Search

Liver transplantation in patients with biliary atresia and polysplenia syndrome requires some technical adjustments. During eight yr, 75 biliary atresia patients underwent living donor liver transplantation. Of these, two patients were complicated by absent inferior vena cava with azygos continuation. Both patients received hemi-liver grafts with short hepatic veins. Outflow was reconstructed using a cryopreserved vena cava. In both patients, the short hepatic vein was anastomosed to the vein graft end-to-end and the end of the vein graft was anastomosed with the common orifices of recipient's hepatic veins. Both of the patients survived the operation with satisfactory graft function. A hemi-liver graft with short hepatic veins can be used for patients with biliary atresia with inferior vena cava agenesia using the current technique.

Background/aims: Despite the impressive results of living donor liver transplantation, hepatic venous reconstruction remains a controversial component., Methodology: A total of 211 consecutive donor hepatectomies were performed. The proximal route of the hepatic vein was exposed by dissection of the connective tissue around the hepatic vein and by dividing and ligating all of the inferior phrenic veins that open into the hepatic vein, into the confluence of the hepatic vein and inferior vena cava, or directly into the inferior vena cava., Results: In the 114 left-side hepatectomy procedures, the number of divided left inferior phrenic veins ranged from 1 to 4 and the diameters of the left and middle hepatic veins ranged from 7 to 33mm. For the 97 right-side procedures, the number of divided right inferior phrenic veins ranged from 1 to 4 and the diameters of right hepatic veins ranged from 9 to 34mm. This maneuver safely allowed for the safe exposure of all trunks and routes of the hepatic veins and the suprahepatic portion of the inferior vena cava., Conclusions: Our technique is useful for obtaining a wide ostium and a sufficient length of the hepatic vein for grafts obtained from living donors.

Background/aims: Although the Model End-Stage Liver Disease (MELD) score has been effective in the prediction of mortality in patients awaiting liver transplantation, its predictive value of survival after living donor liver transplantation (LDLT) needs further study., Methodology: We report our experience with 142 cases of LDLT, analyzing the impact of the MELD score on the graft survival after LDLT., Results: Of 142 grafts, 18 failed during the observation period. One-, 3- and 5-year survival rates were 92%, 87% and 82%, respectively. Cox proportional hazard model revealed that MELD score did not predict graft survival (p=0.43, relative risk = 1.0)., Conclusions: The present results may indicate that the preoperative MELD score was of little help for determining the indication of LDLT.

Living donor liver transplantation (LDLT) was first successfully performed on a child in 1990 and the Shinshu group performed the same procedure on an adult for the first time in 1994. Over the past few years adult LDLT has been increasing worldwide because of the severe shortage of cadaveric organs, especially in locations where the transplantation of organs from brain-dead donors is rarely practiced. The surgical procedures for LDLT are more technically challenging than those for cadaveric whole liver transplantation. LDLT requires a full understanding of hepatobiliary anatomy and continuous technical refinement of the procedure. The development of innovative techniques is a key factor for a successful LDLT. Some of the technical highlights include selective vascular occlusion techniques for donor hepatectomy, hepatic arterial reconstruction under the microscope, the introduction of intraoperative ultrasound, graft volume estimation, hepatic venous reconstruction using cryopreserved vascular grafts, and the use of the right lateral sector of the liver. These techniques have improved the success rate of LDLT over the past few years. This review focuses on the surgical techniques for LDLT on the basis of our experience with adult LDLT at the Tokyo University Hospital.

Background: Bile duct-to-duct reconstruction is now used in living-donor liver transplantation (LDLT) for adult patients., Methods: The results of duct-to-duct reconstruction were retrospectively analyzed. The subjects were 81 adult patients who underwent LDLT at the University of Tokyo Hospital with a follow-up period of at least 1 year. The hilar plate of the recipient was dissected to at least the second-order branch of the bile ducts. Duct-to-duct anastomosis was performed with interrupted sutures, and an external stent tube was inserted from the orifice opposite the hilar plate., Results: During the observation period (median, 664 days), biliary complications were observed in 26 cases (32%). The complications included bile juice leakage at the anastomosis or dissection plane of the graft in 12 patients, anastomotic stenosis in 10 patients, and tube trouble in 6 patients. Two patients had bile juice leakage followed by stenosis. Of the 26 patients, 21 required surgical revision., Conclusions: The current technique did not reduce morbidity as expected. Further technical advancement and refinement are needed for better results.