2008 Annual Meeting Abstracts
Selective Anterior Sector Venous Outflow Reconstruction After Live Donor Liver Transplantation (LDLT): Effect on Patient and Graft Survival
James J. Pomposelli, MD, PhD, Kenneth McPartland, MD, Khashayar Vakili, MD, William D. Lewis, MD, Roger L. Jenkins, MD, Mohamed Akoad, MD, PhD, Elizabeth A. Pomfret, MD, PhD.
Lahey Clinic Medical Center, Burlington, MA, USA.
Objectives: Controversy exists over whether routine inclusion of the middle hepatic vein (MHV) with a right lobe graft during LDLT is necessary to ensure proper venous outflow. This study evaluates selective reconstruction of segments V and VIII based on the extent of graft at risk rather than routine inclusion of the MHV.
Design: Retrospective analysis of a comprehensive database.
Setting: Tertiary care referral center.
Patients: 165 patients who underwent LDLT between 12/1998-4/2008.
Intervention: Selective reconstruction of segments V and VIII venous branches.
Main Outcome Measures: Patency of venous reconstruction, patient and graft survial.
Results: 43 of 165 patients (26%) required segment V and/or VIII venous reconstruction. Conduits used for reconstruction consisted of inferior mesenteric vein (n=6), cryopreserved iliac artery (n=32), and cadaveric iliac artery (n=1) or were anastomosed to the vena cava directly (n=4). Overall patient survival was 86.7% (86.1% with venous reconstruction; 86.9 without venous reconstruction, p=NS). Venous graft patency rates at 7 and 30 days were 69.8% and 58% respectively. 30-day retransplant rate excluding hepatic artery thrombosis was significantly higher with venous reconstruction versus without venous reconstruction (11.6% vs. 1.6% respectively, p<0.05).
Conclusions: Venous reconstruction of segment V and/or VIII branches is required in only 26% of donors obviating the need for routine inclusion of the middle hepatic vein. Selective reconstruction does not affect patient survival but may contribute to a significantly higher early retransplantation rate. In donors where a significant volume of liver drains via segments V or VIII, inclusion of the MHV with the graft should be considered to avoid small for size syndrome and early graft loss as long as donor safety is not compromised.