Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation

Citation
Rm. Ghobrial et al., Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation, LIVER TRANS, 7(6), 2001, pp. 551-555
Citations number
16
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
LIVER TRANSPLANTATION
ISSN journal
15276465 → ACNP
Volume
7
Issue
6
Year of publication
2001
Pages
551 - 555
Database
ISI
SICI code
1527-6465(200106)7:6<551:TCOHVO>2.0.ZU;2-D
Abstract
A right lobe graft that is drained by the right hepatic vein (RHV) is obtai ned by transecting the liver on the right side of the middle hepatic vein ( MHV). On occasion, a small RHV that only drains a portion of the right lobe , with the predominant outflow achieved by the MHV, is encountered. If such variation is not recognized while performing right lobe liver transplantat ion and the RHV only is used for reconstruction, venous outflow obstruction with subsequent graft congestion and eventual graft failure will occur. Ad ditionally, preservation of the main MHV and its branch drainage of the lef t lobe is crucial to avoid outflow blockage to the remaining segment 4 in t he donor. We report 4 cases showing a variant type of small RHV and large M HV branch that drain not only segments 5 and 8, but also segments 6 and 7. These variations were simultaneously associated with a large-caliber inferi or RHV that also required reconstruction. The methods used to diagnose such anatomic variations and the techniques for reconstruction in the donor and recipient are described.