Ann Surg Treat Res.  2014 Jun;86(6):331-333. 10.4174/astr.2014.86.6.331.

Use of right lobe graft with type IV portal vein accompanied by type IV biliary tree in living donor liver transplantation: report of a case

• Shehata MR
• Kim DS
• Jung SW
• Yu YD
• Suh SO

• KMID: 2167112
• DOI: http://doi.org/10.4174/astr.2014.86.6.331

Abstract

Anatomic variations of the portal vein (PV) and bile duct (BD) are more common on the right lobe as compared with left lobe grafts in living donor liver transplantation (LDLT). We recently experienced a case of LDLT for hepatocellular carcinoma combined with liver cirrhosis secondary to hepatitis B virus and hepatitis C virus infection. The only available donor had right lobe graft with type IV PV associated with type IV BD. The patient underwent relaparotomy for PV stenting due to PV stenosis. Percutaneous transhepatic biliary drainage was done for a stricture at the site of biliary reconstruction. Thereafter, the patient was discharged in good health. Our experience suggests that, the use of right lobe graft with type IV PV accompanied by type IV BD should be the last choice for LDLT, because of its technical difficulty and risks of associated complications.

Keyword

Vascular complication; Postoperative complications; Anastomosis; Roux-en-Y

MeSH Terms

Bile Ducts
Biliary Tract*
Carcinoma, Hepatocellular
Constriction, Pathologic
Drainage
Hepacivirus
Hepatitis B virus
Humans
Liver Cirrhosis
Liver Transplantation*
Living Donors*
Portal Vein*
Postoperative Complications
Stents
Tissue Donors
Transplants*

Figure

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  Fig. 1 (A) Reconstruction computed tomography scan showing portal vein anatomy of the donor. (B) Reconstruction computed tomography scan showing arterial anatomy of the donor. (C) Intraoperative cholangiogram showing biliary anatomy of the donor. RAPV, right anterior portal vein; RPPV, right posterior portal vein. LHA, left hepatic artery; RAHA, right anterior hepatic artery; RPHA, right posterior hepatic artery; RPSD, right posterior sectoral duct; RASD, right anterior sectoral duct.

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  Fig. 2 Showing vascular and biliary anatomy of the graft. RPSD, right posterior sectoral duct; RASD, right anterior sectoral duct; RAPV, right anterior portal vein; RAHA, right anterior hepatic artery; RPHA, right posterior hepatic artery; RPPV, right posterior portal vein.

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  Fig. 3 Postoperative course of AST, ALT and bilirubin levels, showing initial decrease in early postoperative days followed by increased levels due to portal vein (PV) stenosis and finally decrease to normal level after application of PV stent.

Reference

1. Marcos A, Ham JM, Fisher RA, Olzinski AT, Posner MP. Surgical management of anatomical variations of the right lobe in living donor liver transplantation. Ann Surg. 2000; 231:824–831.

2. Gadzijev EM. Surgical anatomy of hepatoduodenal ligament and hepatic hilus. J Hepatobiliary Pancreat Surg. 2002; 9:531–533.

3. Ohkubo M, Nagino M, Kamiya J, Yuasa N, Oda K, Arai T, et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg. 2004; 239:82–86.

4. Lee KK, Lee SK, Moon IS, Kim DG, Lee MD. Surgical techniques according to anatomic variations in living donor liver transplantation using the right lobe. Transplant Proc. 2008; 40:2517–2520.

5. 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; 75:3 Suppl. S28–S32.

6. Varotti G, Gondolesi GE, Goldman J, Wayne M, Florman SS, Schwartz ME, et al. Anatomic variations in right liver living donors. J Am Coll Surg. 2004; 198:577–582.

7. Nakamura T, Tanaka K, Kiuchi T, Kasahara M, Oike F, Ueda M, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002; 73:1896–1903.