Middle hepatic vein (MHV) reconstruction is often essential to avoid hepatic congestion and serious graft dysfunction in living donor liver transplantation (LDLT). The aim of this report was to introduce evolution of our MHV reconstruction technique and the excellent outcomes of new simplified one-orifice venoplasty.

We compared clinical outcomes with three types of our one-orifice technique through retrospective review of 258 recipients who underwent LDLT using right lobe graft at our institution from January 2008 to December 2015; group I (n = 34) received separate outflow reconstruction, group II (n = 166) received one-orifice technique that create the wider single outflow with patchwork and group III (n = 58) received more simplified one-orifice technique that invaginate reconstructed MHV into right hepatic vein without patch venoplasty.

Patient demographics did not differ significantly between the three groups, but cold ischemic time and operation time in group II and III were significantly lower than those in group I (134.9 min versus 104.8 min versus 111.1, P[thinsp]=[thinsp]0.000 and 530.3 min versus 398.6 min versus 341.9 min, P=0.000, respectively). No significant difference between two groups in overall survival was observed. The early patency rates of MHV in group II and III were higher than those in group I; 97.6%, 100% versus 85.3% on postoperative day 7 (p=0.000) and 94.6% and 94.8% versus 82.4% on postoperative day 14, respectively (p =0.032). Peak total bilirubin value (within one month after LDLT) in group I and II was significantly higher than that in group III (8.3mg/dL and 6.5mg/dL versus 4.9mg/dL, p=0.009). Especially, MHV or RHV stent insertion during the early post-transplant period did not occur in group III during follow-up period.

This technique is easy to perform without a learning curve or vein patch such as autologous vein or cryopreserved cadaveric vessels. Furthermore, our new simplified one-orifice technique could be an effective method of overcoming technical difficulties and the outflow disturbance in right lobe LDLT without complex bench work to create large outflow.

CITATION INFORMATION: Kim J, Choi D. Technical Refinement to Prevent Hepatic Outflow Disturbance in Right Lobe Living Donor Liver Transplantation: Simplified One-Orifice Venoplasty. Am J Transplant. 2017;17 (suppl 3).

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