Conjoined Unification Venoplasty for Double Portal Vein Branches of Right Liver Graft: 1-Year Experience at a High-Volume Living Donor Liver Transplantation Center

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• 作者：Shin Hwang ; Tae-Yong Ha ; Gi-Won Song ; Dong-Hwan Jung…
• 关键词：Living donor liver transplantation ; Y ; graft ; Portal vein anomaly ; Anastomotic stenosis
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：20
• 期：1
• 页码：199-205
• 全文大小：1,419 KB
• 参考文献：1.Hwang S, Lee SG, Lee YJ, Sung KB, Park KM, Kim KH, et al. Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe. Liver Transpl 2006;12:920–927.PubMed CrossRef
  2.Marcos A, Orloff M, Mieles L, Olzinski A, Sitzmann J. Reconstruction of double hepatic arterial and portal venous branches for right-lobe living donor liver transplantation. Liver Transpl 2001;7:673–679.PubMed CrossRef
  3.Thayer WP, Claridge JA, Pelletier SJ, Oh CK, Sanfey HA, Sawyer RG, et al. Portal vein reconstruction in right lobe living-donor liver transplantation. J Am Coll Surg 2002; 194:96–98.PubMed CrossRef
  4.Lee SG, Hwang S, Kim KH, Ahn CS, Park KM, Lee YJ, et al. Approach to anatomic variations of the graft portal vein in right lobe living-donor liver transplantation. Transplantation 2003;75(suppl):S28–S32.PubMed CrossRef
  5.Hwang S, Lee SG, Ahn CS, Kim KH, Moon DB, Ha TY, et al. Technique and outcome of autologous portal Y-graft interposition for anomalous right portal veins in living donor liver transplantation. Liver Transpl 2009;15:427–434.PubMed CrossRef
  6.Lee HJ, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, et al. Long-term outcomes of portal Y-graft interposition for anomalous right portal veins in living donor liver transplantation. Transplant Proc 2012; 44:454–456.PubMed CrossRef
  7.Ha TY, Hwang S, Moon DB, Ahn CS, Kim KH, Song GW, et al. Conjoined unification venoplasty for graft double portal vein branches as a modification of autologous Y-graft interposition. Liver Transpl 2015;21:707–710.PubMed CrossRef
  8.Moon DB, Lee SG, Ahn C, Hwang S, Kim KH, Ha T, et al. Application of intraoperative cine-portogram to detect spontaneous portosystemic collaterals missed by intraoperative Doppler exam in adult living donor liver transplantation. Liver Transpl 2007;13:1279–1284.PubMed CrossRef
  9.Hwang S, Ha TY, Jung DH, Park JI, Lee SG. Portal vein interposition using homologous iliac vein graft during extensive resection for hilar bile duct cancer. J Gastrointest Surg 2007;11:888–892.PubMed CrossRef
  10.Guler N, Dayangac M, Yaprak O, Akyildiz M, Gunay Y, Taskesen F, et al. Anatomical variations of donor portal vein in right lobe living donor liver transplantation: the safe use of variant portal veins. Transplant Int 2013;26:1191–1197.CrossRef
  11.Sugawara Y, Makuuchi M, Tamura S, Matsui Y, Kaneko J, Hasegawa K, et al. Portal vein reconstruction in adult living donor liver transplantation using cryopreserved vein grafts. Liver Transpl 2006;12:1233–1236.PubMed CrossRef
  12.Moon D, Lee S, Hwang S, Park K, Kim K, Ahn C, et al. Umbilical portion of recipient’s left portal vein: a useful vascular conduit in dual living donor liver transplantation for the thrombosed portal vein. Liver Transpl 2004;10:802–806.PubMed CrossRef
  13.Hwang S, Lee SG, Ahn CS, Moon DB, Kim KH, Sung KB, et al. Morphometric and simulation analyses of right hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts. Liver Transpl 2010; 16:639–648.PubMed
  14.Hwang S, Kim DY, Ahn CS, Moon DB, Kim KM, Park GC, et al. Computational simulation-based vessel interposition reconstruction technique for portal vein hypoplasia in pediatric liver transplantation. Transplant Proc 2013; 45:255–258.PubMed CrossRef
  15.Hwang S, Lee SG, Ahn CS, Moon DB, Kim KH, Ha TY, et al. Outflow vein reconstruction of extended right lobe graft using quilt venoplasty technique. Liver Transpl 2006;12:156–158.PubMed CrossRef
  16.Hwang S, Ha TY, Ahn CS, Moon DB, Song GW, Kim KH, et al. Hemodynamics-compliant reconstruction of the right hepatic vein for adult living donor liver transplantation with a right liver graft. Liver Transpl 2012;18:858–866.PubMed CrossRef
  17.Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, et al. Standardization of modified right lobe grafts to minimize vascular outflow complications for adult living donor liver transplantation. Transplant Proc 2012;44:457–459.PubMed CrossRef
  
• 作者单位：Shin Hwang (1) (2)
  Tae-Yong Ha (1)
  Gi-Won Song (1)
  Dong-Hwan Jung (1)
  Deok-Bog Moon (1)
  Chul-Soo Ahn (1)
  Ki-Hun Kim (1)
  Gil-Chun Park (1)
  Sung-Gyu Lee (1)
  
  1. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  2. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
  
• 刊物主题：Surgery; Gastroenterology;
• 出版者：Springer US
• ISSN：1873-4626

文摘

Autologous portal Y-graft (PYG) interposition has been regarded as the standard procedure for reconstruction of double portal vein (PV) orifices of right liver grafts during living donor liver transplantation, but it has the drawback of being vulnerable to functional PV stenosis. A refined technique of conjoined unification venoplasty (CUV) was developed to secure PV reconstruction. We reviewed the surgical experience on reconstruction of graft double PVs in 28 cases during a 1-year period of 2014. Computational simulation and modeling studies led us to develop CUV, which consists of placing a unification patch between two graft PV orifices and overlying the coverage with a crotch-opened autologous PYG, the shape of which provides a wide range of tolerance for alignment mismatching in PV anastomosis. During the 1-year study period, the numbers of patients using autologous PYG interposition, circumferential PV fencing with greater saphenous vein, homograft vein interposition, and CUV were 11, 3, 1, and 0, respectively, for 6 months before implementing CUV, and 5, 1, 1, and 6, respectively, for 6 months after implementing CUV. PV complications occurred in 2 of 16 patients with autologous PYG interposition, but no complications were observed in 12 patients operated on using other techniques including CUV. The drawback of conventional autologous PYG interposition can be overcome technically by CUV, which secures PV patency through hemodynamic-compliant offset of anatomical discrepancy and anastomotic alignment mismatching. We believe that CUV could be a useful and effective technical option for reconstruction of right liver grafts with two graft PVs. Keywords Living donor liver transplantation Y-graft Portal vein anomaly Anastomotic stenosis