Advertisement

Right Hemihepatectomy for Living Donor Liver Transplantation in Adults (Open Technique)

  • Luciano De Carlis
  • Paolo Aseni
  • Stefano Di Sandro
  • Iacopo Mangoni
  • Raffaella Sguinzi
  • Andrea Lauterio
Chapter

Abstract

In this Chapter we discuss the technical details of the right hemihepatectomy for living donor liver transplantation in adults by open technique. Successful donor outcome and the recipient’s hope for the highest probability of a successful transplant are relevant factors that ethically support the choice for living donor liver tranplantation.

The liver’s extrahepatic vasculobiliary anatomy should be carefully determined by recognizing preoperatively all different types of the anatomical pattern. Graft weight/recipient weight ratio >0.8 % and a graft volume/standard liver volume ratio >40 % are the safe limits to avoid small for size syndrome in recipients. During right hemiepatectomy leave untouched the left triangular ligament or the gastrohepatic ligament, because their section produces an excessive mobility of the left lobe with possible torsion or kinking and outflow occlusion of the remnant graft. Throughout the hilar dissection, extreme care should be employed to avoid the devascularization of the common bile duct with possible ischemic biliary stricture in the donor. The preservation of the mean hepatic vein avoids the congestion of S IV and subsequent liver dysfunction in the donor. Try to perform extensive revascularization of all hepatic vein tributaries of the MHV (V5, V8) and all accessory hepatic veins (V6 and V7), when with caliber >4 mm. To maintain the correct parenchyma transection plane, the “hanging maneuver” may be useful.

Keywords

Hepatic Artery Hepatic Vein Live Donor Liver Transplantation Deceased Donor Biliary Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

AHV

Accessory hepatic vein

DD

Deceased donor

HVTs

Hepatic vein tributaries

LDLT

Living donor liver transplantation

LH

Left hepatectomy

LLS

Left lateral segment

MHV

Middle hepatic vein

RH

Right hemihepatectomy

RHV

Right hepatic vein

SI-VIII

Segment (roman numeration refers to each segment)

SLT

Split liver transplantation

SFSS

Small-for-size syndrome

V 1-8

Vein (hepatic accessory or tributary; Arabic numeration refers to each single segment)

References

  1. 1.
    Marsh JW, Gray E, Ness R, Starzl TE (2009) Complications of right lobe living donor liver transplantation. J Hepatol 51:715–724CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Mathur AK, Ashby VB, Fuller DS, Zhang M, Merion RM, Leichtman A, Kalbfleisch J (2014) Variation in access to the liver transplant waiting list in the United States. Transplantation 98:94–99CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Global observatory on donation and transplantation. Organ donation and transplantation activities, 2012. 1 July 2014. http://issuu.com/o-n- t/docs/2012ad. Accessed 6 July 2015
  4. 4.
    Miller CM, Smith ML, Diago Uso T (2012) Living donor liver transplantation: ethical considerations. Mt Sinai J Med 79:214–222CrossRefPubMedGoogle Scholar
  5. 5.
    Siegler M, Simmerling MC, Siegler JH, Cronin DC 2nd (2006) Recipient deaths during donor surgery: a new ethical problem in living donor liver transplantation (LDLT). Liver Transpl 12:358–360CrossRefPubMedGoogle Scholar
  6. 6.
    Raia S, Nery JR, Mies S (1989) Liver transplantation form live donors. Lancet 2:497CrossRefPubMedGoogle Scholar
  7. 7.
    Strong R, Ong TH, Pillay P, Wall D, Balderson G, Lynch S (1988) A new method of segmental orthotopic liver transplantation in children. Surgery 104:104–107PubMedGoogle Scholar
  8. 8.
    Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistrlethwaite JR, Stevens L et al (1991) Liver transplantation in children from living related donors. Ann Surg 214:428–439CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Tanaka K, Uemoto S, Tokunaga Y, Fujita S, Sano K, Nishizawa T, Sawada H, Shirahase I, Kim HJ, Yamaoka Y et al (1993) Surgical techniques and innovations in living related liver transplantation. Ann Surg 217:82–91CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Yamaoka Y, Washida M, Honda K, Tanaka K, Mori K, Shimahara Y, Okamoto S, Ueda M, Hayashi M, Tanaka A et al (1994) Liver transplantation using a right lobe graft from a living related donor. Transplantation 57:1127–1130CrossRefPubMedGoogle Scholar
  11. 11.
    Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA, Sterling RK, Posner MP (1999) Right lobe living donor liver transplantation. Transplantation 68:798–803CrossRefPubMedGoogle Scholar
  12. 12.
    Nadalin S, Bockhorn M, Malagó M, Valentin-Gamazo C, Frilling A, Broelsch CE (2006) Living donor liver transplantation. HPB (Oxford) 8:10–21Google Scholar
  13. 13.
    Varotti G, Gondolesi GE, Goldman J, Wayne M, Florman SS, Schwartz ME, Miller CM, Sukru E (2004) Anatomic variations in right liver living donors. J Am Coll Surg 198:577–582CrossRefPubMedGoogle Scholar
  14. 14.
    Jeon YM, Lee KW, Yi NJ, Lee JM, Hong G, Choi Y, Park MS, Kim H, Suh KS (2013) The right posterior bile duct anatomy of the donor is important in biliary complications of the recipients after living-donor liver transplantation. Ann Surg 257:702–707CrossRefPubMedGoogle Scholar
  15. 15.
    Roll GR, Parekh JR, Parker WF, Siegler M, Pomfret EA, Ascher NL, Roberts JP (2013) Left hepatectomy versus right hepatectomy for living donor liver transplantation: shifting the risk from the donor to the recipient. Liver Transpl 19:472–481CrossRefPubMedGoogle Scholar
  16. 16.
    Chan SC, Liu CL, Lo CM, Lam BK, Lee EW, Wong Y, Fan ST (2006) Estimating liver weight of adults by body weight and gender. World J Gastroenterol 12:2217–2222CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hill MJ, Hughes M, Jie T, Cohen M, Lake J, Payne WD, Humar A (2009) Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants? Liver Transpl 15:1056–1062CrossRefPubMedGoogle Scholar
  18. 18.
    Ghazaly M, Badawy MT, El-Din Soliman H, El-Gendy M, Ibrahim T, Davidson BR. Venous outflow reconstruction in adult living donor liver transplant: outcome of a policy for right lobe grafts without the middle hepatic vein. HPB Surg 2013, Article ID 280857, 11 pages http://dx.doi.org/10.1155/2013/280857
  19. 19.
    Radtke A, Schroeder T, Sotiropoulos GC, Molmenti E, Schenk A, Paul A, Nadalin S, Lang H, Saner F, Peitgen HO, Broelsch CE, Malagò M (2005) Anatomical and physiological classification of hepatic vein dominance applied to liver transplantation. Eur J Med Res 10:187–194PubMedGoogle Scholar
  20. 20.
    Grewal HP, Shokouh-Amiri MH, Vera S, Stratta R, Bagous W, Gaber AO (2001) Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction. Ann Surg 233:502–508CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Makuuchi M, Sugawara Y (2004) Technical progress in living donor liver transplantation for adults. HPB (Oxford) 6(2):95–98CrossRefGoogle Scholar
  22. 22.
    Kim JD, Choi DL, Han YS (2014) Simplified one-orifice venoplasty for middle hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts. Clin Transplant 28:561–568CrossRefPubMedGoogle Scholar
  23. 23.
    Amin AA, Kamel R, Hatata Y, Attia H, Marawan I, Hosney A, El-Malt O, Tanaka K (2009) Crucial issues of hepatic artery reconstruction in living donor liver transplantation: our experience with 133 cases at Dar Al-Fouad Hospital, Egypt. J Reconstr Microsurg 25:307–312CrossRefPubMedGoogle Scholar
  24. 24.
    Wang SF, Huang ZY, Chen XP (2011) Biliary complications after living donor liver transplantation. Liver Transpl 17:1127–1136CrossRefPubMedGoogle Scholar
  25. 25.
    Shimul A, Shah MD, Gary A, Levy MD, Lesley D, Adcock MD, Gary Gallagher RN, David R, Grant MD (2006) Adult-to-adult living donor liver transplantation. Can J Gastroenterol 20:339–343CrossRefGoogle Scholar
  26. 26.
    Nakamura (2002) Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lesson from 120 cases. Transplantation 73:1896–1903Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Luciano De Carlis
    • 1
  • Paolo Aseni
    • 1
  • Stefano Di Sandro
    • 1
  • Iacopo Mangoni
    • 1
  • Raffaella Sguinzi
    • 1
  • Andrea Lauterio
    • 1
  1. 1.Department of Surgery and Abdominal TransplantationTransplant Center, Niguarda Ca’ Granda HospitalMilanItaly

Personalised recommendations