Efferent blood supply to the right hepatic lobe regarding its transplantation from a living donor: reconstruction features. Part 2
S. E. Voskanyan,
I. Yu. Kolyshev,
А. N. Bashkov,
А. I. Artemiev,
V. S. Rudakov,
M. V. Shabalin,
A. P. Maltseva,
M. V. Popov,
A. I. Sushkov,
G. V. Vohmyanin https://doi.org/10.16931/1995-5464.2023-2-59-69
Abstract
Aim. To present the technical features and results of transplantation of the right hepatic lobe from a living donor with various types of efferent venous anatomy.
Materials and methods. 306 liver transplantations from living related donors were performed from 2009 to 2021. Patients with previously described 14 subtypes of efferent vascular anatomy and classified into 3 types, were divided into 4 groups depending on the number of reconstructed vessels. The author analyzed anatomy variants of the right hepatic lobe, duration of surgery and anhepatic period, postoperative morbidity, volume of blood loss, including with allowance for the number of reconstructed vessels, as well as survivability.
Results. The study demonstrated the principles and features of the reconstruction of the efferent veins of the graft. Time of surgical intervention, duration of anhepatic period, and postoperative morbidity were greatest with a separate type of blood outflow (p < 0.05) Blood loss was greatest during reconstruction veins 3 and 4 (p < 0.05). No difference in blood loss was detected between groups 3 and 4. Survivability within 12, 36, 60 and 120 months accounted for 84%, 83%, 81% and 71%, correspondingly, without any difference between groups.
Conclusion. Successful transplantation of the right hepatic lobe requires precision mapping of the venous anatomy of the donor, preserving all potentially important efferent vessels, and commitment to the most complete reconstruction of them, irrespective of the vascular anatomy complexity.
About the Authors
S. E. Voskanyan
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Sergey E. Voskanyan – Doct. of Sci. (Med.), Head of Department of Surgery with courses in Oncosurgery, Endoscopy, Surgical Pathology, Clinical Transplantation and Organ Donation; Deputy Chief Physician for Surgical Care, Head of Center for Surgery and Transplantation
23, Marshal Novikov str., Moscow, 123098
I. Yu. Kolyshev
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Ilya Yu. Kolyshev – Cand. of Sci. (Med.), Head of Surgery Unit No. 1, Center for New Surgical Technologies
23, Marshal Novikov str., Moscow, 123098
А. N. Bashkov
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Andrey N. Bashkov – Head of X-ray and Radioisotope Diagnostics Unit
23, Marshal Novikov str., Moscow, 123098
А. I. Artemiev
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Alexey I. Artemiev – Cand. of Sci. (Med.), Head of Surgery Unit No. 2, Center for Surgery and Transplantation
23, Marshal Novikov str., Moscow, 123098
V. S. Rudakov
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Vladimir S. Rudakov – Cand. of Sci. (Med.), Surgeon, Center for Surgery and Transplantation
23, Marshal Novikov str., Moscow, 123098
M. V. Shabalin
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Maksim V. Shabalin – Cand. of Sci. (Med.), Surgeon, Center for Surgery and Transplantation
23, Marshal Novikov str., Moscow, 123098
A. P. Maltseva
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Anna P. Maltseva – Surgeon, Center for Surgery and Transplantation
23, Marshal Novikov str., Moscow, 123098
M. V. Popov
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Maksim V. Popov – Doctor in X-ray Endovascular Diagnostics and Treatment, Interventional Radiology Unit
23, Marshal Novikov str., Moscow, 123098
A. I. Sushkov
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Aleksandr I. Sushkov – Head of Laboratory of New Surgical Technologies
23, Marshal Novikov str., Moscow, 123098
G. V. Vohmyanin
Federal State Budgetary Institution “State Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan” of the FMBA of Russia
Russian Federation
Russian Federation
Georgij V. Vohmyanin – Surgeon, Center for Surgery and Transplantation
23, Marshal Novikov str., Moscow, 123098
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1. Рис. 1а. Позиционирование ППВ и НПВ перед формированием гепатикокавального анастомоза | |
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2. Рис. 1б. Гепатикокавальная реконструкция при типе А строении печеночных вен трансплантата | |
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3. Рисунок 2а. Гепатикокавальная реконструкция при типе В строении печеночных вен трансплантата | |
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4. Рисунок 2б. Операционная фотография гепатикокавальной реконструкция при типе В строении печеночных вен трансплантата с использованием ПТФЭ-протеза НПВ | |
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5. Рис. 3a. Объединение устьев ППВ и вены от 7-ого сегмента печени (схема) | |
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6. Рис. 3б. Объединение устьев ППВ и вены от 7-ого сегмента печени (фото) | |
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7. Рис. 4a. Гепатикокавальная реконструкция при наличии дополнительной вены от S5 печени (схема) | |
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8. Рис. 4б. Гепатикокавальная реконструкция при наличии дополнительной вены от S5 печени | |
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9. Рис. 5a. Гепатикокавальная реконструкция при наличии дополнительной вены от S8 печени (схема) | |
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10. Рис. 5б. Гепатикокавальная реконструкция при наличии дополнительной вены от S8 печени (фото) | |
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11. Рис. 6a. Гепатикокавальная реконструкция при наличии двух срединных печеночных вен (тип N) (схема) | |
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12. Рис. 6б. Гепатикокавальная реконструкция при наличии дополнительной вены от S8 печени | |
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13. Рис. 7a. Гепатикокавальная реконструкция при наличии дополнительных вен от S5 и S8 печени (схема) | |
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14. Рис. 7б. Гепатикокавальная реконструкция при наличии дополнительных вен от S5 и S8 печени | |
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15. Рис. 8a. Гепатикокавальная реконструкция при полном сепаратном оттоке крови от трансплантата (тип P) (схема) | |
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16. Рис. 8б. Гепатикокавальная реконструкция при полном сепаратном оттоке крови от трансплантата (тип P) | |
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17. Рис. 9а Стеноз ППВ, гипертрофированным трансплантатом | |
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18. Рис.9б Состояние после стентирования ППВ | |
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19. Вклад авторов | |
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For citations:
Voskanyan S.E., Kolyshev I.Yu., Bashkov А.N., Artemiev А.I., Rudakov V.S., Shabalin M.V., Maltseva A.P., Popov M.V., Sushkov A.I., Vohmyanin G.V. Efferent blood supply to the right hepatic lobe regarding its transplantation from a living donor: reconstruction features. Part 2. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2023;28(2):59-69. (In Russ.) https://doi.org/10.16931/1995-5464.2023-2-59-69
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