Evaluation of risk factors and outcomes of vascular reconstruction in right lobe graft living donor liver transplantation

  • Le Trung Hieu 108 Military Central Hospital
  • Lê Văn Thành Bệnh viện Trung ương Quân đội 108
  • Nguyễn Quang Nghĩa Bệnh viện Hữu nghị Việt Đức

Main Article Content

Keywords

Living donor liver transplantation, vascular reconstruction

Abstract

Objective: To evaluate of risk factors and outcomes of vascular reconstruction in right lobe graft living donor liver transplantation. Subject and method: The prospective study was performed on 52 cases of living donor liver transplantation using right lobe graft at 108 Military Central Hospital from January 2019 to December 2020. Result: There were 3 cases of middle hepatic vein obstruction (2 stenoses, 1 occlusion) (5.7%). The mortality rate of hepatic venous outflow obstruction was 1.9%. There were 5 cases of portal vein complications (9.6%). Portal vein stenosis was diagnosed and treated successfully by stent placement in 2 cases (3.8%). The remaining cases were due to recurrent thrombosis and compression by hematoma (5.8%), which were successfully managed conservatively. Hepatic artery stenosis was diagnosed and treated successfully by internal treatment in 1 case (1.9%). The rate of vascular complications was 17.2%. The overall survival time of the group of patients was 29.7 months. The survival rates were 88.5% at 6 months, 82.7% at 1 year, and 82.7% at 3 years. The caliber of HV anastomosis (< 30mm) was an independent risk factor for hepatic venous outflow obstruction. The size discrepancy between graft and recipient portal veins was an independent risk factor for portal vein stenosis. The hepatic artery diameter of graft < 2mm and hepatic artery dissection of recipient were independent risk factors for hepatic artery stenosis. Conclusion: The single orifice hepatic vein reconstruction in LDLT using a right lobe graft can prevent effectively HV stenosis. The stent placement is a safe and effective treatment for portal vein stenosis. The parachute technique of HA reconstruction under surgical loupes of magnification 3.5X is safe and effective. 

Article Details

References

1. Koc S, Akbulut S, Soyer V et al (2017) Hepatic venous outflow obstruction after living-donor liver transplant: single center experience. Experimental and clinical transplantation 19(8): 1-11.
2. Kim KS, Lee JS, Cho GS et al (2018) Long-term outcomes after stent insertion in patients with early and late hepatic vein outflow obstruction after living donor liver transplantation. Ann Surg Treat Res 95(6): 333-339.
3. Sare A, Chandra V, Shanmugasundaram S et al (2021) Safety and efficacy of endovascular treatment of portal vein stenosis in liver transplant recipients: A systematic review. Vasc Endovascular Surg 55(5): 452-460.
4. Kim KS, Kim JM, Lee SK et al (2019) Stent insertion and balloon angioplasty for portal vein stenosis after liver transplantation: Long-term follow-up results. Diagn Interv Radiol 25(3): 231-237.
5. Li PC, Thorat A, Jeng LB et al (2017) Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients-tips and tricks to overcome the poor hepatic arterial flow. Liver Transpl 23(7): 887-898.
6. Songa S, Kwon CHD, Moon H et al (2015) Single-center experience of consecutive 522 cases of hepatic artery anastomosis in living-donor liver transplantation. Transplantation Proceedings 47: 1905-1911.
7. Ogata S, Song GW, Ahn CS et al (2019) Venous outflow complication after living donor liver transplantation using right-liver graft without middle hepatic vein. Japanese Journal of Gastroenterology and Hepatology 3: 1-7.
8. Jang YJ, Kim KW, Jeong WK et al (2010) Influence of preoperative portal hypertension and graft size on portal blood flow velocity in recipient after living donor liver transplantation with right-lobe graft. AJR 194: 165-170.
9. Shibasaki S, Taniguchi M, Shimamura T et al (2010) Risk factors for portal vein complications in pediatric living donor liver transplantation. Clin Transplant 24: 550-556.
10. Iida T, Kaido T, Yagi S et al (2014) Hepatic arterial complications in adult living donor liver transplant recipients: A single-center experience of 673 cases. Clin Transplant 28: 1025-1030.