Optimizing liver utilization for transplantation with partial grafts undergoing normothermic machine perfusion: Two case reports

Figure 2 Right trisectional graft reconstructions and connection to normothermic machine perfusion pump. A: Depiction of the donor iliac vein interposition graft reconstituting the proximal 4 cm of the middle hepatic vein (MHV) is depicted. Left portal vein ostium from main portal vein is being transversely closed. A donor iliac artery interposition graft to right hepatic artery (HA) will follow. Note at the transection surface that the amount of in-situ split was small (< 25%) to allow bloodless back table dissection and reconstruction of the MHV; B: It shows the placement of the right trisectional graft into the normothermic machine perfusion pump chamber with all the four canulae in their final positions. Note the graft rotan by 90 degrees clockwise to accommodate for the short portal vein. Note the 6 cm donor iliac artery interposition graft to right HA to allow connection to the 18 French arterial canula; C: The arterial inflow reconstruction; D: The arterial inflow reconstruction was performed with anastomosis of the right HA (extended by donor's right iliac artery) to the recipient’s common hepatic and gastroduodenal arteries confluence, creating a spatulated patch.