[Cryopreserved iliac vein for reconstruction of middle hepatic vein in living donor right liver transplantation].

OBJECTIVE

To summarize the experience of living donor liver transplantation using cryopreserved iliac vein for middle hepatic vein reconstruction.

METHODS

Between July 2006 and June 2009, right liver transplantation without middle hepatic vein was performed in 37 cases of 85 patients undergoing living donor liver transplantation; of 37 cases, 30 received middle hepatic vein reconstruction using cryopreserved iliac vein. There were 27 males and 3 females, aged from 10 to 57 years (median, 44 years). Thirty cases included 11 hepatocellular carcinoma, 10 hepatic cirrhosis, 2 Wilson's disease, 1 cholangiocarcinoma, 1 hepatoblastoma, 1 congenital hepatic fibrosis, 1 chronic severe hepatitis, and 1 congenital biliary atresia. Iliac veins harvested from donors were put into 0-4 degrees C mixed antibiotics saline and transported to the operating room. The iliac veins were trimmed, placed into sterile bags (containing RMPI 1640 + 20% DMSO + 10% calf protein solution) and frozen at -70 degrees C. In living donor liver transplantation process, the veins were melt and used for middle hepatic vein reconstruction. After operation, the patency of veins was monitored by regular Doppler ultrasound examination or enhanced CT for 3 months.

RESULTS

In 30 patients, 30 iliac veins were used. The average cryopreserve time was 14 days (range, 3-44 days). Anastomosis were all successful; after cryopreservation, the blood vessels texture and elasticity were fit for surgery. No easily tearing or severe suture bleeding was observed. In 30 patients, 6 had segment V veins reconstruction; 3 had segment VIII; and 21 had both segments V and VIII. The patency rate of reconstructed vessels was 93% at 1 week, 90% at 2 weeks, 90% at 1 month, and 67% at 3 months. No serious complication was observed in donors. The prognosis was good with no small-for-size syndrome.

CONCLUSION

Cryopreserved iliac vein is an ideal material for the right hepatic living donor liver transplantation in the reconstruction of middle hepatic vein.