活体肝移植肝静脉重建.pdf

Original Article Impact of Short Hepatic Vein Reconstruction in Living Donor Adult Liver Transplantation Using a Left Liver Plus Caudate Lobe Graft Yasushi Yamauchi, Tomoaki Noritomi, Koji Mikami,1 Seiishiro Hoshino, Tetsuo Shinohara, Yoshiaki Takahashi, Nobuhide Matsuoka,2 Naotaka Noda, Takafumi Maekawa1 and Yuichi Yamashita, Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 1Department of Surgery, Fukuoka University Chikushi Hospital, and 2Department of Regenerative Medicine and Transplantation, Fukuoka University School of Medicine, Fukuoka, Japan. OBJECTIVE: To investigate the impact of short hepatic vein reconstruction in the transplanted left liver plus caudate lobe graft. METHODS: Six left liver plus caudate lobe grafts used for living donor adult liver transplantation were included in this study. The liver grafts were divided into two groups: those with (V1 group; n = 4) or without (control group; n = 2) short hepatic vein reconstruction. The changes in the transplanted left lobe (seg- ments II–IV) and caudate lobe were compared between the two groups at 1 month after transplantation. RESULTS: The addition of the caudate lobe increased the graft volume by 15 mL, which corresponded to a 4.3% gain of graft volume at the time of transplantation. Although the graft volume/standard liver volume ratio of the whole grafts after transplantation showed no difference between the two groups, the regeneration rate of the caudate lobe in the V1 group was significantly greater than that in the control group (p = 0.04). CONCLUSION: Although no definite advantage from the V1 reconstruction was demonstrated, hepatic vein reconstruction with a significantly-sized short hepatic vein might provide an additional margin of safety for marginally-sized liver grafts during the early phase of graft re