SURGICAL DEVICES FOR DECOMPRESSION OF EXCESSIVE SHEAR STRESS IN SMALL-FOR-SIZE LIVING RELATED DONOR LIVER TRANSPLANTATION -NEW HEPATIC VEIN RECONSTRUCTION-

Field: Medicine (Health Sciences)

P498 Aims: We have reported that the acute elevation of portal pressure, reflecting wall shear stress of sinusoidal endothelial cells, becomes a trigger for liver regeneration after partial hepatectomy and that excessive portal hypertension induces liver failure. So the reduction in excessive portal hypertension after living related donor liver transplantation (LRDLT) might prevent liver injury and post-transplanted hyperbilirubinemia. For prevention of excessive portal hypertension, various medical and surgical devices have been designed and performed. How the hepatic vein should be reconstructed is very important problem to avoid outflow block, especially in case with stenosis or obstruction of recipient’s hepatic vein and small-for-size graft. We underwent new device of hepatic vein reconstruction to make it possible for expansion of anastomotic site. So, we investigated the effects of the new device. Methods: Fourteen adult patients who underwent LRDLT from August 2001 to August 2003 were divided two groups. Nine patients were performed previous method (end to end anastomosis) of hepatic vein reconstruction (group P: mean age 52±6 years old, GV/RBW 0.68±0.14). Five patients were performed new method (group N: mean age 56±4 years old, GV/RBW 0.75±0.16). Before the left lobe liver graft was implanted, the outside of the graft middle and left hepatic vein were incised and enlarged to 40mm in diameter. Longitudinal incision of 40mm length was done into caudal site of recipient’s original hepatic vein of inferior vena cava for new orifice. The graft was rotated a little counterclockwise and sutured end to side anastomosis. Postoperative portal venous pressures and serum total bilirubin level were measured. Repeated measured ANOVA was used to test the differences of both portal venous pressures and serum total bilirubin level between the two groups following LRDLT. A P value less than 0.05 was considered statistically significant. Results: Post-transplanted hepatic venous flow was sufficient by Doppler US and computed tomography. In the group N, portal pressure rapidly decreased below 25cmH2O following LRDLT. Post-transplanted portal pressure in the group N tended to be lesser than that in the group P, however there was no statistical significance. In the group N, however all cases were small-for-size graft, there was no cases occurred post-transplanted hyperbilirubinemia above 10mg/dl. Moreover, serum total bilirubin level in the group N was statistically lower than that in the group P. No complications concerned with the new hepatic vein reconstruction was occurred. Conclusions: We underwent the new device of hepatic vein reconstruction in the adult left lobe liver transplantation. The anastomotic site was expanded twice the size in a diameter and sutured end to side anastomosis to inferior vena cava. This operative procedure is very simple anastomosis without using venous patch. If the hepatic vein of the recipient was narrow or obstructed such as Budd-Chiari syndrome, this procedure is very useful. Even in small-for-size graft, it did not occurred excessive tension in portal vein or hepatic artery anastomosis. Moreover, it is possible to avoid outflow block and post-transplanted hyperbilirubinemia.