Better innovate than compromise: A novel hepatic outflow reconstruction technique in pediatric living donor liver transplantation

• Published in: Pediatric transplantation 2015-05, Vol.19 (3), p.E56-E61
• Main Authors: Cherian, P. Thomas, Mishra, Ashish K., Bangaari, Ashish, Kota, Venugopal, Sathyanarayanan, Mohan, Raya, Ravichandra, Rela, Mohamed
• Format: Article
• Language: English
• Subjects: acute liver failure; Algorithms; Anastomosis, Surgical; Child; graft survival; Hepatectomy - methods; hepatic outflow obstruction; Hepatic Veins - surgery; Humans; innovative technique; live donor safety; Liver - blood supply; Liver Failure; Liver Failure, Acute - surgery; Liver Transplantation - methods; Living Donors; Male; pediatric liver transplantation; Postoperative Period; Reconstructive Surgical Procedures - methods; Risk
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.12437

Pediatric LDLT using donors with unfavorable vascular anatomy is challenging in terms of donor safety, and complexity of reconstruction in the recipient. We describe an innovative technique of hepatic venous outflow reconstruction involving the recipient RHV, in the presence of a rudimentary RHV in the donor. The postoperative course of the donor and recipient was uneventful with satisfactory venous outflow in both. This technique avoided the use of prosthetic material, an important consideration given the recipient age and requirement for growth. This shows that donors previously considered unsuitable for donation can be utilized safely as long as principles of vascular anastomosis are adhered to. Moreover, it highlights that innovation is sometimes necessary to avoid compromise in donor safety.