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Bridge venoplasty: A new technique to simplify venous outflow reconstruction in living donor domino liver transplantation

2009; Elsevier BV; Volume: 148; Issue: 1 Linguagem: Inglês

10.1016/j.surg.2009.08.009

1532-7361

Arvinder S. Soin, Vinay Kumaran, Ravi Mohanka, Naimish Mehta, Neelam Mohan, Samiran Nundy,

Organ Donation and Transplantation

In domino liver transplantation, when the first recipient or the domino donor (DD) receives a living donor (LD) graft, both transplants are performed in an inferior vena cava (IVC) preserving piggyback fashion. 1 Tzakis A. Todo S. Starzl T. Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg. 1989; 210: 649-652 Crossref PubMed Scopus (483) Google Scholar The main technical challenge lies in ensuring a well-constructed venous outflow in the second (domino) recipient (DR) because the right hepatic vein (RHV), middle hepatic vein (MHV), and left hepatic vein (LHV) present as separate orifices in the domino graft. The techniques used to reconstitute venous outflow in the DR include anastomosis of hepatic vein stumps to circular venotomies in a vein patch 2 Matteo C. Grazi G.L. Matteo R. Cucchetti A. Ercolani G. Pinna A.D. Modified outflow reconstruction with a venous patch in domino liver transplantation. Liver Transpl. 2007; 13: 1756-1757 Crossref PubMed Scopus (10) Google Scholar or Y-grafts using either portal vein bifurcation 3 Cerqueira A. Pacheco-Moreira L. Enne M. Alves J. Amil R. Balbi E. et al. Outflow reconstruction in domino liver transplantation with interposition of autologous portal vein graft. A new technical option in living donor domino liver transplant scenario. Liver Transpl. 2006; 12: 1298-1300 Crossref PubMed Scopus (12) Google Scholar or cadaveric iliac vein confluence. 4 Jabbour N. Gagandeep S. Genyk Y. Selby R. Mateo R. Caval preservation with reconstruction of the hepatic veins using caval-common iliac bifurcation graft for domino liver transplantation. Liver Transpl. 2006; 12: 324-325 Crossref PubMed Scopus (19) Google Scholar We describe a new method using a cryopreserved portal vein graft, which is split open and used as a vein patch to bridge the gap between the RHV and the common channel of MHV and LHV. This simple technique (Fig 1, A–C) permits a wide, triangulated outflow anastomosis (Fig 2) in which the natural lie of hepatic veins is preserved. Fig 2Hepatic vein orifices in DR after native hepatectomy depicted on the left (A). Shaded areas excised to obtain triangular opening (B) in DR IVC to which the reconstructed triangular outflow of the domino graft is anastomosed. View Large Image Figure Viewer Download Hi-res image