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Open Access 01-12-2022 | Liver Transplantation | Research

IV segment portal vein reconstruction in split-liver transplantation with extended right grafts

Authors: Dong Wang, Ning Fan, Xin Wang, Yandong Sun, Ge Guan, Jianhong Wang, Xiaodan Zhu, Yunjin Zang, Jinzhen Cai, Yuan Guo

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

Liver transplantation is one of the most effective treatments for end-stage liver disease. Split liver transplantation (SLT) can effectively improve the utilization efficiency of grafts. However, split liver transplantation still faces shortcomings and is not widely used in surgery. How to improve the effective transplantation volume of split liver transplantation and promote the postoperative recovery of patients has important clinical significance.

Methods

In our study, the donor’s liver was split into the extended right graft and left lateral sector, and the IV segment occur ischemia. To guarantee the functional graft size, and avoid complications, we reconstructed the IV segment portal vein and left portal vein. And we analyzed the operation time, intraoperative bleeding, liver function, and postoperative complications.

Results

In our research, 14 patients underwent IV segment portal vein reconstruction, and 8 patients did not undergo vascular reconstruction. We found that the ischemic area of the IV segment decreased significantly after IV segment portal vein reconstruction. We found that there was no significant difference in operation time and postoperative complications between the patients of the groups. There were significant differences in ALT on the 1st day and albumin on the 6th day after the operation.

Conclusion

It indicates that IV segment reconstruction in SLT surgery can alleviate the graft ischemic and promote the recovery of liver function after the operation. And, IV segment reconstruction as a novel operating procedure may be widely used in SLT.

Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. Split liver transplantation: current developments. World J Gastroenterol. 2018;24:5312–21. https://doi.org/10.3748/wjg.v24.i47.5312.CrossRefPubMedPubMedCentral

Lee WC, Chan KM, Chou HS, Wu TJ, Lee CF, Soong RS, et al. Feasibility of split liver transplantation for 2 adults in the model of end-stage liver disease era. Ann Surg. 2013;258:306–11. https://doi.org/10.1097/SLA.0b013e3182754b8e.CrossRefPubMed

Moussaoui D, Toso C, Nowacka A, McLin VA, Bednarkiewicz M, Andres A, et al. Early complications after liver transplantation in children and adults: are split grafts equal to each other and equal to whole livers? Pediatr Transplant. 2017;21:e12908. https://doi.org/10.1111/petr.12908.CrossRef

Maggi U, De Feo TM, Andorno E, Cillo U, De Carlis L, Colledan M, et al. Fifteen years and 382 extended right grafts from in situ split livers in a multicenter study: are these still extended criteria liver grafts? Liver Transpl. 2015;21:500–11. https://doi.org/10.1002/lt.24070.CrossRefPubMed

Hashimoto K, Quintini C, Aucejo FN, Fujiki M, Diago T, Watson MJ, et al. Split liver transplantation using Hemiliver graft in the MELD era: a single center experience in the United States. Am J Transplant. 2014;14:2072–80. https://doi.org/10.1111/ajt.12791.CrossRefPubMed

Battula NR, Platto M, Anbarasan R, Perera MT, Ong E, Roll GR, et al. Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center. Ann Surg. 2017;265:1009–15. https://doi.org/10.1097/sla.0000000000001816.CrossRefPubMed

Hashimoto K, Fujiki M, Quintini C, Aucejo FN, Uso TD, Kelly DM, et al. Split liver transplantation in adults. World J Gastroenterol. 2016;22:7500–6. https://doi.org/10.3748/wjg.v22.i33.7500.CrossRefPubMedPubMedCentral

Doyle MB, Maynard E, Lin Y, Vachharajani N, Shenoy S, Anderson C, et al. Outcomes with split liver transplantation are equivalent to those with whole organ transplantation. J Am Coll Surg. 2013;217:102–12. https://doi.org/10.1016/j.jamcollsurg.2013.03.003 (discussion 113-104).CrossRefPubMed

Chul Yoon K, Song S, Jwa EK, Lee S, Man Kim J, Kim OK, et al. Survival outcomes in split compared with whole liver transplantation. Liver Transpl. 2018;24:1411–24. https://doi.org/10.1002/lt.25196.CrossRefPubMed

10.

Quesnelle KM, Bystrom PV, Toledo-Pereyra LH. Molecular responses to ischemia and reperfusion in the liver. Arch Toxicol. 2015;89:651–7. https://doi.org/10.1007/s00204-014-1437-x.CrossRefPubMed

11.

Heaton N. Small-for-size liver syndrome after auxiliary and split liver transplantation: donor selection. Liver Transpl. 2003;9:S26-28. https://doi.org/10.1053/jlts.2003.50197.CrossRefPubMed

12.

Ross MW, Cescon M, Angelico R, Andorno E, Rossi G, Pinna A, et al. A matched pair analysis of multicenter longterm follow-up after split-liver transplantation with extended right grafts. Liver Transpl. 2017;23:1384–95. https://doi.org/10.1002/lt.24808.CrossRefPubMed

13.

Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H. Transplantation of a donor liver to 2 recipients (splitting transplantation)—a new method in the further development of segmental liver transplantation. Langenbecks Arch Chir. 1988;373:127–30.CrossRef

14.

Perito ER, Roll G, Dodge JL, Rhee S, Roberts JP. Split liver transplantation and pediatric waitlist mortality in the United States: potential for improvement. Transplantation. 2019;103:552–7. https://doi.org/10.1097/TP.0000000000002249.CrossRefPubMedPubMedCentral

15.

Malagó M, Hertl M, Testa G, Rogiers X, Broelsch CE. Split-liver transplantation: future use of scarce donor organs. World J Surg. 2002;26:275–82. https://doi.org/10.1007/s00268-001-0216-z.CrossRefPubMed

16.

Perkins JD, Dick AA, Healey PJ, Montenovo MI, Biggins SW, Sibulesky L, et al. New evidence supporting increased use of split liver transplantation. Transplantation. 2020;104:299–307. https://doi.org/10.1097/tp.0000000000002853.CrossRefPubMed

17.

Gong N, Chen X. Partial liver transplantation. Front Med. 2011;5:1–7. https://doi.org/10.1007/s11684-010-0105-7.CrossRefPubMed

18.

Lauterio A, Di Sandro S, Concone G, De Carlis R, Giacomoni A, De Carlis L. Current status and perspectives in split liver transplantation. World J Gastroenterol. 2015;21:11003–15. https://doi.org/10.3748/wjg.v21.i39.11003.CrossRefPubMedPubMedCentral

19.

Cauley RP, Vakili K, Fullington N, Potanos K, Graham DA, Finkelstein JA, et al. Deceased-donor split-liver transplantation in adult recipients: is the learning curve over? J Am Coll Surg. 2013;217:672-684.e671. https://doi.org/10.1016/j.jamcollsurg.2013.06.005.CrossRefPubMedPubMedCentral

Title: IV segment portal vein reconstruction in split-liver transplantation with extended right grafts
Authors: Dong Wang
Ning Fan
Xin Wang
Yandong Sun
Ge Guan
Jianhong Wang
Xiaodan Zhu
Yunjin Zang
Jinzhen Cai
Yuan Guo
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01761-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

IV segment portal vein reconstruction in split-liver transplantation with extended right grafts

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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