Venous outflow reconstruction with surgically reopened obliterated umbilical vein in domino liver transplantation

✍ Scribed by Hynek Mergental; Annette S.H. Gouw; Maarten J.H. Slooff; Koert P. de Jong

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 898 KB
• Volume: 13
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21067

✦ Synopsis

A proper venous outflow after liver transplantation (LT) is critical for good liver function. In partial liver grafting and in domino LT, there may be the need for vascular reconstruction of the venous outflow tract in order to prevent congestion of the graft. [1][2][3][4] Sharing of sufficient caval vein for both the donor and the recipient for adequate venous outflow is a technical challenge in domino LT. We report on the use of the reopened umbilical vein for reconstruction of a domino liver graft with insufficient suprahepatic inferior vena cava (IVC).

A 62-year-old man with hemochromatosis, liver cirrhosis, and hepatocellular carcinoma was referred for LT to our institution. The patient received a domino liver graft from a patient with familial amyloid polyneuropathy. For technical reasons, insufficient IVC cuff remained with the graft, and a reconstruction of the hepatic venous outflow tract was necessary to make it transplantable by using the piggyback technique (Fig. 1A). However, a vessel tool kit was not available from the deceased donor. Left groin exploration of the domino recipient revealed that the greater saphenous vein was of insufficient quality to be used for reconstruction. It was decided to use the obliterated umbilical vein in the round ligament of the explanted liver of the recipient of the domino liver.

In order to bring the orifices of the left and middle hepatic vein closer to that of the right hepatic vein, the caudate lobe of the domino liver was resected. The left side of the caval vein was approached to the orificia of the left and middle hepatic vein, making it possible to reunite the 3 hepatic veins (Fig.