The importance of Inferior Hepatic vein reconstruction in right lobe liver grafts: Does it really matter? - 23/12/21
, Inbaraj Balradja, MS, MCh, S. Sreejith, MS, MCh, DNB, Bhargava R Chikkala, MS, MRCS, Rajesh Dey, MS, MRCS, M. Rajgopal Acharya, MS, Yuktansh Pandey, MS, Shaleen Agarwal, MS, MCh, Subhash Gupta, MS, FRCS ⁎ , Sapana Verma ⁎
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Highlights |
• | This article mentions about our experience of Living donor liver transplant (LDLT) done for 1225 patients. |
• | We compared outcome of RLG with IHV reconstruction vs those without IHV reconstruction. |
• | We found reconstruction of these IHV associated with better overall outcome and RHV occlusion was also significantly lower with IHV reconstruction which may explain the role of better positioning of the graft and preventing outflow obstruction. |
• | IHV reconstruction helps in improving graft function not only by drainage but also holding the graft in true orthotopic position. |
Abstract |
Background |
Reconstruction of large IHV is mandatory to preserve graft outflow. However, outcome of small IHV reconstruction is not known as they often get blocked postoperatively. We therefore retrospectively analysed the role of IHV reconstruction and compared outcome of smaller IHV to ascertain role in graft alignment and improving graft outflow.
Methods |
All patients receiving RLG from January,2014 to September,2019 were reviewed. Patients were classified in two groups-grafts without IHV reconstruction(Group RV) and with IHV reconstruction(Group IRV). Small IHVs were compared between two group according to their postoperative patency.
Results |
There was no difference between two groups (Group IRV, n = 430, Group RV, n = 795) in pre/intra-operative variables except ischemia times. However, Clavien Dindo grade 3 complications, RHV occlusion and mortality were significantly higher in group RV. 55.1% of small IHVs were blocked in the postoperative period. However, there was no difference in outcome between blocked and patent IHVs.
Conclusion |
Outcome of liver grafts with IHV reconstruction was better than those without IHV reconstruction. RHV occlusion was also significantly lower with IHV reconstruction which may explain the role of better positioning of the graft and preventing outflow obstruction. IHVs should preferably always be reconstructed and even they get blocked may improve overall outcome by maintaining graft in true orthotopic position.
Le texte complet de cet article est disponible en PDF.Keywords : Inferior hepatic vein, Short hepatic vein, Inferior vein, Right lobe grafts, Liver transplantation, Graft position, Graft rotation
Abbreviations : LDLT, IHV, RLG, MHV, RHV, LHV, IVC, CT, CECT, USG, MRCP, SGOT, SGPT, MRL, SRL, ERL, LAI, HBV, HCV, HCC, CIT, WIT, GW, GRWR, PVT, CTP, MELD, NASH, BMI, ALF, ACLF, ABOi, HAT, PVEG, POD, PV
Plan
| Institute(s): Max Super Speciality Hospital, center for Liver & Biliary Science, Saket, New Delhi, India. |
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| Ethical clearance: Consent taken from all patients and their respective donors before surgery, after clearance from institutional committee for liver transplantation. Clearance also taken from Institutional review broad for conduction of the study. |
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| Conflict of interest: None declared. |
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| Funding Source: None. |
Vol 3
Article 100025- juillet 2021 Retour au numéro
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