Implantation of the Right Graft After Splitting for Two Adult Grafts or After Right Living Donor Procurement
Implantation of the left graft when the liver is split for two adult recipients is described in the chapter on left living donor transplantation.
In the situation of living donor procurement or split liver procedure for two adult recipients, the cava remains in the donor or with the left graft, respectively. Therefore, the venous outflow is reconstructed by anastomosing the donor's hepatic veins to the recipient's vena cava. The hepatectomy in the recipient is performed as for an orthotopic liver transplantation with preservation of the inferior vena cava. The orifices of the middle and left hepatic veins are oversewn or stapled; the right hepatic vein is directly anastomosed to the stump of the right hepatic vein or to a wider orifice in the recipient's vena cava. Any inferior hepatic veins more than 5 mm in diameter are also anastomosed directly to the inferior vena cava. A significant hepatic vein from segment 5 or 8 needs to be drained. This can be achieved by constructing a jump graft by means of a saphenous vein or, depending on the anatomic situation, by creating a common orifice with the right hepatic vein.
Anastomoses of the portal vein and the hepatic artery are performed as for the split graft for adult and pediatric recipients and the biliary continuity can be restored by biliodigestive anastomosis as shown in the Figure or by the direct connection between right hepatic duct of the right graft and common bile duct of the recipient.
Implantation of the Left Graft in a Pediatric Recipient (Sg2 and 3) As in this situation the cava stays with the right graft, the left hepatic vein is anastomosed directly on the inferior vena cava of the recipient. It is fundamental to keep the hepatic vein short as too long a vein can lead to kinking of the caval anastomosis. End-to-end anastomosis of the portal vein between the donor's left portal vein and the recipient common trunk is performed. Finally, the celiac axis of the left graft is anastomosed to the hepatic artery of the recipient at the level of the gastroduodenal artery and biliary continuity is reconstituted by a Roux-en-Y biliodigestive anastomosis.
Was this article helpful?
For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.