[Using vein grafts in living donor liver transplantation]

Abstract

Objective: To study the use of vein grafts in adult-to-adult (AA) living donor liver transplantation (LDLT), we transplanted recipient vena saphena magna grafts for drainage of the paramedian portion of the right lobe liver grafts without a middle hepatic vein in LDLT.

Methods: From January 2002 to March 2006, 26 patients underwent A-A LDLT, and recipient saphenous vein grafts were used for revascularization of veins and arteries such as: tributaries of the middle hepatic vein from V5, V8; right inferior hepatic vein; injured portal vein; and hepatic artery.

Results: Total outflow reconstruction ratio of V5, V8 and right inferior hepatic vein was 76.9% (20/26), the ratio of one-vein reconstruction was 57.7%, and the ratio of two-vein reconstruction was 19.2%. Reconstruction patterns and cases were demonstrated as follows: V5 (n=3), V8 (n=2), V5 and V8 (n=3), V5 and right inferior hepatic vein (n=1), V8 and right inferior hepatic vein (n=1), right inferior hepatic vein (n=10), injured portal vein of the donor (n=1). Total ratio of hepatic artery bypass grafting was 11.5% (3/26), anastomosis between hepatic artery and abdominal aorta (n=2), and anastomosis between hepatic artery and hepatic artery (n=1). Doppler ultrasound showed no thrombosis and the blood flowed smoothly and without venous outflow obstruction during the 2 to 48 months follow-up period.

Conclusion: Reconstruction of V5 or V8 outflow and hepatic artery bypass grafting using vena saphena magna of the recipients can provide sufficient venous outflow and prevent the small-for-size syndrome and solve hepatic artery complications. This approach can be recommended.