Middle hepatic vein incorporation in live donor liver graft transplantation; implication and safety

Mahmoud Ali Abdi; Tayeb Sabir Kareem; Assad Abidon Hassoun

doi:10.24017/science.2021.1.14

Authors

Mahmoud Ali Abdi Digestive Surgery department, College of Medicine, Fellow at Kurdistan Board for Medical Specialization, Zheen International Hospital, Erbil, Iraq
Tayeb Sabir Kareem Department of digestive surgery, Hawler Medical University, Kurdistan Board for Medical Specialization, Rizgary Teaching Hospital, Erbil, Iraq
Assad Abidon Hassoun Department of Digestive Surgery, Kurdistan Board for Medical Specialization, General surgery & organ transplant surgeon, Zheen International Hospital, Erbil, Iraq

Abstract

Background: In this study, we have used the middle hepatic vein with the right lobe, and we studied the venous outflow dynamics immediately after transplant retrospectively meanwhile we studied the impact of the graft function on donor functionality and overall donor safety.

Method: Between October 2017 to October 2020, we performed 40 adult to adult live donor liver transplants at Zheen International Hospital (Erbil, Kurdistan Region). Postoperative Doppler ultrasound was performed for recipients and donors immediately after surgery and then daily until discharge.

Results: The donor age (28.5 ± 6.9) year, male/ female 19/ 21, intensive care unit stay (1.2 ± 0.43), floor stay (5.2 ± 1.4) days, their portal vein velocity (43.5 ± 18.4 ml/sec), hepatic artery resistive index (0.6 ± 0.09) and triphasic/ continuous venous outflow 30/10, their postoperative day one and at the discharge total serum bilirubin were (2.8 ± 1.8) and (2 ± 1.4), their postoperative day one and at the discharge international normalization ratio were (1.7 ± 0.5) and (1.2 ± 0.2) respectively. The recipient age (48.5 ± 11.3), male/female 27/13, intensive care unit stay (4.75 ± 3.9), floor stay (7.7 ± 3.7) days, portal vein velocity (63.96 ± 24.65 ml/sec), hepatic artery peak systolic velocity (74.76 ± 32.85) hepatic artery resistive index (0.7 ± 0.15), and triphasic/continuous venous outflow 27/13.

Conclusions: Middle hepatic vein incorporation in live donor liver graft is safe with a favorable outcome for recipient and donor, doppler US is one the important tool for evaluation and follow up of donor and recipient for detection of vascular complications and assessment of venous outflow and graft function. In addition, early discharge of the donor is a reasonable option.

Keywords:

LDLT, MHV, Donor safety, Doppler US, Venous outflow, liver transplant

References

[1] F. Dahm, P. Georgiev, P. C.-A. J. Of, and U. 2005, "Small?for?size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications," Wiley Online Libr., Accessed: Sep. 12, 2020. [Online]. Available: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-6143.2005.01081.x.
[2] C. H. N. Tan, S. Hwang, G. K. Bonney, I. S. Ganpathi, K. Madhavan, and W. C. A. Kow, "The influence of the middle hepatic vein and its impact on outcomes in right lobe living donor liver transplantation," Hpb, vol. 21, no. 5, pp. 547-556, 2019, doi: 10.1016/j.hpb.2018.09.003.
https://doi.org/10.1016/j.hpb.2018.09.003
[3] T. Ito et al., "Changes in portal venous pressure in the early phase after living-donor liver transplantation: Pathogenesis and clinical implications," Transplantation, vol. 75, no. 8, pp. 1313-1317, 2003, doi:10.1097/01.TP.0000063707.90525.10.
https://doi.org/10.1097/01.TP.0000063707.90525.10
[4] S. H. Kim, E. C. Lee, J. R. Shim, and S. J. Park, "Right lobe living donors ages 55 years old and older in liver transplantation," Liver Transplant., vol. 23, no. 10, pp. 1305-1311, 2017, doi: 10.1002/lt.24823.
https://doi.org/10.1002/lt.24823
[5] S. K. G. Lee et al., "Anterior segment congestion of a right liver lobe graft in living-donor liver transplantation and strategy to prevent congestion," J. Hepatobiliary. Pancreat. Surg., vol. 10, no. 1, pp. 16-25, 2003, doi: 10.1007/s10534-002-0789-5.
https://doi.org/10.1007/s10534-002-0789-5
[6] M. Appukuttan et al., "Functional hepatic venous outflow and its correlation with early graft function in live donor liver transplantation," Hpb, vol. 18, p. e556, 2016, doi: 10.1016/j.hpb.2016.03.485.
https://doi.org/10.1016/j.hpb.2016.03.485
[7] H. R. Yang et al., "Living donor right hepatectomy with inclusion of the middle hepatic vein: Outcome in 200 donors," Transplant. Proc., vol. 44, no. 2, pp. 460-462, 2012, doi: 10.1016/j.transproceed.2012.01.060.
https://doi.org/10.1016/j.transproceed.2012.01.060
[8] T. Ikegami, S. Onda, K. Furukawa, K. Haruki, Y. Shirai, and T. Gocho, Small-for-size graft, small-for-size syndrome and inflow modulation in living donor liver transplantation, vol. 27, no. 11. 2020.
https://doi.org/10.1002/jhbp.822
[9] X. Z. Jiang et al., "Safety of Donor in Adult-to-Adult Living Donor Liver Transplantation Using Right Lobe Graft," Transplant. Proc., vol. 39, no. 1, pp. 150-152, 2007, doi: 10.1016/j.transproceed.2006.10.013.
https://doi.org/10.1016/j.transproceed.2006.10.013
[10] M. Dayangac et al., "Use of middle hepatic vein in right lobe living donor liver transplantation," Transpl. Int., vol. 23, no. 3, pp. 285-291, 2010, doi: 10.1111/j.1432-2277.2009.00978.x.
https://doi.org/10.1111/j.1432-2277.2009.00978.x
[11] O. Abdelaziz and H. Attia, "2016 Liver Transplantation?: Global view Doppler ultrasonography in living donor liver transplantation recipients?: Intra- and post-operative vascular complications," vol. 22, no. 27, pp. 6145-6172, 2016, doi: 10.3748/wjg.v22.i27.6145.
https://doi.org/10.3748/wjg.v22.i27.6145
[12] J. G. Lee et al., "Donor safety in living donor liver transplantation: The Korean organ transplantation registry study," Liver Transplant., vol. 23, no. 8, pp. 999-1006, 2017, doi: 10.1002/lt.24778.
https://doi.org/10.1002/lt.24778
[13] S. Goja, S. Kumar Yadav, and A. Singh Soin, "Readdressing the Middle Hepatic Vein in Right Lobe Liver Donation: Triangle of Safety," Liver Transplant., vol. 24, no. 10, pp. 1363-1376, 2018, doi: 10.1002/lt.25289.
https://doi.org/10.1002/lt.25289