Impact of non-congestive graft size in living donor liver transplantation: New indicator for additional vein reconstruction in right liver graft
โ Scribed by Hideya Kamei; Yasuhiro Fujimoto; Shunji Nagai; Ryuichiro Suda; Hidekazu Yamamoto; Tetsuya Kiuchi
- Publisher
- John Wiley and Sons
- Year
- 2007
- Tongue
- English
- Weight
- 181 KB
- Volume
- 13
- Category
- Article
- ISSN
- 1527-6465
- DOI
- 10.1002/lt.21231
No coin nor oath required. For personal study only.
โฆ Synopsis
Addition of the middle hepatic vein (MHV) or reconstruction of its tributaries to increase noncongestive graft volume is expected to improve graft function in right liver living donor liver transplantation (LDLT). However, the relationship between noncongestive graft volume and graft function after transplantation has not been clarified and definitive criteria for the reconstruction of MHV tributaries have yet to be established. We analyzed 29 right liver LDLT cases. The noncongestive graft weight was calculated as the total weight of the graft regions drained by hepatic veins reconstructed without postoperative occlusion. We calculated the noncongestive graft-to-recipient weight ratio (ncGRWR) by comparing it to the GRWR. Indocyanine green (ICG) clearance results on days 1 and 3 were significantly correlated with ncGRWR, but not with GRWR. Patients were then divided into 2 groups based on ncGRWR: lower than the median (L-ncGRWR group) and above the median (H-ncGRWR group). ICG clearance in the H-ncGRWR group was significantly better on days 1 and 3. For a different analysis, the patients were again divided into 2 groups, those with and without prolonged cholestasis after transplantation. ncGRWR was significantly lower in patients with prolonged cholestasis, and 7 of 9 patients with an ncGRWR value lower than 0.65 suffered from prolonged cholestasis. Our results demonstrated that the noncongestive volume of a right liver graft has a significant association with early graft function. Further, ncGRWR can play a key role in preoperative determination for additional vein reconstruction of MHV tributaries. When the estimated ncGRWR value with reconstruction of only the right hepatic vein (RHV) (+ inferior right hepatic vein [IRHV]) is less than 0.65, additional vein reconstruction of MHV tributaries should be planned.
๐ SIMILAR VOLUMES
RHD, right hepatic duct; RHV, right hepatic vein; RPS, right posterior segment; type I PV, PV variant with bifurcation; type II PV, PV variant with trifurcation; type III PV, PV variant with independent RPS PV branching from main PV; type A RHD, RHD variant with usual bifurcation of the hilar bile d
The incidence of clinically significant right hepatic vein (RHV) stenosis after adult living donor liver transplantation has been higher than expected. In this study, an assessment of the risk factors for the development of RHV stenosis in this context was undertaken. Hepatic anatomy, surgical techn
An accurate preoperative estimate of the graft weight is vital to avoid small-for-size syndrome in the recipient and ensure donor safety after adult living donor liver transplantation (LDLT). Here we describe a simple method for estimating the graft volume (GV) that uses the maximal right portal vei