Liver transplantation techniques: Difference between revisions
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==Liver transplantation techniques== | ==Liver transplantation techniques== | ||
'''Left lobe transplantation''' | '''Left lobe transplantation''' | ||
* The left and middle hepatic veins, left hepatic artery, and left portal vein are dissected.<ref name="pmid1953097">{{cite journal| author=Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L et al.| title=Liver transplantation in children from living related donors. Surgical techniques and results. | journal=Ann Surg | year= 1991 | volume= 214 | issue= 4 | pages= 428-37; discussion 437-9 | pmid=1953097 | doi= | pmc=1358542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1953097 }}</ref> | * The left and [[Hepatic vein|middle hepatic veins]], [[Hepatic artery|left hepatic artery]], and left [[portal vein]] are dissected.<ref name="pmid1953097">{{cite journal| author=Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L et al.| title=Liver transplantation in children from living related donors. Surgical techniques and results. | journal=Ann Surg | year= 1991 | volume= 214 | issue= 4 | pages= 428-37; discussion 437-9 | pmid=1953097 | doi= | pmc=1358542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1953097 }}</ref> | ||
* Small portal vein branches are ligated. The left bile duct is divided | * Small portal vein branches are ligated. The left [[bile duct]] is divided. | ||
* Vascular and biliary structures entering segment 4 are divided or left intact. | * Vascular and biliary structures entering segment 4 are divided or left intact. | ||
* The parenchyma is transected and then the left hepatic artery and left portal vein are divided, releasing the graft. | * The [[parenchyma]] is transected and then the left [[hepatic artery]] and left [[portal vein]] are divided, releasing the graft. | ||
* The middle hepatic vein is removed with the graft when a full lobectomy is performed. | * The middle [[hepatic vein]] is removed with the graft when a full [[lobectomy]] is performed. | ||
== Video shows left lobe transplantation steps == | == Video shows left lobe transplantation steps == | ||
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* The right lobe fits correctly into the right subphrenic space, making the vascular anastomoses easier to perform.<ref name="pmid10515380">{{cite journal| author=Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA et al.| title=Right lobe living donor liver transplantation. | journal=Transplantation | year= 1999 | volume= 68 | issue= 6 | pages= 798-803 | pmid=10515380 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10515380 }}</ref> | * The right lobe fits correctly into the right subphrenic space, making the vascular anastomoses easier to perform.<ref name="pmid10515380">{{cite journal| author=Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA et al.| title=Right lobe living donor liver transplantation. | journal=Transplantation | year= 1999 | volume= 68 | issue= 6 | pages= 798-803 | pmid=10515380 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10515380 }}</ref> | ||
* Right lobe grafts are prone to a variety of technical complications. | * Right lobe grafts are prone to a variety of technical complications. | ||
* After cholecystectomy, intraoperative ultrasound may be used to | * After [[cholecystectomy]], [[Intraoperative monitoring|intraoperative ultrasound]] may be used to mark the position of the [[Hepatic vein|hepatic veins]] and portal branches. | ||
* The right hepatic artery and right portal vein are dissected, followed by the retrohepatic vena cava, isolating the origin of the right hepatic vein. | * The right [[hepatic artery]] and right [[portal vein]] are dissected, followed by the retrohepatic [[Vena cavae|vena cava]], isolating the origin of the right hepatic vein. | ||
* The right bile duct is isolated, completing mobilization of the right lobe.<ref name="pmid9846514">{{cite journal| author=Wachs ME, Bak TE, Karrer FM, Everson GT, Shrestha R, Trouillot TE et al.| title=Adult living donor liver transplantation using a right hepatic lobe. | journal=Transplantation | year= 1998 | volume= 66 | issue= 10 | pages= 1313-6 | pmid=9846514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9846514 }}</ref> | * The right [[bile duct]] is isolated, completing mobilization of the right lobe.<ref name="pmid9846514">{{cite journal| author=Wachs ME, Bak TE, Karrer FM, Everson GT, Shrestha R, Trouillot TE et al.| title=Adult living donor liver transplantation using a right hepatic lobe. | journal=Transplantation | year= 1998 | volume= 66 | issue= 10 | pages= 1313-6 | pmid=9846514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9846514 }}</ref> | ||
* The liver parenchyma is transected using an ultrasonic scalpel. | * The liver parenchyma is transected using an ultrasonic scalpel. | ||
* A portoportal anastomosis is then made between the donor right portal vein and the portal vein of the recipient. | * A portoportal anastomosis is then made between the donor right portal vein and the portal vein of the recipient. | ||
Revision as of 16:23, 21 December 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Liver transplantation techniques
Left lobe transplantation
- The left and middle hepatic veins, left hepatic artery, and left portal vein are dissected.[1]
- Small portal vein branches are ligated. The left bile duct is divided.
- Vascular and biliary structures entering segment 4 are divided or left intact.
- The parenchyma is transected and then the left hepatic artery and left portal vein are divided, releasing the graft.
- The middle hepatic vein is removed with the graft when a full lobectomy is performed.
Video shows left lobe transplantation steps
{{#ev:youtube|bVCJ5Fch2OU}}
Right lobe transplantation
- The right lobe fits correctly into the right subphrenic space, making the vascular anastomoses easier to perform.[2]
- Right lobe grafts are prone to a variety of technical complications.
- After cholecystectomy, intraoperative ultrasound may be used to mark the position of the hepatic veins and portal branches.
- The right hepatic artery and right portal vein are dissected, followed by the retrohepatic vena cava, isolating the origin of the right hepatic vein.
- The right bile duct is isolated, completing mobilization of the right lobe.[3]
- The liver parenchyma is transected using an ultrasonic scalpel.
- A portoportal anastomosis is then made between the donor right portal vein and the portal vein of the recipient.
Video shows right lobe transplantation steps
{{#ev:youtube|iNEcmYFRbfY}}
Split-liver transplantation
- Splitting donor livers into left lateral and extended right grafts for transplantation into a pediatric and an adult recipient.[4]
- Splitting livers into right and left lobes for transplantation has been investigated as a way to increase the supply of donor organs.
- Approximately 20 percent of donors could be split.
- Five-year survival rates were 77 percent, with graft survival rates of 76 percent.
- For children, 5-year survival rates were 75 percent, with graft survival rates of 63 percent.
MARGINAL LIVER GRAFT OUTCOMES Marginal liver grafts included those with any of the following characteristics:[5]
- Liver donor age >70 years
- Livers discarded regionally and shared nationally
- Livers from hepatitis C positive donors
- Livers with cold ischemia time >12 hours
- Livers from donation after cardiac death donors
- Livers with >30 percent steatosis
- Livers split between two recipients
References
- ↑ Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L; et al. (1991). "Liver transplantation in children from living related donors. Surgical techniques and results". Ann Surg. 214 (4): 428–37, discussion 437-9. PMC 1358542. PMID 1953097.
- ↑ Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA; et al. (1999). "Right lobe living donor liver transplantation". Transplantation. 68 (6): 798–803. PMID 10515380.
- ↑ Wachs ME, Bak TE, Karrer FM, Everson GT, Shrestha R, Trouillot TE; et al. (1998). "Adult living donor liver transplantation using a right hepatic lobe". Transplantation. 66 (10): 1313–6. PMID 9846514.
- ↑ Emond JC, Freeman RB, Renz JF, Yersiz H, Rogiers X, Busuttil RW (2002). "Optimizing the use of donated cadaver livers: analysis and policy development to increase the application of split-liver transplantation". Liver Transpl. 8 (10): 863–72. doi:10.1053/jlts.2002.34639. PMID 12360426.
- ↑ Halazun KJ, Quillin RC, Rosenblatt R, Bongu A, Griesemer AD, Kato T; et al. (2017). "Expanding the Margins: High Volume Utilization of Marginal Liver Grafts Among >2000 Liver Transplants at a Single Institution". Ann Surg. 266 (3): 441–449. doi:10.1097/SLA.0000000000002383. PMID 28657945.