From January 2013 to February 2016 total of 21 patients underwent consecutive Living Donor Liver Transplant in our center. All patients were transplanted using right lobe liver graft without middle hepatic vein. Recipient hepatectomy was done and right hepatic vein (RHV), middle and left hepatic vein stumps were closed using prolene suture. All graft were placed in the right subdiaphragmatic space. Site of cavotomy for anastomosis to right hepatic vein was decided so that the anastomosis was perpendicular to the IVC and graft will lie without any twist in the RHV. This site was inferior to the original RHV orifice on the IVC. The venous anastomosis was done using 4/0 prolene continuous suture.

Out of 21 recipients 17 were male and 3 females. Age distribution was from 25 to 75 years with mean of 41 years. Four patients were transplanted for fulminant liver failure and 17 had decompensated cirrhosis. Etiology for fulminant liver failure was rat poisoning in 2 patients, halothane poisoning in 1 patient and pregnancy induced liver failure in 1 patient.

For non fulminant cases, etiology were alcohol in 3 patients, autoimmune 2 , hepatitis B 5 , hepatitis C 1, NASH 2, schistosomiasis in 2, hemochromatosis in 1 and PSC in 1 patient.

Cold ischemia time rangede of 43 mins to 194 mins, average of 91.7 mins.

Warm ischemia time ranged between 15 to 102 mins, average being 52 mins.

Follow up ranged from 10 months to 46 months , mean follow up of 25 months.

Complications were seen in the form of bile leaks in 4 (19%) cases, biliary stricture in 1 (4%),case, portal vein thrombosis in 2 (9%)cases and hepatic artery thrombosis in 1 (4%)case. No hepatic vein stenosis or thrombosis was seen in any patient. Three patients (14%) died within 1 month of transplant, two related to sepsis and 1 due to hepatic artery thrombosis. In most centers in case of right lobe living donor liver transplant RHV is anastomosed to RHV orifice of the recipient.

We describe a technique of placing the right lobe liver graft slightly inferiorly and selecting the RHV anastomosis site on the inferior vena cava as per the lie of the graft. This helps in creating a short and perpendicular anastomosis as well as in case of short right portal vein or right hepatic artery we can get an extra length due to inferior position of the graft.

We did not find any venous anastomotic complication and our other complication rates were comparable to published literature.

CITATION INFORMATION: Rai R, Trivedi E, Shaikh I, Nagral S, Doctor N. Technique and Result of Anastomosing Right Hepatic Vein to Inferior Vena Cava with a Separate Cavotomy Inferior to Right Hepatic Vein Orfice. Am J Transplant. 2017;17 (suppl 3).

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