Published online Dec 24, 2015. doi: 10.5500/wjt.v5.i4.145
Peer-review started: July 5, 2015
First decision: July 28, 2015
Revised: August 30, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: December 24, 2015
Processing time: 177 Days and 20 Hours
The reconstruction of the vascular outflow tract of partial liver grafts has received considerable attention in the past, especially in the setting of right liver grafts with undrained segments. Hepatic venous outflow reconstruction is an important factor for successful living donor liver transplantation outcome. However, in presence of undrained anterior sector and presence of multiple short hepatic veins that drain substantial portions of liver, outflow reconstruction without backtable venoplasty may lead to severe graft congestion and subsequent graft dysfunction. Various backtable venoplasty techniques in presence of multiple hepatic veins that can be used in either right- or left-lobe liver transplantation are devised to ensure a single, wide outflow channel. In this overview, various techniques to overcome the hepatic venous variations of liver allograft and outflow reconstruction are discussed.
Core tip: Outflow reconstruction in living donor liver transplantation is crucial for proper graft functioning. The right liver graft is a partial graft and requires backtable venoplasty to restore segmental venous drainage. A right liver graft without the middle hepatic vein along with presence of multiple short hepatic veins makes outflow reconstruction technically complex. To avoid postoperative liver congestion, suitable surgical techniques are applied to form a common outflow channel that provides adequate drainage for all the segments of liver. This article gives a comprehensive viewpoint for the venous outflow reconstruction in living donor liver transplantation.