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KMID : 0870420070110030001
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2007 Volume.11 No. 3 p.1 ~ p.7
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Hepatic Vein Reconstruction for Living Donor Liver Transplantation using a Modified Right lobe Graft: Experience at Asan Medical Center and focused on Middle Hepatic Vein Reconstruction
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Hwang Shin
Lee Sung-Gyu
Ahn Chul-Soo
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Abstract
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Living donor liver transplantation is now widely accepted as a therapeutic option for adult patients suffering with various end-stage liver diseases. The major concerns for use of a right lobe (RL) graft have focused on the safety for the donor and the necessity for including the middle hepatic vein (MHV) into the graft to avoid congestion of the right anterior segment. There are 5 types of RL grafts (simple RL, modified RL, modified extended RL, extended RL with V4b preservation and extended RL), and the selection is usually determined after consideration of the graft size to the recipient, the availability of a vessel graft, the amount of hepatic venous congestion and the reconstruction technique. Various kinds of vessel grafts have been used in practice: 1) greater saphenous vein, paraumbilical vein, portal vein and internal jugular vein from the recipient, 2) various veins and arteries from the deceased donors and 3) bovine pericardium and synthetic vessels. Interposition of a vessel graft is the basic principle for MHV reconstruction. Triphasic liver computed tomography and Doppler ultrasonography are the most useful tools for posttransplant follow-up. When outflow obstruction occurs at the interposed vessel grafts that replace the MHV trunk, then radiological intervention with metallic stent insertion seems to be a feasible and reliable treatment modality. At Asan Medical Center, 200 cases of adult living donor liver transplantation using a modified RL graft revealed a > 90% 2-week patency rate regardless of the types of vessel grafts. In conclusion, it is recommended to make the MHV reconstruction resemble the original configuration of the donor’s MHV trunk according to the hemodynamic principles.
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KEYWORD
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Middle hepatic vein, hepatic venous congestion, liver
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