Experience of Right Lobe Hepatectomy in Living Donor Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Wentao , ZHANG Li , ZENG Zhigui , WEI Lin , ZHU Zhijun , ZHENG Hong , PAN Cheng , DENG Yonglin , SHEN Zhongyang

Transplant Center, Tianjing First Central Hospital, Tianjin 300192, China;

Corresponding author：

Keywords：

Living donor liver transplantation; Procurement of liver graft; Surgical experience; Perioperative period

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Objective To report our experience in living donor liver harvesting of right lobe grafts. Methods
The data of 76 living donors of right lobe grafts hepatectomy between August 2007 and December 2008 were studied. Before operation, the graft size, remnant liver volume rate, fatty liver, middle hepatic vein type, and the level of portal hypertension of recipient were comprehensive assessed to determine whether harvested middle hepatic vein. The graft was harvested depending on the port vein and hepatic artery ischemia-line. B-ultrasound was used to definite the structure and branch of middle hepatic vein, and intraoperative cholangiography was performed to definite the structure and variation of bile duct. Donor operative time, intraoperative blood loss, postoperative hospital stay, levels of bilirubin, international normalized ratio （INR）, and ALT, and complications after operation were recorded. Results All the operations were successful. The operative time was (8.3±1.3) h, the blood loss was (325±127) ml without blood transfusion in operation. The ALT, INR, and bilirubin recovered on the 12th day. The most common complication in early post-operation was wound infection in 5 cases, 4 cases had cholestasis, 4 cases occurred cross-section bile leakage, and 11 cases occurred varying degrees of delayed gastric emptying in 4～7 d after operation, who were all alleviated by corresponding treatments. The hospital stay was 9～21 d (median: 14 d) after operation. Conclusion Preoperative evaluation of the hepatic anatomy and precise surgical procedure are crucial, which will help the development of graft harvesting and rehabilitation of donor.

Citation： JIANG Wentao,ZHANG Li,ZENG Zhigui,WEI Lin,ZHU Zhijun,ZHENG Hong,PAN Cheng,DENG Yonglin,SHEN Zhongyang. Experience of Right Lobe Hepatectomy in Living Donor Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 528-531. doi: Copy

1.	朱志军，侯建存，张雅敏, 等. 活体右半肝移植肝中静脉取舍选择与供受者的安全性 [J]. 中华医学杂志， 2009， 89（26）： 1825-1829.
2.	Gruttadauria S, Marsh JW, Vizzini GB, et al. Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation [J]. World J Gastroenterol, 2008; 14(20): 3159-3164.
3.	Hasegawa Y, Kawachi S, Shimazu M, et al. Discontinuation of living donor liver transplantation for PSC due to histological abnormalities in intraoperative donor liver biopsy [J]. Am J Transplant, 2007; 7(9): 2204-2207.
4.	Tanaka K, Uemoto S, Tokunaga Y, et al. Surgical techniques and innovations in living related liver transplantation. [J]. Ann Surg, 1993; 217(1): 82-91.
5.	Kubota K, Makuuchi M, Takayama T, et al. Successful hepatic vein reconstruction in 42 consecutive living related liver transplantations [J]. Surgery, 2000; 128(1): 48-53.
6.	Moon DB, Lee SG. Adult-to-adult living donor liver transplantation at the Asan Medical Center [J]. Yonsei Med J, 2004; 45(6): 1162-1168.
7.	Orguc S, Tercan M, Bozoklar A, et al. Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe [J]. Transplant Proc, 2004; 36(9): 2727-2732.
8.	陈拥军，彭承宏，沈柏用, 等. 成人间活体肝移植供体行改良扩大右半肝切除的安全性 [J]. 外科理论与实践, 2008; 13（4）: 316-321.
9.	Grewal HP, Thistlewaite JR Jr, Loss GE, et al. Complications in 100 living-liver donors [J]. Ann Surg, 1998; 228(2): 214-219.
10.	Ikegami T, Nishizaki T, Yanaga K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors [J]. Surgery, 2001; 129(1): 86-90.
11.	Azoulay D, Marin-Hargreaves G, Castaing D, et al. Duct-to-duct biliary anastomosis in living related liver transplantation: the Paul Brousse technique [J]. Arch Surg, 2001; 136(10): 1197-1200.
12.	Sterneck MR, Fischer L, Nischwitz U, et al. Selection of the living liver donor [J]. Transplantation, 1995; 60(7): 667-671.
13.	Cho EH, Suh KS, Lee HW, et al. Safety of modified extended right hepatectomy in living liver donors [J]. Transpl Int, 2007; 20(9): 779-783.
14.	Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
15.	Marcos A, Ham JM, Fisher RA, et al. Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe [J]. Liver Transpl, 2000; 6(3): 296-301.
16.	Grewal HP, Shokouh-Amiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction [J]. Ann Surg, 2001; 233(4): 502-508.
17.	Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
18.	Middleton PF, Duffield M, Lynch SV, et al. Living donor liver transplantation-adult donor outcomes: a systematic review [J]. Liver Transpl, 2006; 12(1): 24-30.
19.	Ghobrial RM, Hsieh CB, Lerner S, et al. Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation [J]. Liver Transpl, 2001; 7(6): 551-555.
20.	陈虎，张恺欣，王瑞, 等. 前入路绕肝提拉法在复杂右半肝切除中的应用体会 [J]. 医学信息(内·外科版), 2009; 22(8): 711-712.
21.	Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection [J]. Liver Transpl, 2003; 9(9): S26-S28.
22.	Poon RT, Chan J, Fan ST. Left hepatic vein kinking after right trisegmentectomy: a potential cause of postoperative liver failure [J]. Hepatogastroenterology, 1998; 45(20): 508-509.
23.	Masselot R, Leborgne J. Anatomical study of the hepatic veins [J]. Anat Clin, 1978; 1: 109-125.
24.	Imamura H, Makuuchi M, Sakamoto Y, et al. Anatomical keys and pitfalls in living donor liver transplantation [J]. J Hepatobiliary Pancreat Surg, 2000; 7(4): 380-394.
25.	El Moghazy WM, Hedaya MS, Kaido T, et al. Two different methods for donor hepatic transection: cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial [J]. Liver Transpl, 2009; 15(1): 102-105.

1. 朱志军，侯建存，张雅敏, 等. 活体右半肝移植肝中静脉取舍选择与供受者的安全性 [J]. 中华医学杂志， 2009， 89（26）： 1825-1829.
2. Gruttadauria S, Marsh JW, Vizzini GB, et al. Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation [J]. World J Gastroenterol, 2008; 14(20): 3159-3164.
3. Hasegawa Y, Kawachi S, Shimazu M, et al. Discontinuation of living donor liver transplantation for PSC due to histological abnormalities in intraoperative donor liver biopsy [J]. Am J Transplant, 2007; 7(9): 2204-2207.
4. Tanaka K, Uemoto S, Tokunaga Y, et al. Surgical techniques and innovations in living related liver transplantation. [J]. Ann Surg, 1993; 217(1): 82-91.
5. Kubota K, Makuuchi M, Takayama T, et al. Successful hepatic vein reconstruction in 42 consecutive living related liver transplantations [J]. Surgery, 2000; 128(1): 48-53.
6. Moon DB, Lee SG. Adult-to-adult living donor liver transplantation at the Asan Medical Center [J]. Yonsei Med J, 2004; 45(6): 1162-1168.
7. Orguc S, Tercan M, Bozoklar A, et al. Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe [J]. Transplant Proc, 2004; 36(9): 2727-2732.
8. 陈拥军，彭承宏，沈柏用, 等. 成人间活体肝移植供体行改良扩大右半肝切除的安全性 [J]. 外科理论与实践, 2008; 13（4）: 316-321.
9. Grewal HP, Thistlewaite JR Jr, Loss GE, et al. Complications in 100 living-liver donors [J]. Ann Surg, 1998; 228(2): 214-219.
10. Ikegami T, Nishizaki T, Yanaga K, et al. Changes in the caudate lobe that is transplanted with extended left lobe liver graft from living donors [J]. Surgery, 2001; 129(1): 86-90.
11. Azoulay D, Marin-Hargreaves G, Castaing D, et al. Duct-to-duct biliary anastomosis in living related liver transplantation: the Paul Brousse technique [J]. Arch Surg, 2001; 136(10): 1197-1200.
12. Sterneck MR, Fischer L, Nischwitz U, et al. Selection of the living liver donor [J]. Transplantation, 1995; 60(7): 667-671.
13. Cho EH, Suh KS, Lee HW, et al. Safety of modified extended right hepatectomy in living liver donors [J]. Transpl Int, 2007; 20(9): 779-783.
14. Fan ST, Lo CM, Liu CL, et al. Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation [J]. Ann Surg, 2003; 238(1): 137-148.
15. Marcos A, Ham JM, Fisher RA, et al. Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe [J]. Liver Transpl, 2000; 6(3): 296-301.
16. Grewal HP, Shokouh-Amiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction [J]. Ann Surg, 2001; 233(4): 502-508.
17. Inomata Y, Uemoto S, Asonuma K, et al. Right lobe graft in living donor liver transplantation [J]. Transplantation, 2000; 69(2): 258-264.
18. Middleton PF, Duffield M, Lynch SV, et al. Living donor liver transplantation-adult donor outcomes: a systematic review [J]. Liver Transpl, 2006; 12(1): 24-30.
19. Ghobrial RM, Hsieh CB, Lerner S, et al. Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation [J]. Liver Transpl, 2001; 7(6): 551-555.
20. 陈虎，张恺欣，王瑞, 等. 前入路绕肝提拉法在复杂右半肝切除中的应用体会 [J]. 医学信息(内·外科版), 2009; 22(8): 711-712.
21. Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection [J]. Liver Transpl, 2003; 9(9): S26-S28.
22. Poon RT, Chan J, Fan ST. Left hepatic vein kinking after right trisegmentectomy: a potential cause of postoperative liver failure [J]. Hepatogastroenterology, 1998; 45(20): 508-509.
23. Masselot R, Leborgne J. Anatomical study of the hepatic veins [J]. Anat Clin, 1978; 1: 109-125.
24. Imamura H, Makuuchi M, Sakamoto Y, et al. Anatomical keys and pitfalls in living donor liver transplantation [J]. J Hepatobiliary Pancreat Surg, 2000; 7(4): 380-394.
25. El Moghazy WM, Hedaya MS, Kaido T, et al. Two different methods for donor hepatic transection: cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial [J]. Liver Transpl, 2009; 15(1): 102-105.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of Right Lobe Hepatectomy in Living Donor Liver Transplantation

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