Sheung-Tat Fan1, Chung-Mau Lo, Chi-Leung Liu, Wen-Xi Wang, John Wong. 1. Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. hrmsfst@hkucc.hku.hk
Abstract
OBJECTIVE: To evaluate the safety of donors who have donated the middle hepatic vein in right lobe live donor liver transplantation (LDLT) and to determine whether such inclusion is necessary for optimum graft function. SUMMARY BACKGROUND DATA: The necessity to include the middle hepatic vein in a right lobe graft in adult-to-adult LDLT is controversial. Inclusion of the middle hepatic vein in the graft provides uniform hepatic venous drainage but may lead to congestion of segment IV in the donor. METHODS: From 1996 to 2002, 93 right-lobe LDLTs were performed. All right-lobe grafts except 1 contained the middle hepatic vein. In the donor operation, attention was paid to preserve the segment IV hepatic artery and to avoid prolonged rotation of the right lobe. The middle hepatic vein was transected proximal to a major segment IVb hepatic vein whereas possible to preserve the venous drainage in the liver remnant. RESULTS: There was no donor death. Two donors had intraoperative complications (accidental left hepatic vein occlusion and portal vein thrombosis) and were well after immediate rectification. Twenty-four donors (26%) had postoperative complications, mostly minor wound infection. The postoperative international normalized ratio on day 1 was better in the donors with preservation of segment IVb hepatic vein than those without the preservation, but, in all donors, the liver function was largely normal by postoperative day 7. The first recipient had severe graft congestion as the middle hepatic vein was not reconstructed before reperfusion. In 7 other recipients, the middle hepatic vein was found occluded intraoperatively owing to technical errors. The postoperative hepatic and renal function of the recipients with an occluded or absent middle hepatic vein was worse than those with a patent middle hepatic vein. The hospital mortality rate was also higher in those with an occluded middle hepatic vein (3/9 vs. 5/84, P = 0.028). CONCLUSIONS: Inclusion of the middle hepatic vein in right-lobe LDLT is safe and is essential for optimum graft function and patient survival.
OBJECTIVE: To evaluate the safety of donors who have donated the middle hepatic vein in right lobe live donor liver transplantation (LDLT) and to determine whether such inclusion is necessary for optimum graft function. SUMMARY BACKGROUND DATA: The necessity to include the middle hepatic vein in a right lobe graft in adult-to-adult LDLT is controversial. Inclusion of the middle hepatic vein in the graft provides uniform hepatic venous drainage but may lead to congestion of segment IV in the donor. METHODS: From 1996 to 2002, 93 right-lobe LDLTs were performed. All right-lobe grafts except 1 contained the middle hepatic vein. In the donor operation, attention was paid to preserve the segment IV hepatic artery and to avoid prolonged rotation of the right lobe. The middle hepatic vein was transected proximal to a major segment IVb hepatic vein whereas possible to preserve the venous drainage in the liver remnant. RESULTS: There was no donor death. Two donors had intraoperative complications (accidental left hepatic vein occlusion and portal vein thrombosis) and were well after immediate rectification. Twenty-four donors (26%) had postoperative complications, mostly minor wound infection. The postoperative international normalized ratio on day 1 was better in the donors with preservation of segment IVb hepatic vein than those without the preservation, but, in all donors, the liver function was largely normal by postoperative day 7. The first recipient had severe graft congestion as the middle hepatic vein was not reconstructed before reperfusion. In 7 other recipients, the middle hepatic vein was found occluded intraoperatively owing to technical errors. The postoperative hepatic and renal function of the recipients with an occluded or absent middle hepatic vein was worse than those with a patent middle hepatic vein. The hospital mortality rate was also higher in those with an occluded middle hepatic vein (3/9 vs. 5/84, P = 0.028). CONCLUSIONS: Inclusion of the middle hepatic vein in right-lobe LDLT is safe and is essential for optimum graft function and patient survival.
Authors: A Marcos; R A Fisher; J M Ham; A T Olzinski; M L Shiffman; A J Sanyal; V A Luketic; R K Sterling; M P Posner Journal: Transplantation Date: 2000-05-27 Impact factor: 4.939
Authors: S Uemoto; Y Inomata; T Sakurai; H Egawa; S Fujita; T Kiuchi; M Hayashi; M Yasutomi; H Yamabe; K Tanaka Journal: Transplantation Date: 2000-07-15 Impact factor: 4.939
Authors: A Marcos; R A Fisher; J M Ham; A T Olzinski; M L Shiffman; A J Sanyal; V A Luketic; R K Sterling; M E Olbrisch; M P Posner Journal: Transplantation Date: 2000-06-15 Impact factor: 4.939
Authors: See Ching Chan; Chi Leung Liu; Chung Mau Lo; Banny K Lam; Evelyn W Lee; Yik Wong; Sheung Tat Fan Journal: World J Gastroenterol Date: 2006-04-14 Impact factor: 5.742
Authors: Yuen Ki Fong; See Ching Chan; Tan To Cheung; Wing Chiu Dai; Kenneth S H Chok; Albert C Y Chan; William W Sharr; Chung Mau Lo Journal: Hepatol Int Date: 2012-11-14 Impact factor: 6.047
Authors: Albert C Chan; Sheung Tat Fan; Chung Mau Lo; Chi Leung Liu; See Ching Chan; Kelvin K Ng; Boon Hun Yong; Alexander Chiu; Banny K Lam Journal: Hepatol Int Date: 2009-08-13 Impact factor: 6.047