Korean J Transplant.  2021 Jun;35(2):124-129. 10.4285/kjt.20.0055.

Recipient liver splitting to facilitate piggyback hepatectomy in adult living donor liver transplantation

• Kim SM
• Hwang S
• Moon DB
• Jung DH

• KMID: 2517296
• DOI: http://doi.org/10.4285/kjt.20.0055

Abstract

Recipient hepatectomy for an enlarged stony-hard liver is a demanding procedure, thus it is often accompanied by massive blood loss. Recipient liver splitting under prolonged hepatic inflow occlusion would facilitate the piggyback recipient hepatectomy. We herein present a case of recipient liver splitting, which was used for living donor liver transplantation (LDLT). A 48-year-old male patient diagnosed with acute-on-chronic liver failure underwent LDLT. During the recipient operation, the native liver was stony-hard and heavily adherent to the retrohepatic inferior vena cava (IVC). During liver mobilization, diffuse oozing occurred due to disseminated intravascular coagulation. As a change in the concept, we decided to perform in situ liver splitting of the recipient liver to facilitate dissection of the retrohepatic IVC. Under hepatic inflow occlusion, right-left liver splitting was performed along the usual plane of extended left hepatectomy. The procedures time for recipient liver splitting and removal was 60 minutes. A modified right liver graft recovered from his daughter was implanted according to the standard procedures of LDLT. We think that recipient liver splitting is a feasible technical option for coping with difficult recipient hepatectomy, especially in patients with an enlarged stony-hard liver and heavy adhesion around the IVC.

Keyword

Hepatectomy; Massive bleeding; Coagulopathy; Transfusion; Liver splitting

Figure

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  Fig. 1 Preoperative dynamic computed tomography findings. Hepatomegaly is visible (A) with poor development of portal vein collaterals (B).

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  Fig. 2 Intraoperative photographs. (A, B) Right-left hemiliver splitting along the usual plane of extended left hepatectomy or right hepatectomy was performed under hepatic inflow occlusion. (C) The left liver along with the caudate lobe was removed with temporary closure of the left-middle hepatic vein trunk. (D) The three hepatic vein stumps in the recipient inferior vena cava were widely open, and the left-sided edge was reinforced with an autologous saphenous vein patch.

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  Fig. 3 Posttransplant dynamic computed tomography (CT) findings. (A) CT scan taken 2 weeks after transplantation shows no abnormal findings with bulged portion of the graft hepatic vein reconstruction. (B) CT scan taken 10 years after transplantation also shows no abnormal findings.

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