Simplifying Hepatic Venous Outflow Reconstruction in Sequential Living Donor Liver Transplantation

The native liver of a familial amyloidotic polyneuropathy recipient who undergoes living donor liver transplantation used as a graft for sequential liver transplantation does not include the inferior vena cava. Implantation of this whole liver graft to a second recipient could be simplified by borrowing the experience from right liver living donor liver transplantation. With careful release of the hepatic vein from its surrounding adventitia mainly by sharp dissections, adequate lengths of these veins could be attained without compromising the native inferior vena cava. Following venoplasty of the right and middle/left hepatic vein stumps, the single cuff of the hepatic veins is anastomosed to the inferior vena cava without interpositional venous graft or patch. Satisfactory venous outflow is reliably achieved because this is the most direct outflow tract. Liver Transpl 15: 1514-1518, 2009. (C) 2009 AASLD.