One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living donor liver transplantation

Toru Ikegami, Ken Shirabe, Shohei Yoshiya, Yuji Soejima, Tomoharu Yoshizumi, Hideaki Uchiyama, Takeo Toshima, Takashi Motomura, Yoshihiko Maehara

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purposes: Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts. Methods: We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31). Results: In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 % in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p < 0.001) and these patients had higher alanine transaminase values (142 ± 79 vs. 96 ± 46 IU/L, p = 0.024) on postoperative day POD 7. However, the 6-month short-term graft survival rates were 100 % with one-step reconstruction and 83.9 % with direct anastomosis, respectively. Conclusion: One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.

Original languageEnglish
Pages (from-to)769-776
Number of pages8
JournalSurgery today
Volume43
Issue number7
DOIs
Publication statusPublished - Jul 1 2013

Fingerprint

Hepatic Veins
Living Donors
Liver Transplantation
Transplants
Cold Ischemia
Jugular Veins
Inferior Vena Cava
Graft Survival
Portal Vein
Alanine Transaminase
Survival Rate

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living donor liver transplantation. / Ikegami, Toru; Shirabe, Ken; Yoshiya, Shohei; Soejima, Yuji; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Toshima, Takeo; Motomura, Takashi; Maehara, Yoshihiko.

In: Surgery today, Vol. 43, No. 7, 01.07.2013, p. 769-776.

Research output: Contribution to journalArticle

Ikegami, Toru ; Shirabe, Ken ; Yoshiya, Shohei ; Soejima, Yuji ; Yoshizumi, Tomoharu ; Uchiyama, Hideaki ; Toshima, Takeo ; Motomura, Takashi ; Maehara, Yoshihiko. / One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living donor liver transplantation. In: Surgery today. 2013 ; Vol. 43, No. 7. pp. 769-776.
@article{c6f78edfdf914f5588e4cfc9c913f629,
title = "One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living donor liver transplantation",
abstract = "Purposes: Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts. Methods: We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31). Results: In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 {\%} in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p < 0.001) and these patients had higher alanine transaminase values (142 ± 79 vs. 96 ± 46 IU/L, p = 0.024) on postoperative day POD 7. However, the 6-month short-term graft survival rates were 100 {\%} with one-step reconstruction and 83.9 {\%} with direct anastomosis, respectively. Conclusion: One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.",
author = "Toru Ikegami and Ken Shirabe and Shohei Yoshiya and Yuji Soejima and Tomoharu Yoshizumi and Hideaki Uchiyama and Takeo Toshima and Takashi Motomura and Yoshihiko Maehara",
year = "2013",
month = "7",
day = "1",
doi = "10.1007/s00595-012-0449-5",
language = "English",
volume = "43",
pages = "769--776",
journal = "Surgery Today",
issn = "0941-1291",
publisher = "Springer Japan",
number = "7",

}

TY - JOUR

T1 - One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living donor liver transplantation

AU - Ikegami, Toru

AU - Shirabe, Ken

AU - Yoshiya, Shohei

AU - Soejima, Yuji

AU - Yoshizumi, Tomoharu

AU - Uchiyama, Hideaki

AU - Toshima, Takeo

AU - Motomura, Takashi

AU - Maehara, Yoshihiko

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Purposes: Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts. Methods: We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31). Results: In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 % in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p < 0.001) and these patients had higher alanine transaminase values (142 ± 79 vs. 96 ± 46 IU/L, p = 0.024) on postoperative day POD 7. However, the 6-month short-term graft survival rates were 100 % with one-step reconstruction and 83.9 % with direct anastomosis, respectively. Conclusion: One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.

AB - Purposes: Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts. Methods: We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31). Results: In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 % in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p < 0.001) and these patients had higher alanine transaminase values (142 ± 79 vs. 96 ± 46 IU/L, p = 0.024) on postoperative day POD 7. However, the 6-month short-term graft survival rates were 100 % with one-step reconstruction and 83.9 % with direct anastomosis, respectively. Conclusion: One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.

UR - http://www.scopus.com/inward/record.url?scp=84879265561&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879265561&partnerID=8YFLogxK

U2 - 10.1007/s00595-012-0449-5

DO - 10.1007/s00595-012-0449-5

M3 - Article

VL - 43

SP - 769

EP - 776

JO - Surgery Today

JF - Surgery Today

SN - 0941-1291

IS - 7

ER -