, these techniques avoid interposition grafts, are easily performed at the back table, simplify graft-to-recipient cava anastomosis, and avoid venous outflow narrowing.

Concejero A ，Chen CL ，Wang CC ，Wang SH ，Lin CC ，Liu YW ，Yang CH ，Yong CC ，Lin TS ，Ibrahim S ，Jawan B ，Cheng YF ，Huang TL ... -  《LIVER TRANSPLANTATION》

Hepatic venoplasty in living-donor liver transplantation using right lobe graft with middle hepatic vein.

Lo CM ，Fan ST ，Liu CL ，Wong J ... -  《TRANSPLANTATION》

Outflow reconstruction in right hepatic live donor liver transplantation.

Kinkhabwala MM ，Guarrera JV ，Leno R ，Brown RS ，Prowda J ，Kapur S ，Emond JC ... -  《SURGERY》

Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation.

Yu PF ，Wu J ，Zheng SS 《Hepatobiliary & Pancreatic Diseases International》

Living-donor liver transplantation using the left liver, with special reference to vein reconstruction.

Makuuchi M ，Sugawara Y 《TRANSPLANTATION》