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Functional venous anatomy for right-lobe grafting and techniques to optimize outflow
1Department of Surgery, Division of Transplantation, University of Rochester Medical Center, Rochester, NY, USA. amadeo_marcos@urmc.rochester.edu
Summary
Right-lobe living donor liver transplantation offers a viable alternative to cadaveric grafts. This technique, focusing on preserving hepatic veins, shows low complication rates and high graft survival, making it a safe and effective option.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Medicine
- Surgical Anatomy
Background:
- Right-lobe living donor liver transplantation is an alternative to cadaveric transplantation.
- Understanding the unique anatomy of the right lobe is crucial for technical modifications.
Purpose of the Study:
- To describe a modified technique for right-lobe living donor liver transplantation.
- To evaluate the safety and efficacy of this technique regarding donor complications and recipient outcomes.
Main Methods:
- Right lobectomy with preservation of inferior hepatic veins.
- Parenchymal division along a plane approximating the midhepatic vein (MHV), including the distal MHV with the graft.
- Anastomosis using complete cavoplasty and reconstruction of significant venous tributaries when possible.
Main Results:
- Forty-eight procedures were performed with no donor complications.
- 46 of 48 recipients survived with their original graft.
- Low rates of venous complications and ascites were observed, similar to whole organ transplants.
Conclusions:
- The described methods for parenchymal transection and venous reconstruction are associated with a low complication rate.
- Wide anastomosis and collateral pathways appear more critical than direct reconstruction of specific venous tributaries.