Hepatic venous outflow reconstruction in partial liver grafts: The middle path

Abstract

Background: Liver transplantation is the gold standard treatment in end-stage liver disease. Although organ donation is on the rise, living donor liver transplantation (LDLT) is still the bulk of all the transplantation procedures in our country (India). LDLT is a technically complex surgical procedure. In addition to known complications in the recipient donor morbidity and mortality are still fearsome complications, recipent complications includes multiple vasculo- biliary complications and graft dysfunctions. The surgical technique has evolved over the years to increase the recipient outcomes with negligible donor morbidities. One of them is shift from full middle hepatic vein grafts to modfied right lobe (MRL) grafts. Methods: MRL grafts were performed. In MRL grafts, drainage of the anterior sector is the critical step. Failure of this will lead to graft congestion and loss of functional graft volume. However, not all veins need to be drained. Results: In this article, we have described a simple and effective technique which we follow routinely in our institute to identify the intrahepatic veno-venous communications. Conclusion: MRL technique optimizes the drainage procedure with maximum yield.

Keywords

• Hepatic venous outflow reconstruction
• intrahepatic veno-venous communications
• living donor liver transplantation
• saline flush