Hepatic vein reconstruction in ex situ split-liver transplantation.

摘要

BACKGROUND Anatomy of the left hepatic vein (LHV) was studied in a series of 53 consecutive cadaveric liver grafts that were divided for transplantation.METHODS All divisions were performed ex situ and provided a left split graft with only the LHV as the hepatic outflow. The anatomy was categorized into three types: (A) single LHV trunk, (B) two veins closely merging toward the median hepatic vein, or (C) a double outflow.RESULTS Direct implantation of the graft was performed in type A and was possible in type B after simple plasty of the ostia to create a single orifice. In type C, a venous jump graft could be interposed at bench work to allow direct anastomosis into the recipient. There were no related complications, except one type A case with late outflow obstruction.CONCLUSION Liver division can be performed safely in liver grafts with variant LHV anatomy, if appropriate techniques for reconstruction are used. Also ex situ liver division has the advantage of allowing a detailed anatomic evaluation before dividing LHV: reconstruction can be performed ex situ, allowing a single-step direct anastomosis in the recipient, thus shortening suturing time.