Peculiarities of implantation of the right graft veins into the inferior vena cava during living donor liver transplantation.

Abstract

Background: Living donor liver transplantation (LDLT) is a crucial alternative to deceased donor transplantation, especially in regions with limited access to cadaveric organs. Right lobe graft implantation into the inferior vena cava (IVC) requires advanced surgical techniques to optimize outcomes and reduce complications.

Aim: To compare two venous anastomosis techniques-direct polytetrafluoroethylene (PTFE) grafting of V5-V8 veins to the IVC vs triangulation to the right hepatic vein (RHV)-in terms of graft viability and postoperative outcomes.

Methods: A retrospective analysis was conducted on 96 patients who underwent LDLT with right lobe grafts between 2014 and 2023. Patients were divided into three groups: (1) No venous outflow reconstruction; (2) PTFE graft direct anastomosis to the IVC; and (3) PTFE graft anastomosis using triangulation to the RHV. Perioperative and postoperative outcomes, including bile duct complications, alanine aminotransferase/aspartate aminotransferase levels, and graft perfusion, were compared across groups.

Results: Group 3 (triangulation to RHV) showed significantly improved venous outflow, fewer complications, and faster normalization of liver function tests. Bile duct complications were highest in group 1 (12.8%) and lowest in group 3 (7%). Doppler ultrasonography revealed better graft perfusion in group 3 compared to groups 1 and 2.

Conclusion: Triangulation to the RHV improves graft viability, reduces biliary complications, and enhances early postoperative outcomes compared to direct PTFE grafting to the IVC.