Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation
Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation
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DOI：
10.1097/01.sla.0000077921.38307.16
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发表时间：
2003-07-01
影响因子：
9
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Fan, ST;Lo, CM;Wong, J
目的：为了评估安全的捐助者谁捐赠了肝中静脉右叶活体肝移植（LDLT），并确定是否这样的列入是必要的最佳graft function.Summary背景资料：包括肝中静脉右叶移植在成人对成人LDLT的必要性是有争议的。包含在移植物中的肝中静脉提供了均匀的肝静脉引流，但可能会导致在donor.Methods的第四段充血：从1996年至2002年，93右叶LDLT进行。除我外，所有的右叶移植物都含有肝中静脉。在供体手术中，注意保留IV段肝动脉，避免右叶长时间旋转。肝中静脉在IVb段肝静脉近端切断，以保留残肝的静脉回流。两名供体出现术中并发症（意外左肝静脉闭塞和门静脉血栓形成），立即纠正后情况良好。24例供体（26%）出现术后并发症，大多数为轻微伤口感染。IVb段肝静脉保留供体术后第1天的国际标准化比值优于未保留的供体，但所有供体术后第7天肝功能基本正常。第一个受体有严重的移植物充血，因为肝中静脉在再灌注前没有重建。在其他7名受者中，由于技术失误，术中发现肝中静脉闭塞。肝中静脉闭塞或缺如者术后肝肾功能较肝中静脉通畅者差。肝中静脉闭塞患者的住院死亡率也更高（3/9 vs. 5/84，P = 0.028）。结论：肝中静脉在右叶LDLT中的应用是安全的，对于最佳的移植物功能和患者生存至关重要。
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 I 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 I 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.