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Complex hepatic outflow reconstruction in domino liver transplantation |
Rafael S Pinheiro, Quirino Lai, Carola Dahrenmoller and Jan Lerut |
Brussels, Belgium
Author Affiliations: Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc, Université Catholique Louvain UCL Brussels, Belgium (Pinheiro RS); Department of Gastroenterology, São Paulo University School of Medicine, São Paulo, Brazil (Pinheiro RS, Lai Q, Dahrenmoller C and Lerut J)
Corresponding Author: Rafael S Pinheiro, MD, Department of Gastro¬enterology, University of São Paulo, Hospital das Clínicas, Rua Dr. Enéas de Carvalho Aguiar, 255, 9° andar - sala 9113/9114, CEP 05403-900 - São Paulo - SP, Brazil (Tel: 55-11-26613323; Fax: 55-11-26616250; Email: rsnpinheiro@gmail.com) |
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Abstract Domino liver transplantation has been accepted as a safe procedure to further expand the organ donor pool. The most important technical challenge of the procedure resides in restoring a proper hepatic venous allograft outflow in the familial amyloidotic polyneuropathy-liver recipient. To overcome this issue, combined techniques were used to perform an innovative outflow reconstruction. A domino liver transplantation was successfully performed with reconstruction of complex venous outflow. The inferior vena cava sparing hepatectomy technique in the familial amyloidotic polyneuropathy-donor was used to cut the hepatic vein to the liver parenchyma. To overcome this issue the venous outflow tract was reconstructed using a longitudinally opened iliac vein graft from a post-mortem donor to create a new outflow tract using a diamond patch between the right and middle/left hepatic veins.
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