Outflow reconstruction is a crucial step in living donor liver transplantation(LDLT)for proper graft functioning as any inadequacy of the venous drainage can cause severe graft congestion. This risk of congestion is higher for the right liver allografts with undrained anterior sector and multiple IRHVs. We introduced our novel technique of “V-Plasty” using dual ePTFE grafts for combined MHV & IRHV reconstruction that requires single outflow anastomosis.In present case series we aim to highlight the modified “Loop V-Plasty” using single, large loop of ePTFE vascular graft whereby possible turbulence of flow at junction of 2 ePTFE grafts(as in “V-Plasty”)is avoided.

Methods:

From Jan 2015 to Nov 2015,104 LDLT were performed at our institute.The MHV tributaries with or without IRHVs were reconstructed using ePTFE vascular conduits in 101 liver grafts.Among these 6 liver grafts that underwent combined MHV and IRHV reconstruction using “Loop V-Plasty” technique were prospectively studied and the postoperative outcome of the respective recipients was analyzed.

Results:

The study cohort comprised of 6recipients(M:F,3:3)with a mean age of 60.3 years(range,55-67).The average GRWR was 1.28 %.The mean diameter of V5, V8 and IRHV was 6 mm,7mm,& 9mm,respectively.The average cold ischemia was 79 minutes whereas the warm ischemia time was 21 minutes.Reperfusion of the liver allograft was achieved using single right hepatic vein-to inferior vena cava anastomosis.The intraoperative and postoperative Doppler ultrasound study showed satisfactory inflow and outflow in all the 6 recipients. There was no reported acute thrombosis of the ePTFE vascular grafts.

Conclusions:

The “loop V-Plasty” technique is a feasible surgical technique for complex MHV and IRHV reconstruction that entails using single loop of ePTFE vascular conduit when conventional “V-Plasty” cannot be performed. By applying this technique the second veno-caval anastomosis is avoided which may be difficult in limited retrohepatic space.

CITATION INFORMATION: Chen T.-H, Noriega L, Thorat A, Li P.-C, Yang H.-R, Hsu S.-C, Jeng L, Li M.-L. Technique of “Loop V-Plasty” for Combined Reconstruction of the Middle Hepatic Vein and Multiple Inferior Right Hepatic Veins Using Single Polytetrafluoroethylene Graft in a Right Lobe Living Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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