Fibrin Sealing of the Cut Surface of Liver Grafts in Partial Liver Transplantation with Living Related Donors

Abstract

One of the key issues in liver transplantation with living related donors (LRLT) is to control bleeding and bile leakage from the cut surface of the partial liver graft. For this purpose we covered the cut surface of the liver with fibrin sealant. From June 1990 to December 1992, we performed a series of 50 LRLT on children with end-stage liver disease, with the informed consent of their parents and the approval of the Ethics Committee of Kyoto University. In the donor, the cutting plane of liver resection was determined preoperatively based on the size and the vascular structure of the liver. Procurement of the partial liver graft was performed without vascular clamping and without graft manipulation to maintain graft viability. The hepatic parenchyma was transected with an ultrasonic aspirator, bipolar electrocautery, and elaborate ligation or suture ligation of the blood vessels. At the “back table”, the blood vessels were prepared for smooth and prompt reconstruction and fibrin glue was sprayed on the dried cut surface using compressed air. Actuarial recipient survival rate was 90 % (37 out of 41) in elective cases and 67 % (six out of nine) in urgent cases. No bleeding or biliary leakage was observed on the cut surface throughout the operation or during the postoperative phase in any of the cases thus far. No definite puric discharge from the graft cut surface was observed at laparotomy for surgical complications after transplantation. Our initial experiences of liver transplantation involving living related donors indicated that fibrin sealant was effective in securing hemostasis and preventing bile leakage after elaborate ligation of the vessels and bile ducts in the cut surface.