Hepatic Artery Reconstruction Using the Recipient's Right Gastroepiploic Artery in Living Donor Liver Transplantation

PURPOSE: The hepatic arteries of transplant recipients are sometimes in too poor a condition to make a good anastomosis in living donor liver transplantation. The aim of this study was to evaluate the outcome of hepatic artery reconstruction using the recipient's right gastroepiploic artery. METHODS: A total of 153 LDLTs were performed at Seoul National University Hospital from January 1999 to December 2003. In 10 cases, arterial reconstruction was performed by anastomosis of the donor's hepatic artery to the recipient's right gastroepiploic artery. Hepatic artery reconstruction was carried out with the aid of an operating microscope and with using the interrupted Carrel's technique. The adequate blood flow was verified during the operation by the Doppler ultrasonography and also daily for seven days after transplantation by means of Doppler ultrasonography. The median length of the follow-up was 40 months (range: 20~60 months). RESULTS: In seven cases out of ten, the recipient's right gastroepiploic artery was initially used due to arterial thrombosis or because of severe endothelial damage of the recipient's hepatic artery. In the remaining three cases, the graft was revascularized using the recipient's right gastroepiploic artery. In all cases, excellent hepatic arterial flow was confirmed by the Doppler ultrasonography during the operation. Complications related to the hepatic artery were not detected during the follow-up period. CONCLUSION: The recipient's right gastroepiploic artery is a suitable alternative for hepatic artery reconstruction in LDLT.

Modified technique for construction of orthotopic liver transplantation model in mice / 中国普通外科杂志

Objective To study the surgical technique of construction of orthopic liver transplantation model in mice by a single operator.Methods On the basis of two-cuff technique,running suture was used to reestablish the suprahepatic vena cava(SHVC),"two-cuff"technology to reestablish the portal vein(PV)and infrahepatic vena cava(IHVC),and"stent"to reestablish the bile duct.Operation was performed in 70 mice,the 24 h,1 week,1M postoperative survival rate were noted,and hepatic function and pathological change were observed.Results The 24 h,1 week and 1M survival rate was 95.7%,90.9%,85.1%,respectively.The ALT increased gradually in the first postoperative week,and dropped to normal level in the first month.Pathology showed the structure of liver tissue was fine.Conclusions The method is an ideal mothod to establish the orthotopic liver transplantation model in mice,because it has high survival rate,good stability and is easily replicated.

The perioperative management of orthotopic liver transplantation in Chinese inbred miniature porcine / 中国普通外科杂志

Objective To summarise the perioperative features of orthotopic liver transplantations(OLTs) in miniature porcine,to establish mature、stable OLT models.Methods In order to observe hemodynamics and blood changes and improved perioperative management and summarise the perioperative characteristics,8 preliminary experiments(group A) and 18 experiments(group B) of OLTs were performed without veno-venous bypass(VVB) in Chinese inbred miniature porcine.Results The mean operation time was(179.6?14.3)min in our 18 OLTs,and the mean anhepatic phase time was(27.3?3.4)min.Dramatic hemodynamic and metabolic changes were identified during anhepatic phase.The oneweek survival rate was 88.9% in group B,but all the 8 pigs in group A died.The experiment group pigs urinated after 3～5hours and had normal diet after 3days.Conclusions Decreasing the operation time and stability of hemodynamics in anhepatic phase are the keys for success in OLTs without VVB.

Repair of anatomic anomaly of hepatic artery in donor liver / 中国普通外科杂志

Objective To study the characteristics of hepatic artery anatomy and master the method of arterial repair,especially the method and technology of repair of anomalous donor arteries.Methods Sixty-four(human) liver arteries were dissected and repaired,and 31 of these were used in liver transplantation.Results Twelve of 64 cases had anatomical anomaly of hepatic artery(12/64,18.75%).Five of 24 fetal(liver) donors(20.83%) had anatomical anomaly of hepatic artery,one arose from the superior mesentery(artery) as a replaced right hepatic artery,3 from accessory right hepatic artery,and in 1 case the hepatic(artery) arose from superior mesentery artery directly.Seven adults had hepatic artery anomalies:2 cases of right hepatic artery being replaced by artery derived from SMA,2 cases of left hepatic artery deriving from left gastric artery and 3 cases of accessory right hepatic artery derived from SMA.In 31 hepatic(transplantations),4 grafts with anatomical anomaly of right hepatic artery were used.Conclusions (Reconstruction) of hepatic artery plays an important role in hepatic transplantation.Avoidance of injury to(aberrant) hepatic avteries during removal of donor liver is a key to ensure successful arterial repair.During(repair) of very small accessory hepatic arteries,ligation or repair of the artery may be determined after(observation) of backflow from collateral vessels.

Clinical analysis of right lobe hepatectomy in adult-to-adult living donor liver transplantations / 中国普通外科杂志

Objective To study the surgical technique of right hemihepatectomy in adult-to-adult living donor liver transplantation . Methods Eight donors underwent right hemihepatectomy in adult-to-adult living donor liver transplantation . Among these donors operation, there were 5 right hemihepatectomy and 3 extended right hemihepatectomy . If the diameter of the auxiliary right hepatic vein more than 0.8cm, it should be reserved. The dissection line of right hemihepatectomy was at the 0.5cm～1.0cm to the right side of middle hepatic vein, and the dissection line of extended right hemihepatectomy was at 0.5cm～1.0cm to the left side of middle hepatic vein. Intraoperative cholangiogram was performed, and without inflow vascular occlusion was done during the operation.Results The donor average operation time was 448 min (ranged from 353 min to 510 min). The average blood loss of operation was 384 ml (ranged from 170ml to 900ml). The grafts average weight was 669.4g (ranged from 445g to 900g), the right hemihepatic grafts weighted 667.0g averagely and the extended right hemihepatectic grafts weighted 673.3g averagely.The average graft-to-recipient body weight was 1.16% (ranged from 0.76% to 1.50% ). There were 2 donors occurred complications including biliary leak in 1, and dysfunction of liver and kidney in 1, all the 2 complications were cured. There was no donor mortality and all donors well recovered,All the donors were discharged within three weeks after operation.All of the 8 grafts and 8 recipients survived one year. Conclusions The right hemihepatectomy and extended right hemihepatectomy in adult-to-adult living donor liver transplantation can be performed safely,if the liver resection techmqne is proformed exactly and successfully.