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Article: Safety and Necessity of Including the Middle Hepatic Vein in the Right Lobe Graft in Adult-to-Adult Live Donor Liver Transplantation
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TitleSafety and Necessity of Including the Middle Hepatic Vein in the Right Lobe Graft in Adult-to-Adult Live Donor Liver Transplantation
 
AuthorsFan, ST1
Lo, CM1
Liu, CL1
Wang, WX1
Wong, J1
 
Issue Date2003
 
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
 
CitationAnnals Of Surgery, 2003, v. 238 n. 1, p. 137-148 [How to Cite?]
DOI: http://dx.doi.org/10.1097/00000658-200307000-00018
 
AbstractObjective: To evaluate the safety of donors who have donated the middle hepatic vein in right lobe live donor liver transplantation (LDLT) and to determine whether such inclusion is necessary for optimum graft function. Summary Background Data: The necessity to include the middle hepatic vein in a right lobe graft in adult-to-adult LDLT is controversial. Inclusion of the middle hepatic vein in the graft provides uniform hepatic venous drainage but may lead to congestion of segment IV in the donor. Methods: From 1996 to 2002, 93 right-lobe LDLTs were performed. All right-lobe grafts except 1 contained the middle hepatic vein. In the donor operation, attention was paid to preserve the segment IV hepatic artery and to avoid prolonged rotation of the right lobe. The middle hepatic vein was transected proximal to a major segment IVb hepatic vein whereas possible to preserve the venous drainage in the liver remnant. Results: There was no donor death. Two donors had intraoperative complications (accidental left hepatic vein occlusion and portal vein thrombosis) and were well after immediate rectification. Twenty-four donors (26%) had postoperative complications, mostly minor wound infection. The postoperative international normalized ratio on day 1 was better in the donors with preservation of segment IVb hepatic vein than those without the preservation, but, in all donors, the liver function was largely normal by postoperative day 7. The first recipient had severe graft congestion as the middle hepatic vein was not reconstructed before reperfusion. In 7 other recipients, the middle hepatic vein was found occluded intraoperatively owing to technical errors. The postoperative hepatic and renal function of the recipients with an occluded or absent middle hepatic vein was worse than those with a patent middle hepatic vein. The hospital mortality rate was also higher in those with an occluded middle hepatic vein (3/9 vs. 5/84, P = 0.028). Conclusions: Inclusion of the middle hepatic vein in right-lobe LDLT is safe and is essential for optimum graft function and patient survival.
 
ISSN0003-4932
2013 Impact Factor: 7.188
 
DOIhttp://dx.doi.org/10.1097/00000658-200307000-00018
 
PubMed Central IDPMC1422669
 
ISI Accession Number IDWOS:000185834900018
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorFan, ST
 
dc.contributor.authorLo, CM
 
dc.contributor.authorLiu, CL
 
dc.contributor.authorWang, WX
 
dc.contributor.authorWong, J
 
dc.date.accessioned2008-06-12T06:39:53Z
 
dc.date.available2008-06-12T06:39:53Z
 
dc.date.issued2003
 
dc.description.abstractObjective: To evaluate the safety of donors who have donated the middle hepatic vein in right lobe live donor liver transplantation (LDLT) and to determine whether such inclusion is necessary for optimum graft function. Summary Background Data: The necessity to include the middle hepatic vein in a right lobe graft in adult-to-adult LDLT is controversial. Inclusion of the middle hepatic vein in the graft provides uniform hepatic venous drainage but may lead to congestion of segment IV in the donor. Methods: From 1996 to 2002, 93 right-lobe LDLTs were performed. All right-lobe grafts except 1 contained the middle hepatic vein. In the donor operation, attention was paid to preserve the segment IV hepatic artery and to avoid prolonged rotation of the right lobe. The middle hepatic vein was transected proximal to a major segment IVb hepatic vein whereas possible to preserve the venous drainage in the liver remnant. Results: There was no donor death. Two donors had intraoperative complications (accidental left hepatic vein occlusion and portal vein thrombosis) and were well after immediate rectification. Twenty-four donors (26%) had postoperative complications, mostly minor wound infection. The postoperative international normalized ratio on day 1 was better in the donors with preservation of segment IVb hepatic vein than those without the preservation, but, in all donors, the liver function was largely normal by postoperative day 7. The first recipient had severe graft congestion as the middle hepatic vein was not reconstructed before reperfusion. In 7 other recipients, the middle hepatic vein was found occluded intraoperatively owing to technical errors. The postoperative hepatic and renal function of the recipients with an occluded or absent middle hepatic vein was worse than those with a patent middle hepatic vein. The hospital mortality rate was also higher in those with an occluded middle hepatic vein (3/9 vs. 5/84, P = 0.028). Conclusions: Inclusion of the middle hepatic vein in right-lobe LDLT is safe and is essential for optimum graft function and patient survival.
 
dc.description.naturepublished_or_final_version
 
dc.format.extent388 bytes
 
dc.format.mimetypetext/html
 
dc.identifier.citationAnnals Of Surgery, 2003, v. 238 n. 1, p. 137-148 [How to Cite?]
DOI: http://dx.doi.org/10.1097/00000658-200307000-00018
 
dc.identifier.doihttp://dx.doi.org/10.1097/00000658-200307000-00018
 
dc.identifier.epage148
 
dc.identifier.hkuros85314
 
dc.identifier.isiWOS:000185834900018
 
dc.identifier.issn0003-4932
2013 Impact Factor: 7.188
 
dc.identifier.issue1
 
dc.identifier.openurl
 
dc.identifier.pmcidPMC1422669
 
dc.identifier.pmid12832976
 
dc.identifier.scopuseid_2-s2.0-0042381928
 
dc.identifier.spage137
 
dc.identifier.urihttp://hdl.handle.net/10722/49341
 
dc.identifier.volume238
 
dc.languageeng
 
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
 
dc.publisher.placeUnited States
 
dc.relation.ispartofAnnals of Surgery
 
dc.relation.referencesReferences in Scopus
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshHepatic Veins - transplantation
 
dc.subject.meshLiver - blood supply - surgery
 
dc.subject.meshLiver Transplantation - methods
 
dc.subject.meshTransplants - standards
 
dc.subject.meshLiving Donors
 
dc.titleSafety and Necessity of Including the Middle Hepatic Vein in the Right Lobe Graft in Adult-to-Adult Live Donor Liver Transplantation
 
dc.typeArticle
 
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Author Affiliations
  1. The University of Hong Kong