Morphometric study comparing two methods of hepatic venous outflow reconstruction in piggyback liver transplantation

Abstract

Introduction: The incidence of hepatic venous outflow complications after piggyback liver transplantation varies according to the type of venous reconstruction. The use of the three main hepatic veins of the recipient (RML) has lower frequency of hepatic venous outflow obstruction. On the other hand, the venous return during the anhepatic phase was reduced. The use of the right and middle hepatic veins (RM) limits the inferior vena cava (IVC) constriction. However, this benefit is only justified if a hepatic venous tract with no anatomical restrictions can be obtained. Purpose: To compare the congruence of the IVC perimeter with the perimeter of the venous outflow tract at

the anastomotic site and its opening into the IVC both in the RM and RML modalities. Methods: A prospective morphometric study was performed in 16 fresh human cadavers by measuring the perimeter of the IVC (IVCP) and, in RM and RML reconstructions, the perimeter of the venous outflow tract at the anastomotic site (RMP and RMLP) and at its opening into the IVC (RMoP and RMLoP). The statistical analysis was performed using the variance analysis (ANOVA) for repeated measurements. Results: The mean RMLP (137.2 + 24.3 mm; p<0.001), RMP (123.2 + 20.1 mm; p=0.003) and RMoP (116.6 + 17.5 mm; p=0.027) amounts were significantly larger than IVCP (107.9 +18.8 mm). RMLP amounts were significantly larger than RMP (p=0.004) and RMoP (p=0.001). Conclusion: RM reconstruction presents a larger perimeter than IVC both at the anastomotic site and at the opening into IVC. When comparing to RML, the RM modality presents a more congruent perimeter with IVC.