Techniques of reconstruction of hepatic veins in living-donor liver transplantation, especially for right hepatic vein and major short hepatic veins of right-lobe graft |
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Authors: | Lee Sung-Gyu |
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Institution: | (1) The Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Gu, Seoul, 138-736, Korea |
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Abstract: | Living-donor liver transplantation (LDLT) is now widely accepted as a therapeutic option for adult patients with acute and
chronic end-stage liver disease. In the early period, the left lobe was the major liver graft used in adult LDLT to ensure
donor safety, especially in Eastern countries. However, the frequent extremes of graft-size insufficiency in left-lobe LDLT
represented a greater risk of small-for-size graft syndrome in the recipient, which has focused attention on transplantation
of the right lobe from a living donor. The major concern of right-lobe LDLT has focused on its safety for the donor and the
necessity for including the middle hepatic vein (MHV) in the graft to avoid congestion of the right anterior segment. The
MHV carries out important venous drainage for the right anterior segment and is essential for perfect graft function. The
decision of whether to take the MHV with the liver graft (extended right lobe graft) or whether to retain it in the donor,
with reconstruction of the MHV tributaries in the liver graft (modified right lobe graft) has been extensively discussed in
numerous studies. However, adequate right hepatic vein and major short hepatic vein (middle and inferior right hepatic vein
RHV]) drainage of the liver graft is perhaps equally important as MHV outflow drainage for the integrity of right-lobe graft
function. Herein, the author describes various techniques of venoplasty of the right hepatic vein (RHV) and the major short
hepatic veins to obviate venous outflow obstruction in these veins. |
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Keywords: | Outflow obstruction Middle hepatis vein Hepatic veins of right lobe |
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