Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation

Toru Ikegami, Yuji Soejima, Akinobu Taketomi, Tomoharu Yoshizumi, Noboru Harada, Hideaki Uchiyama, Mitsuo Shimada, Yoshihiko Maehara

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. The availability of a venous graft is limited in the setting of living donor liver transplantation (LDLT), and the management of the middle hepatic vein middle hepatic vein tributaries in right lobe LDLT still remains controversial. METHODS. Twenty-three right lobe LDLT grafts, with the reconstruction of middle hepatic vein tributaries using the explanted portal veins from the explanted livers, were evaluated for the patency, postLDLT liver function tests, and graft survival. RESULTS. The methods of outflow reconstruction were classified into three types: the interposition of the graft to the middle/left hepatic vein (n=12), to the vena cava (n=9), and to the vena cava as a co-orifice with the graft right hepatic vein (n=2). The 1- and 3-year patency rates were 76.7% and 76.7% respectively, with the graft occlusion in five cases. The occluded cases (n=5) had significantly higher aspartate aminotransferase and alanine transaminase levels as compared with those of patent cases (n=18) at 4 weeks after transplantation (P<0.01). However, there was no significant difference in the total bilirubin and prothrombin time in either group during the observation periods. The 1- and 3-year graft survival rates were 91.1% and 91.1%, respectively. In addition, there was no graft loss due to occlusion. CONCLUSION. The use of the recipient's explanted full-length hilar portal vein for the reconstruction of the middle hepatic vein tributaries is thus considered to be a feasible and valuable strategy in the setting of a right lobe LDLT, where appropriate vascular grafts are not always available.

Original languageEnglish
Pages (from-to)836-841
Number of pages6
JournalTransplantation
Volume84
Issue number7
DOIs
Publication statusPublished - Oct 1 2007

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Hepatic Veins
Living Donors
Portal Vein
Liver Transplantation
Transplants
Venae Cavae
Graft Survival
Aspartate Aminotransferases
Liver Function Tests
Prothrombin Time
Alanine Transaminase
Bilirubin
Blood Vessels
Transplantation
Observation
Liver

All Science Journal Classification (ASJC) codes

  • Transplantation

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Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. / Ikegami, Toru; Soejima, Yuji; Taketomi, Akinobu; Yoshizumi, Tomoharu; Harada, Noboru; Uchiyama, Hideaki; Shimada, Mitsuo; Maehara, Yoshihiko.

In: Transplantation, Vol. 84, No. 7, 01.10.2007, p. 836-841.

Research output: Contribution to journalArticle

Ikegami, Toru ; Soejima, Yuji ; Taketomi, Akinobu ; Yoshizumi, Tomoharu ; Harada, Noboru ; Uchiyama, Hideaki ; Shimada, Mitsuo ; Maehara, Yoshihiko. / Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation. In: Transplantation. 2007 ; Vol. 84, No. 7. pp. 836-841.
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abstract = "BACKGROUND. The availability of a venous graft is limited in the setting of living donor liver transplantation (LDLT), and the management of the middle hepatic vein middle hepatic vein tributaries in right lobe LDLT still remains controversial. METHODS. Twenty-three right lobe LDLT grafts, with the reconstruction of middle hepatic vein tributaries using the explanted portal veins from the explanted livers, were evaluated for the patency, postLDLT liver function tests, and graft survival. RESULTS. The methods of outflow reconstruction were classified into three types: the interposition of the graft to the middle/left hepatic vein (n=12), to the vena cava (n=9), and to the vena cava as a co-orifice with the graft right hepatic vein (n=2). The 1- and 3-year patency rates were 76.7{\%} and 76.7{\%} respectively, with the graft occlusion in five cases. The occluded cases (n=5) had significantly higher aspartate aminotransferase and alanine transaminase levels as compared with those of patent cases (n=18) at 4 weeks after transplantation (P<0.01). However, there was no significant difference in the total bilirubin and prothrombin time in either group during the observation periods. The 1- and 3-year graft survival rates were 91.1{\%} and 91.1{\%}, respectively. In addition, there was no graft loss due to occlusion. CONCLUSION. The use of the recipient's explanted full-length hilar portal vein for the reconstruction of the middle hepatic vein tributaries is thus considered to be a feasible and valuable strategy in the setting of a right lobe LDLT, where appropriate vascular grafts are not always available.",
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AU - Soejima, Yuji

AU - Taketomi, Akinobu

AU - Yoshizumi, Tomoharu

AU - Harada, Noboru

AU - Uchiyama, Hideaki

AU - Shimada, Mitsuo

AU - Maehara, Yoshihiko

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N2 - BACKGROUND. The availability of a venous graft is limited in the setting of living donor liver transplantation (LDLT), and the management of the middle hepatic vein middle hepatic vein tributaries in right lobe LDLT still remains controversial. METHODS. Twenty-three right lobe LDLT grafts, with the reconstruction of middle hepatic vein tributaries using the explanted portal veins from the explanted livers, were evaluated for the patency, postLDLT liver function tests, and graft survival. RESULTS. The methods of outflow reconstruction were classified into three types: the interposition of the graft to the middle/left hepatic vein (n=12), to the vena cava (n=9), and to the vena cava as a co-orifice with the graft right hepatic vein (n=2). The 1- and 3-year patency rates were 76.7% and 76.7% respectively, with the graft occlusion in five cases. The occluded cases (n=5) had significantly higher aspartate aminotransferase and alanine transaminase levels as compared with those of patent cases (n=18) at 4 weeks after transplantation (P<0.01). However, there was no significant difference in the total bilirubin and prothrombin time in either group during the observation periods. The 1- and 3-year graft survival rates were 91.1% and 91.1%, respectively. In addition, there was no graft loss due to occlusion. CONCLUSION. The use of the recipient's explanted full-length hilar portal vein for the reconstruction of the middle hepatic vein tributaries is thus considered to be a feasible and valuable strategy in the setting of a right lobe LDLT, where appropriate vascular grafts are not always available.

AB - BACKGROUND. The availability of a venous graft is limited in the setting of living donor liver transplantation (LDLT), and the management of the middle hepatic vein middle hepatic vein tributaries in right lobe LDLT still remains controversial. METHODS. Twenty-three right lobe LDLT grafts, with the reconstruction of middle hepatic vein tributaries using the explanted portal veins from the explanted livers, were evaluated for the patency, postLDLT liver function tests, and graft survival. RESULTS. The methods of outflow reconstruction were classified into three types: the interposition of the graft to the middle/left hepatic vein (n=12), to the vena cava (n=9), and to the vena cava as a co-orifice with the graft right hepatic vein (n=2). The 1- and 3-year patency rates were 76.7% and 76.7% respectively, with the graft occlusion in five cases. The occluded cases (n=5) had significantly higher aspartate aminotransferase and alanine transaminase levels as compared with those of patent cases (n=18) at 4 weeks after transplantation (P<0.01). However, there was no significant difference in the total bilirubin and prothrombin time in either group during the observation periods. The 1- and 3-year graft survival rates were 91.1% and 91.1%, respectively. In addition, there was no graft loss due to occlusion. CONCLUSION. The use of the recipient's explanted full-length hilar portal vein for the reconstruction of the middle hepatic vein tributaries is thus considered to be a feasible and valuable strategy in the setting of a right lobe LDLT, where appropriate vascular grafts are not always available.

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