Technical Aspects of Reconstruction of Middle Hepatic Vein and Multiple Inferior Right Hepatic Veins Using Dual Artificial Vascular Grafts in Right Lobe Living Donor Liver Transplantation: “V-Plasty” Technique for Common Outflow Reconstruction Vs Second IVC Anastomosis
Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
Meeting: 2015 American Transplant Congress
Abstract number: B156
Keywords: Living-related liver donors
Session Information
Session Name: Poster Session B: Liver: Living Donors
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background:
Presence of multiple inferior right hepatic veins (IRHV) along with undrained median sector pose technical difficulties in right lobe living donor liver transplantation (LDLT). Several techniques have been published in this regard, but authenticity of right technique that incorporates all IRHVs along with middle hepatic vein (MHV) reconstruction still remains debated. As increased warm ischemia time remains a concern during outflow reconstruction, a feasible technique that includes both MHV tributaries and IRHVs in single lumen has rarely been discussed. Herein we intend to analyse the credibility of V-plasty technique using dual ePTFE grafts to form common outflow channel vs conventional second IVC anastomosis during outflow reconstruction in LDLT.
Materials and Methods:
From March 2011 to September 2014, 325 patients received right lobe LDLT. 51 liver allografts had additional IRHVs. Among these, 16 liver grafts required backtable “V-Plasty” with dual ePTFE vascular grafts to reconstruct MHV as well as IRHVs (Group A) while second IVC anastomosis was feasible and performed in 29 recipients without reconstruction of the IRHVs (Group B). Volumetric blood flow assessment was done as per the protocol.
Results:
The number IRHVs present in group A was 2 or more in all the allografts with a mean IHRV diameter of 8.33 ± 1.32 mm (7-10 mm).The mean IRHV diameter was 8.31 ± 2.05 mm (6-13 mm) in group B liver allografts. The average warm ischemia time was 25.25 ± 8.11 minutes in group A recipients and was significantly more for group B recipients that required second IVC anastomosis with a value of 34.56±5.07 minutes (p=0.000012). The functional recovery of allograft was same for both the groups with no additional increased risk of thrombosis for group A patients. The patency rates of the ePTFE grafts used in group A patients were 100% for first 2 months.
Conclusion:
The V-plasty technique ensures adequate drainage of all the IRHVs as well as MHV tributaries by providing single outflow channel. Use of multiple artificial vascular grafts is thus safe with no additional risk of thrombosis. The grafts which may need 2 or more IVC anastomosis, the outflow reconstruction is far easier with V-Plasty that provides common front for MHV & IRHVs.
To cite this abstract in AMA style:
Li P-C, Jeng L, Thorat A, Yang H-R, Yeh C-C, Chen T-H, Hsu S-C. Technical Aspects of Reconstruction of Middle Hepatic Vein and Multiple Inferior Right Hepatic Veins Using Dual Artificial Vascular Grafts in Right Lobe Living Donor Liver Transplantation: “V-Plasty” Technique for Common Outflow Reconstruction Vs Second IVC Anastomosis [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/technical-aspects-of-reconstruction-of-middle-hepatic-vein-and-multiple-inferior-right-hepatic-veins-using-dual-artificial-vascular-grafts-in-right-lobe-living-donor-liver-transplantation-v-pla/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress