Feasibility and outcomes of living-donor liver transplantation utilizing the right hemi-liver graft with portal vein anatomical variations - Scorecard - MDSpire

Feasibility and outcomes of living-donor liver transplantation utilizing the right hemi-liver graft with portal vein anatomical variations

  • By

  • Ahmed Shehta

  • Mohamed Elshobari

  • Tarek Salah

  • Ahmad M. Sultan

  • Amr Yasen

  • Usama Shiha

  • Mohamed El-Saadany

  • Ahmed Monier

  • Rami Said

  • Mohamed S. Habl

  • Reham Adly

  • Basma Abd Elmoaem El Ged

  • Rasha Karam

  • Reem Khaled

  • Hassan Magdy Abd El Razek

  • Ehab E. Abdel-Khalek

  • Mohamed Abdel Wahab

  • October 4, 2023

  • 0 min

Share

Clinical Scorecard: Assessment of the Viability and Results of Living-Donor Liver Transplantation Using Right Hemi-Liver Grafts with Variations in Portal Vein Anatomy

At a Glance

CategoryDetail
ConditionEnd stage liver disease and selected hepatic malignancies requiring liver transplantation
Key MechanismsLiving-donor liver transplantation (LDLT) using right hemi-liver grafts with portal vein (PV) anatomical variations and reconstruction techniques
Target PopulationAdult patients requiring liver transplantation in settings lacking deceased donor liver transplantation programs
Care SettingSpecialized liver transplantation centers performing LDLT with advanced surgical techniques

Key Highlights

  • Right hemi-liver grafts provide adequate liver volume for adult recipients but have high incidence of vascular and biliary anatomical variations.
  • Portal vein anatomical variations occur in 10-35% of donors, complicating portal vein reconstruction during LDLT.
  • Various surgical techniques for PV reconstruction include direct venoplasty, autologous Y-graft interposition, and in situ dual PV anastomoses.

Guideline-Based Recommendations

Diagnosis

  • Preoperative evaluation of portal vein anatomy by computed tomographic portography using Cheng classification.
  • Identification of PV variation types (I-IV) to plan surgical reconstruction.

Management

  • Use direct venoplasty for closely positioned RPV branches (Type II) to create a common orifice.
  • Apply autologous Y-graft interposition or in situ dual PV anastomoses for widely separated RPV branches (Types III and IV).
  • Perform hepatic venous outflow reconstruction first, followed by portal, arterial, and biliary reconstruction.

Monitoring & Follow-up

  • Postoperative monitoring of portal vein patency and graft function.
  • Regular imaging and clinical assessment to detect vascular complications.

Risks

  • Surgical challenges due to anatomical variations increase risk of vascular complications.
  • Potential for portal vein thrombosis or stenosis if reconstruction is suboptimal.

Patient & Prescribing Data

Adult liver transplant recipients receiving right hemi-liver grafts from living donors with portal vein anatomical variations

Tailored surgical reconstruction techniques based on PV anatomy improve feasibility and outcomes of LDLT in this population.

Clinical Best Practices

  • Comprehensive preoperative imaging and classification of portal vein anatomy to guide surgical planning.
  • Selection of appropriate PV reconstruction technique based on anatomical variation type.
  • Meticulous surgical technique with polypropylene 6/0 sutures for venoplasty and anastomoses.
  • Multidisciplinary approach including anesthetic, cardiopulmonary, neuropsychiatric, and gastrointestinal evaluations preoperatively.

References

Original Source(s)

Feasibility and outcomes of living-donor liver transplantation utilizing the right hemi-liver graft with portal vein anatomical variations

  • by Ahmed Shehta, Mohamed Elshobari, Tarek Salah, Ahmad M. Sultan, Amr Yasen, Usama Shiha, Mohamed El-Saadany, Ahmed Monier, Rami Said, Mohamed S. Habl, Reham Adly, Basma Abd Elmoaem El Ged, Rasha Karam, Reem Khaled, Hassan Magdy Abd El Razek, Ehab E. Abdel-Khalek, Mohamed Abdel Wahab

  • October 4, 2023

Related Content

Top 10 States for Physician-Owned Hospitals

These 10 states make it more practical for physicians to participate in hospital ownership by aligning statutory structure, corporate practice of medicine rules, and population trends.

FDA Grants Accelerated Approval for OTOF Gene Therapy

A one-time intracochlear gene therapy improved hearing outcomes in patients with OTOF-related sensorineural hearing loss in the phase 1/2 CHORD trial.

Lactate–Albumin Ratio Tied to TBI Mortality

Admission biomarker showed prognostic value alongside clinical scoring systems in pediatric intensive care