Posterior cavoplasty: a new approach to avoid venous outflow obstruction and symptoms for small-for-size syndrome in right lobe living donor liver transplantation

Langenbecks Arch Surg. 2011 Mar;396(3):389-95. doi: 10.1007/s00423-010-0736-9. Epub 2011 Jan 5.

Abstract

Purpose: A common and serious problem after living donor liver transplantation (LDLT) of small grafts is small-for-size syndrome (SFSS). Although hyperdynamic portal inflow and portal hypertension are cornerstones in the development of SFSS, inadequate outflow may aggravate SFSS. Therefore, enlargement of the portal outflow tract by incision of the anterior rim of the orifice of the right hepatic vein (RHV) has been advocated for right lobe LDLT. But backwards tilt of a small graft into a large abdominal cavity may lead to a choking of the otherwise large anastomosis and thus we propose posterior enlargement of the orifice of the RHV.

Method: In this test-of-concept study, we evaluated portal vein pressure (PVP), clinical parameters, and laboratory measurements in 22 patients that underwent right lobe LDLT and either received standard end-to-end anastomosis of the RHV or posterior cavoplasty.

Results: In patients that underwent posterior cavoplasty, we observed significantly lower PVP and less hyperbilirubinemia. There was a non-significant trend to lower incidence of SFSS. Other laboratory measurements and clinical parameters were not significantly different.

Conclusion: We recommend posterior cavoplasty for enlargement of the hepatic venous outflow tract in right lobe LDLT as a method to avoid portal hypertension, hyperbilirubinemia, and possibly SFSS, especially in patients that receive small grafts.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anastomosis, Surgical / methods
  • Case-Control Studies
  • Constriction, Pathologic / prevention & control
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Hepatic Veins / physiopathology
  • Hepatic Veins / surgery*
  • Humans
  • Kaplan-Meier Estimate
  • Liver Circulation / physiology
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Living Donors*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Survival Rate
  • Treatment Outcome
  • Vascular Patency / physiology
  • Vascular Surgical Procedures / methods*
  • Venous Pressure*