Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2015; 5(4): 145-153
Published online Dec 24, 2015. doi: 10.5500/wjt.v5.i4.145
Venous outflow reconstruction in living donor liver transplantation: Dealing with venous anomalies
Long-Bin Jeng, Ashok Thorat, Horng-Ren Yang, Ping-Chun Li
Long-Bin Jeng, Ashok Thorat, Horng-Ren Yang, Organ Transplantation Center, China Medical University Hospital, Taichung 40447, Taiwan
Long-Bin Jeng, Horng-Ren Yang, Department of Surgery, China Medical University Hospital, Taichung 40447, Taiwan
Ping-Chun Li, Department of Cardio-vascular Surgery, China Medical University Hospital, Taichung 40447, Taiwan
Author contributions: Jeng LB and Thorat A designed the structure, searched the literature and wrote the article; Yang HR and Li PC provided the details of techniques, and images.
Conflict-of-interest statement: Authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Long-Bin Jeng, MD, Organ Transplantation Center, China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan. otc@mail.cmuh.org.tw
Telephone: +886-4-22052121-1765 Fax: +886-4-22029083
Received: June 28, 2015
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
Abstract

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.

Keywords: Venoplasty; Outflow reconstruction; Living donor liver transplantation; “V-Plasty” technique; Single oval ostium technique

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.