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  • Title: Which is the best technique for hepatic venous reconstruction in pediatric living-donor liver transplantation? Experience from a single center.
    Author: Tannuri U, Santos MM, Tannuri AC, Gibelli NE, Moreira A, Carnevale FC, Ayoub AA, Maksoud-Filho JG, Andrade WC, Velhote MC, Silva MM, Pinho-Apezzato ML, Miyatani HT, Guimarães RR.
    Journal: J Pediatr Surg; 2011 Jul; 46(7):1379-84. PubMed ID: 21763838.
    Abstract:
    BACKGROUND/PURPOSE: The introduction of the piggyback technique for reconstruction of the liver outflow in reduced-size liver transplants for pediatric patients has increased the incidence of hepatic venous outflow block (HVOB). Here, we proposed a new technique for hepatic venous reconstruction in pediatric living-donor liver transplantation. METHODS: Three techniques were used: direct anastomosis of the orifice of the donor hepatic veins and the orifice of the recipient hepatic veins (group 1); triangular anastomosis after creating a wide triangular orifice in the recipient inferior vena cava at the confluence of all the hepatic veins (group 2); and a new technique, which is a wide longitudinal anastomosis performed at the anterior wall of the inferior vena cava (group 3). RESULTS: In groups 1 and 2, the incidences of HVOB were 27.7% and 5.7%, respectively. In group 3, no patient presented HVOB (P = .001). No difference was noted between groups 2 and 3. CONCLUSIONS: Hepatic venous reconstruction in pediatric living-donor liver transplantation must be preferentially performed by using a wide longitudinal incision at the anterior wall of the recipient inferior vena cava. As an alternative technique, triangulation of the recipient inferior vena cava, including the orifices of the 3 hepatic veins, may be used.
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