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Technical dilemma in living-donor or split-liver transplant
K Sano1, M Makuuchi, T Takayama
1Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
Hepato-Gastroenterology
|December 2, 2000
Summary
Reconstructing middle hepatic vein tributaries in adult partial liver transplants is crucial when Doppler ultrasound shows poor blood flow. This improves graft function and patient recovery after living-donor liver transplantation.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Surgery
- Vascular Surgery
Background:
- Criteria for reconstructing middle hepatic vein (MHV) tributaries in adult partial liver transplantation remain unclear.
- Living-donor liver transplantation (LDLT) using left liver grafts often involves dividing MHV branches.
Observation:
- Color Doppler ultrasonography (CDUS) revealed absent hepatic venous outflow and reversed portal venous inflow in a left paramedian sector after MHV branch division.
- This sector, drained by the divided MHV branch, showed dark discoloration under arterial occlusion, indicating congestion.
Findings:
- Reconstruction of the divided MHV tributary restored normal venous outflow and portal inflow, confirmed by CDUS.
- The patient experienced an uneventful postoperative course with rapid liver function recovery.
Implications:
- CDUS findings of absent venous flow and reversed portal flow, coupled with insufficient viable liver volume, indicate the need for MHV tributary reconstruction.
- This approach can optimize graft perfusion and improve outcomes in adult partial liver transplantation, particularly in LDLT with left grafts.