Document Detail


Anomalous hepatic vein anatomy of the left lateral section graft and customized unification venoplasty for pediatric living donor liver transplantation.
MedLine Citation:
PMID:  23045153     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
In liver transplantation, a left lateral section (LLS) graft may have unusual variant left hepatic vein (LHV) anatomy. This study was designed to analyze the incidence of unusual variant LHV and to determine technical methods for its effective reconstruction in infant recipients weighing around 10 Kg or less. The study comprised three parts: LHV variation analysis, simulation-based design for technical modification of graft LHV venoplasty, and its clinical application. The LHV anatomy of 300 potential LLS graft donors was classified into four types according to the number and location of hepatic vein openings: single opening (type 1; n=218, 72.7%), two large adjacent openings (type 2; n=29, 9.7%), one large and one small adjacent opening (type 3; n=34, 11.3%), and two widely spaced openings (type 4; n=19, 6.3%). LHV types 2 and 3 require wedged unification venoplasty, and type 4 requires additional vein interposition. In our series of 49 cases using a LLS graft, graft hepatic vein complication rate was 4.5% at 3 years, in which stenting was necessary in 1 of 36 grafts of type 1 LHV (2.8%) and 1 of 13 grafts of type 2-4 LHV (7.7%) (p=0.464). A customized interposition-wedged unification venoplasty to cope with type 4 vein variations was developed using a simulation-based approach, and was successfully applied to a 10 month-old male infant receiving a LLS graft with type 4 LHV. In conclusion, nearly all LHV variations can be effectively managed by customized unification venoplasty. These venoplasty techniques represent beneficial surgical options as part of graft standardization for hepatic vein reconstruction in pediatric living donor liver transplantation. © 2012 American Association for the Study of Liver Diseases.
Authors:
Shin Hwang; Ki-Hun Kim; Dae-Yeon Kim; Kyoung-Mo Kim; Chul-Soo Ahn; Deok-Bog Moon; Tae-Yong Ha; Gi-Won Song; Dong-Hwan Jung; Jung-Man Namgoong; Gil-Chun Park; David C Cronin 2; Sung-Gyu Lee
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-8
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  -     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Association for the Study of Liver Diseases.
Affiliation:
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery Seoul, Korea.
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