J Korean Soc Transplant.  2015 Sep;29(3):109-117. 10.4285/jkstn.2015.29.3.109.

Liver Procurement

• Choi YR
• Lee KW

• KMID: 2202583
• DOI: http://doi.org/10.4285/jkstn.2015.29.3.109

Abstract

With increasing demand for liver transplantation, liver grafts are used from marginal donors who were not considered suitable. This trend toward the use of marginal donors reinforces the need to balance the recipient's condition and graft quality and to perform a liver retrieval process with a proper method for preservation of liver function. Although the issues in organ procurement are debatable, rapid and high pressure perfusion for the aorta only with a cold dissection method can be an optimal method for the successful recipient outcome in liver transplantation using a marginal graft.

Keyword

Liver transplantation; Organ procurement; Organ donor

MeSH Terms

Aorta
Humans
Liver Transplantation
Liver*
Perfusion
Tissue and Organ Procurement
Tissue Donors
Transplants

Figure

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  Fig. 1. Yearly distribution of deceased donor age. Adapted from Table 1–2–2 of reference [1].

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  Fig. 2. Thoracoabdominal incision. A complete midline incision is performed from the suprasternal notch to the pubis.

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  Fig. 3. Liver mobilization and Kocherization. (A) Ligamentum venosum was identified, (B) Dissection of the right paracolic gutter, (C) Inferior vena cava exposure after Kocherizaiton.

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  Fig. 4. Preparation for cannulation.(A) The inferior mesenteric vein was encircled, (B) Abdominal aorta encircled with 1∼0 Nylon, (C) Lumbar artery was identified and ligated, (D) Inferior vena cava was dissected with a blunt right angle clamp, (E) The supraceliac aorta was palpable and right crus muscle was dissected, (F) The aorta was exposed.

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  Fig. 5. Catheterizations and rapid cooling. (A) Inferior mesenteric vein was cannulated, (B) The distal aorta was ligated and proximal abdominal aorta was clamped before cannulation, (C) Rapid cooling of thoracoabdominal organs after the aorta cross-clamping and preservation solution infusion.

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  Fig. 6. Gallbladder irrigation. Gallbladder irrigation with cold saline after rapid cooling.

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  Fig. 7. Liver harvesting. (A) Gastroduodenal artery was identified, (B) Superior mesenteric vein was resected and a catheter from inferior mesenteric vein was located in the vessel lumen, (C) Common bile duct was resected and bile should be irrigated, (D) Celiac axis was resected with aortic patch, (E) Diaphragm dissection after putting a index finger into inferior vena cava,(F) Intrahepatic inferior vena cava was dissected and resected above the orifice of renal vein.

Reference

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