Importance of reconstruction of middle hepatic vein tributaries of right-lobe grafts in living donor liver transplantation: demonstration of the reconstruction technique
Importance of reconstruction of middle hepatic vein tributaries of right-lobe grafts in living donor liver transplantation: demonstration of the reconstruction technique
复制标题
右叶肝中静脉支流重建在活体肝移植中的重要性：重建技术示范
DOI：
10.1007/s00423-021-02398-0
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Takada Y
中科院分区：
文献类型：
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作者：
Sakamoto K;Ogawa K;Tamura K;Ito C;Iwata M;Sakamoto A;Matsui T;Nishi Y;Nagaoka T;Uraoka M;Funamizu N;Takai A;Takada Y
PurposeThe目的本研究的活体肝移植（LDLT）使用右叶移植物没有肝中静脉（MHV）的目的是调查的临床影响MHV分支重建使用我们的标准和techniques.MethodsThe的医疗记录40例患者接受成人LDLT使用右叶移植物没有MHV 2008年4月至2020年12月进行了回顾性分析。在该队列中，MHV分支重建的标准是每个MHV分支的估计引流量大于100 mL。采用静脉补片移植重建8段引流静脉作为肝右静脉和V8的共同口，采用人工血管移植重建5段引流静脉。比较MHV分支重建组和未重建组的结局。与术后大量腹水的相关因素也investigated.ResultsTwenty例患者进行了MHV分支重建。两组患者术后腹水量、Clavien-Dindo分级≥ III级的术后并发症和90天住院死亡率差异无统计学意义（分别为P= 0.678、P = 1.000和P = 0.244）。在多变量分析中，低估计的功能移植物与受体重量比（使用估计的移植物体积减去未重建的MHV分支区域计算）被确定为术后大量腹水的独立预测因子（优势比，40.479; 95%置信区间，3.823-428.622）。结论本研究表明，选择性MHV分支重建可能有助于获得成功的移植功能。
PurposeThe aim of the present study on living donor liver transplantation (LDLT) using a right-lobe graft without the middle hepatic vein (MHV) was to investigate the clinical impact of MHV tributary reconstruction using our criteria and techniques.MethodsThe medical records of 40 patients who underwent adult LDLT using a right-lobe graft without the MHV between April 2008 and December 2020 were retrospectively reviewed. In this cohort, the criterion for MHV tributary reconstruction was estimated drainage volume of each MHV tributary greater than 100 mL. The drainage vein of segment 8 (V8) was reconstructed as the common orifice of the right hepatic vein and V8 using a venous patch graft, and that of segment 5 was reconstructed using artificial vascular grafts. The outcomes were compared between the groups with and without MHV tributary reconstruction. Factors associated with postoperative massive ascites were also investigated.ResultsTwenty patients underwent MHV tributary reconstruction. There were no significant differences in the amount of postoperative ascites, Clavien-Dindo classification ≥ III postoperative complications, and 90-day in-hospital mortality between the groups (P= 0.678,P= 1.000, andP= 0.244, respectively). On multivariate analyses, a low-estimated functional graft-to-recipient weight ratio, which was calculated using estimated graft volume minus the territory of MHV tributaries that was not reconstructed, was identified as an independent predictor of postoperative massive ascites (odds ratio, 40.479; 95% confidence interval, 3.823–428.622).ConclusionThe present study suggests that selective MHV tributary reconstruction might be useful for achieving successful graft function.