Application of middle hepatic vein splitting and reconstruction technique in split liver transplantation from low-age donor livers
10.12464/j.issn.1674-7445.2025053
- VernacularTitle:肝中静脉劈分-重建技术在低龄儿童来源供肝劈离式肝移植的应用
- Author:
Hui TANG
1
;
Binsheng FU
1
;
Qing YANG
1
;
Jia YAO
1
;
Kaining ZENG
1
;
Xiao FENG
1
;
Shuhong YI
1
;
Yang YANG
2
,
3
Author Information
1. Department of Hepatobiliary Surgery, Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
2. Department of Hepatobiliary Surgery, Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
3. .
- Publication Type:OriginalArticle
- Keywords:
Middle hepatic vein splitting and reconstruction;
Low-age donor liver;
Split liver transplantation;
Graft to recipient weight ratio;
Body mass index;
Liver function;
International normalized ratio;
Cold ischemia time
- From:
Organ Transplantation
2025;16(3):453-459
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the feasibility and clinical experience of the middle hepatic vein splitting-reconstruction technique in split liver transplantation from low-age donor livers. Methods A retrospective analysis was conducted on the cases of two low-age donor livers that underwent middle hepatic vein splitting-reconstruction, which were transplanted into four child recipients at the Liver Transplantation Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to July 2023. The surgical and postoperative conditions were summarized and analyzed. Results Donor 1 was a 6-year-old and 4-month-old girl with a body weight of 21 kg, and the obtained donor liver weighed 496 g. After splitting, the left and right liver weights were 201 g and 280 g, and transplanted into a 9-month-old boy weighing 6.5 kg and a 9-month-old boy weighing 7.5 kg, respectively. The graft to recipient weight ratio (GRWR) was 3.09% and 3.73%, respectively. Donor 2 was a 5-year-old and 8-month-old boy with a body weight of 19 kg, and the donor liver weighed 673 g. After splitting, the left and right liver weights were 230 g and 400 g, and transplanted into a 13-month-old girl weighing 9.5 kg and a 15-month-old boy weighing 12 kg. The GRWR was 2.42% and 3.33%, respectively. Both donor livers were split ex vivo, with the middle hepatic vein being completely split in the middle and reconstructed using allogeneic iliac vein and iliac artery vascular patches. According to GRWR, none of the 4 transplant livers were reduced in volume. Among the 4 recipients, one died due to postoperative portal vein thrombosis and non-function of the transplant liver, while the other three cases recovered smoothly without early or late complications. Regular follow-up was conducted until July 31, 2023, and liver function recovered well. Conclusions Under the premise of detailed assessment of the donor liver and meticulous intraoperative operation, as well as matching with suitable child recipients, low-age donor livers may be selected for splitting. The complete splitting and reconstruction of the middle hepatic vein in the middle may effectively ensure the adequate venous return of the left and right liver and provide sufficient functional liver volume.
