Backgound. Inconstant venous anatomy increases the risk of outflow complications in right hepatic live donor liver transplantation (RH-LDT), but no consensus has emerged guiding optimal reconstruction for venous outflow. Methods. We retrospectively analyzed surgical venous reconstruction using a flexible approach to anterior accessory veins in 48 RH-LDTs performed between April, 1998 and July, 2002. Results. Actuarial recipient graft and patient survival was 79 % and 85 %, respectively. Single hepatic venous anastomosis was performed in 74 % of the patients. Twelve patients underwent reconstruction of 20 accessory veins, including 7 posterior segment veins and 13 anterior segment veins. Anterior vein reconstruction techniques included end-to-end anastomosis to the middle hepatic vein, interposition conduit, venoplasty, or a combination of techniques. Documented complications related to the venous anastomosis occurred in only 1 patient (2 %), with no patient having a documented venous thrombosis of either the main RHV or a reconstructed accessory vein. There were no differences in outcome based on single versus multiple venous reconstruction. Anteromedial congestion was noted in 3 patients in the absence anatomic venous anastomotic complication, but the clinical significance of this finding is unclear. Conclusions. Despite variations in segmental venous drainage and a propensity for anteromedial congestion in right hepatic grafts, RH-LDT can be performed without outflow obstruction with close attention to a wide RHV anastomosis. In addition, anterior accessory vein reconstruction can be reserved for grafts of marginal size or quality where early postoperative venous congestion may impair early graft function. Routine extended hepatectomy incorporating the MHV with the graft is unnecessary.
机构:
DHR Hlth, Hepatobiliary & Pancreat Unit & Transplantat, Mcallen, TX 78504 USA
Univ Fed Rio de Janeiro, Hosp Adventista Silvestre, Hosp Sao Lucas Copacabana, Dept Gastrointestinal & Transplant Surg, Rio de Janeiro, Brazil
Univ Fed Rio de Janeiro, Hosp Univ Clementino Fraga Filho, Rio de Janeiro, BrazilDHR Hlth, Hepatobiliary & Pancreat Unit & Transplantat, Mcallen, TX 78504 USA
Fernandes, Eduardo de Souza M.
de Mello, Felipe Pedreira T.
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Univ Fed Rio de Janeiro, Hosp Adventista Silvestre, Hosp Sao Lucas Copacabana, Dept Gastrointestinal & Transplant Surg, Rio de Janeiro, Brazil
Univ Fed Rio de Janeiro, Hosp Univ Clementino Fraga Filho, Rio de Janeiro, BrazilDHR Hlth, Hepatobiliary & Pancreat Unit & Transplantat, Mcallen, TX 78504 USA
de Mello, Felipe Pedreira T.
Braga, Eduardo Pinho
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Hosp Sao Lucas Copacabana, Rio De Janeiro, BrazilDHR Hlth, Hepatobiliary & Pancreat Unit & Transplantat, Mcallen, TX 78504 USA
Braga, Eduardo Pinho
Girao, Camila Liberato
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Univ Fed Rio de Janeiro, Hosp Adventista Silvestre, Hosp Sao Lucas Copacabana, Dept Gastrointestinal & Transplant Surg, Rio de Janeiro, Brazil
Univ Fed Rio de Janeiro, Hosp Univ Clementino Fraga Filho, Rio de Janeiro, BrazilDHR Hlth, Hepatobiliary & Pancreat Unit & Transplantat, Mcallen, TX 78504 USA
WU Hong YANG Jia-yin YAN L-nan LI Bo ZENG Yong WEN Tian-fu ZHAO Ji-chun WANG Wen-tao XU Ming-qing LU Qiang CHEN Zhe-yu MA Yu-kui LI Jin Center of Liver Transplantation
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WU Hong YANG Jia-yin YAN L-nan LI Bo ZENG Yong WEN Tian-fu ZHAO Ji-chun WANG Wen-tao XU Ming-qing LU Qiang CHEN Zhe-yu MA Yu-kui LI Jin Center of Liver Transplantation
WU Hong YANG Jiayin YAN Lnan LI Bo ZENG Yong WEN Tianfu ZHAO Jichun WANG Wentao XU Mingqing LU Qiang CHEN Zheyu MA Yukui LI Jin Center of Liver TransplantationWest China HospitalSichuan UniversityChengdu China
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WU Hong YANG Jiayin YAN Lnan LI Bo ZENG Yong WEN Tianfu ZHAO Jichun WANG Wentao XU Mingqing LU Qiang CHEN Zheyu MA Yukui LI Jin Center of Liver TransplantationWest China HospitalSichuan UniversityChengdu China
机构:
Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Wu Hong
Yang Jia-yin
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Yang Jia-yin
Yan Lu-Nan
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Yan Lu-Nan
Li Bo
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Li Bo
Zeng Yong
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Zeng Yong
Wen Tian-fu
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Wen Tian-fu
Zhao Ji-chun
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Zhao Ji-chun
Wang Wen-tao
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Wang Wen-tao
Xu Ming-qing
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Xu Ming-qing
Lu Qiang
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Lu Qiang
Chen Zhe-yu
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Chen Zhe-yu
Ma Yu-kui
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China
Ma Yu-kui
Li Jin
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Sichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R ChinaSichuan Univ, W China Hosp, Ctr Liver Transplantat, Chengdu 610041, Peoples R China