Morphometric and simulation analyses of right hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts

Shin Hwang, Sung Gyu Lee, Chul Soo Ahn, Deok Bog Moon, Ki Hun Kim, Kyu Bo Sung, Gi Young Ko, Tae Yong Ha, Gi Won Song, Dong Hwan Jung, Dong Il Gwon, Kyoung Won Kim, Nam Kyu Choi, Kwan Woo Kim, Young Dong Yu, Gil Chun Park

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14 Citations (Scopus)

Abstract

The incidence of clinically significant right hepatic vein (RHV) stenosis after adult living donor liver transplantation has been higher than expected. In this study, an assessment of the risk factors for the development of RHV stenosis in this context was undertaken. Hepatic anatomy, surgical techniques, and the incidence of RHV stenosis 1 year after transplantation were evaluated retrospectively in 225 recipients of right lobe grafts. These patients underwent independent RHV reconstruction, which was facilitated by the application of computed tomography morphometry and computational simulation analyses. Three types of preparation of the orifice of the graft RHV and 7 types of preparation for venoplasty of the recipient RHV were used. The frequency of high, middle, and low sites of RHV insertion into the inferior vena cava (IVC) was 56.0%, 36.4%, and 7.6%, respectively, for donors, and 26.7%, 58.7%, and 14.7%, respectively, for recipients. Nine patients (4%) developed RHV stenosis of early onset that required stent insertion during the first 2 postoperative weeks; in 12 patients (5.3%), RHV stenosis of delayed onset occurred. Inappropriate matching of RHV sites of insertion correlated with the incidence of stenosis of early onset (P = 0.039). Technical refinements to avoid adverse consequences of inappropriate ventrodorsal matching of RHV sites of insertion include making the recipient RHV orifice wide and enlarging the recipient IVC by a customized incision and patch venoplasty after anatomical assessment of the RHV and IVC of the graft and recipient.

Original languageEnglish
Pages (from-to)639-648
Number of pages10
JournalLiver Transplantation
Volume16
Issue number5
DOIs
Publication statusPublished - 2010 May
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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    Hwang, S., Lee, S. G., Ahn, C. S., Moon, D. B., Kim, K. H., Sung, K. B., Ko, G. Y., Ha, T. Y., Song, G. W., Jung, D. H., Gwon, D. I., Kim, K. W., Choi, N. K., Kim, K. W., Yu, Y. D., & Park, G. C. (2010). Morphometric and simulation analyses of right hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts. Liver Transplantation, 16(5), 639-648. https://doi.org/10.1002/lt.22045