Ann Liver Transplant.  2021 May;1(1):86-94. 10.52604/alt.21.0004.

Quilt unification venoplasty of the right hepatic veins enabling double inferior vena cava anastomosis in living donor liver transplantation using a right liver graft

• Jung DH
• Hwang S
• Ahn CS
• Moon DB
• Ha TY
• Song GW
• Park GC
• Na BG
• Lee SG

• KMID: 2560856
• DOI: http://doi.org/10.52604/alt.21.0004

Abstract

The inferior right hepatic veins (IRHVs) and major short hepatic veins (SHVs) are indicated for vascular reconstruction to prevent hepatic venous congestion of the right liver grafts. As separate anastomoses of multiple IRHV/SHVs are vulnerable to stenosis, single large anastomosis through the unification of multiple hepatic vein openings is preferred. All right hepatic vein (RHV) openings can be unified through quilt unification venoplasty (QUV). After the introduction of QUV in 2004, we have developed several techniques and institutional guidelines for QUV. There are two types of QUV, all-in-one and RHV types. All-in-one QUV unifies the orthodox RHV, IRHV, SHV, and middle hepatic vein (MHV) branches using a large patch and MHV conduit. QUV for RHVs unifies the orthodox RHV, IRHV, and SHV, with separate reconstruction of the MHV conduit because a conjoined MHV conduit can be associated with outflow problems. For side-to-side anastomosis of QUV as like the double vena cava reconstruction, deep side-clamping of the recipient inferior vena cava is usually performed; however, shallow partial clamping can be used if necessary. The anatomy of the donor liver SHVs and the availability of sizable vessel patches are the primary determinants for designing the individualized configuration of QUV. We suggest that QUV using various vessel patches is useful for secure reconstruction of multiple IRHVs and SHVs to achieve successful implantation of the right liver grafts.

Keyword

Hepatic vein outflow obstruction; Right hepatic vein; Vein homograft; Stenosis; Living donor liver transplantation