The Experts below are selected from a list of 7383 Experts worldwide ranked by ideXlab platform

Masatoshi Makuuchi - One of the best experts on this subject based on the ideXlab platform.

  • one orifice Vein Reconstruction in left liver plus caudate lobe grafts
    Transplantation, 2007
    Co-Authors: Takuya Hashimoto, Sumihito Tamura, Yasuhiko Sugawara, Junichi Kaneko, Noboru Motomura, Shinichi Takamoto, Masatoshi Makuuchi
    Abstract:

    For maximum use of left liver plus caudate lobe grafts, the short hepatic Vein draining the caudate lobe should be reconstructed. We devised a new venoplasty technique. On the graft side, a wide venous orifice with a long cuff was formed by gathering the left, middle, and short hepatic Veins using a conduit Vein graft and patch Vein grafts. On the recipient side, three hepatic Veins were connected to make a wide orifice. The liver graft was then connected to the recipient vena cava with a wide outflow tract and a venous reservoir. This new technique was adopted in 12 patients and the short-term results of this technique were satisfactory. The present procedure should simplify venous Reconstruction in the recipient and might be useful to prevent hepatic venous stenosis resulting from graft regeneration.

  • portal Vein Reconstruction in adult living donor liver transplantation using cryopreserved Vein grafts
    Liver Transplantation, 2006
    Co-Authors: Yasuhiko Sugawara, Sumihito Tamura, Kiyoshi Hasegawa, Masatoshi Makuuchi, Norihiro Kokudo, Hiroshi Imamura, Junichi Kaneko, Yuichi Matsui, Noboru Motomura, Shinichi Takamoto
    Abstract:

    No data are available for the management of venous jump or interposition conduits for portal Vein (PV) Reconstruction in adult living donor liver transplantation (LDLT). The feasibility of using cryopreserved Vein grafts as PV conduits was examined. Cryopreserved Vein (n = 23) was used as a patch, interposition, or jump graft. The patency results were compared with those of anastomosis without Vein patch (n = 217) or those with Vein autografts (n = 10). The 5-yr primary and secondary patency rates of the cryopreserved Vein grafts were 58% and 79%, respectively. In conclusion, our data indicate that the use of cryopreserved Vein grafts should be limited as conduits in PV Reconstruction in adult LDLT.

  • new hepatic Vein Reconstruction in left liver graft
    Liver Transplantation, 2005
    Co-Authors: Nobuyuki Takemura, Nobuhisa Akamatsu, Sumihito Tamura, Yasuhiko Sugawara, Takuya Hashimoto, Yoji Kishi, Masatoshi Makuuchi
    Abstract:

    The incidence of hepatic venous stenosis is higher in partial liver transplantation. New methods for hepatic venous Reconstruction in left liver transplantation, which secure wide anastomosis, were devised and are reported here. In the graft, the right side of the middle hepatic Vein or the left side of the left hepatic Vein was cut longitudinally and a rectangular-shaped Vein patch was attached for venoplasty. In the recipient, after the left and middle hepatic Veins were joined, the right side of the middle hepatic Vein was cut toward the closed right hepatic Vein, making a horizontal cavotomy for anastomosis. Of 92 patients who underwent conventional hepatic Vein Reconstruction, 3 were complicated by hepatic venous stenosis (median follow-up 43 months). By contrast, there were no hepatic Vein complications in the 20 patients who underwent the new technique (7 months). The current method appears to be technically feasible for outflow Reconstruction in left liver graft transplantation.

  • effects of middle hepatic Vein Reconstruction on right liver graft regeneration
    Transplantation, 2003
    Co-Authors: Nobuhisa Akamatsu, Norihiro Kokudo, Yasuhiko Sugawara, Hiroshi Imamura, Keiji Sano, Junichi Kaneko, Masatoshi Makuuchi
    Abstract:

    Background. A right liver graft without the middle hepatic Vein (MHV) trunk is now commonly used in living-donor liver transplantation for adult patients. The significance of MHV Reconstruction on regeneration or functional recovery of right liver grafts after living-donor liver transplantation, however, remains unclear. Methods. From 2000 to 2002 at the University of Tokyo Hospital in Tokyo, Japan, 56 adult patients received a right liver graft. The patients were divided into three groups by graft type: right liver graft without MHV trunk or MHV Reconstruction (n=17); right liver graft without MHV trunk, but with MHV Reconstruction (n=27); and extended right liver graft (n=12). Regeneration rate and postoperative liver function were compared among groups. Predictive factors associated with the graft regeneration were identified among clinical variables, including the graft type. Results. The regeneration rate of the right paramedian sector and the whole graft was lowest in the right liver grafts without the MHV trunk or MHV Reconstruction. The regeneration rate of the lateral sector was highest in this type of graft, but the difference was not statistically significant. The factors that significantly correlated with the regeneration rate were preoperative graft volume and graft type. There was no significant difference among groups in any of the liver function parameters. Conclusions. In the present series, satisfactory outcome was independent of the type of graft used, which indicates that MHV Reconstruction should not be omitted routinely but should be performed in selected patients.

  • living donor liver transplantation using the left liver with special reference to Vein Reconstruction
    Transplantation, 2003
    Co-Authors: Masatoshi Makuuchi, Yasuhiko Sugawara
    Abstract:

    The authors describe their techniques for hepatic Vein Reconstruction, devised for safe living-donor liver transplantation using a left liver graft. End-to-end anastomosis of the hepatic Veins is performed to prevent an outflow occlusion. To ensure adequate hepatic venous flow, it is necessary to obtain a wide ostium and sufficient length of the hepatic Vein for anastomosis, which should be secured by venoplasty of the hepatic Veins of the graft and the recipient. A left liver with a caudate lobe graft is useful for overcoming the problem of a small graft. Reconstruction of the short hepatic Vein of the caudate lobe may allow this portion to regenerate at the same rate as the left liver. In a left liver graft without the trunk of the middle hepatic Vein, Reconstruction of a tributary of this Vein might be necessary to prevent graft congestion in segment IV. Color Doppler ultrasonography or a hepatic arterial clamping test should be performed in donor hepatectomy to evaluate the need for middle hepatic Vein Reconstruction.

Yasuhiko Sugawara - One of the best experts on this subject based on the ideXlab platform.

  • one orifice Vein Reconstruction in left liver plus caudate lobe grafts
    Transplantation, 2007
    Co-Authors: Takuya Hashimoto, Sumihito Tamura, Yasuhiko Sugawara, Junichi Kaneko, Noboru Motomura, Shinichi Takamoto, Masatoshi Makuuchi
    Abstract:

    For maximum use of left liver plus caudate lobe grafts, the short hepatic Vein draining the caudate lobe should be reconstructed. We devised a new venoplasty technique. On the graft side, a wide venous orifice with a long cuff was formed by gathering the left, middle, and short hepatic Veins using a conduit Vein graft and patch Vein grafts. On the recipient side, three hepatic Veins were connected to make a wide orifice. The liver graft was then connected to the recipient vena cava with a wide outflow tract and a venous reservoir. This new technique was adopted in 12 patients and the short-term results of this technique were satisfactory. The present procedure should simplify venous Reconstruction in the recipient and might be useful to prevent hepatic venous stenosis resulting from graft regeneration.

  • portal Vein Reconstruction in adult living donor liver transplantation using cryopreserved Vein grafts
    Liver Transplantation, 2006
    Co-Authors: Yasuhiko Sugawara, Sumihito Tamura, Kiyoshi Hasegawa, Masatoshi Makuuchi, Norihiro Kokudo, Hiroshi Imamura, Junichi Kaneko, Yuichi Matsui, Noboru Motomura, Shinichi Takamoto
    Abstract:

    No data are available for the management of venous jump or interposition conduits for portal Vein (PV) Reconstruction in adult living donor liver transplantation (LDLT). The feasibility of using cryopreserved Vein grafts as PV conduits was examined. Cryopreserved Vein (n = 23) was used as a patch, interposition, or jump graft. The patency results were compared with those of anastomosis without Vein patch (n = 217) or those with Vein autografts (n = 10). The 5-yr primary and secondary patency rates of the cryopreserved Vein grafts were 58% and 79%, respectively. In conclusion, our data indicate that the use of cryopreserved Vein grafts should be limited as conduits in PV Reconstruction in adult LDLT.

  • new hepatic Vein Reconstruction in left liver graft
    Liver Transplantation, 2005
    Co-Authors: Nobuyuki Takemura, Nobuhisa Akamatsu, Sumihito Tamura, Yasuhiko Sugawara, Takuya Hashimoto, Yoji Kishi, Masatoshi Makuuchi
    Abstract:

    The incidence of hepatic venous stenosis is higher in partial liver transplantation. New methods for hepatic venous Reconstruction in left liver transplantation, which secure wide anastomosis, were devised and are reported here. In the graft, the right side of the middle hepatic Vein or the left side of the left hepatic Vein was cut longitudinally and a rectangular-shaped Vein patch was attached for venoplasty. In the recipient, after the left and middle hepatic Veins were joined, the right side of the middle hepatic Vein was cut toward the closed right hepatic Vein, making a horizontal cavotomy for anastomosis. Of 92 patients who underwent conventional hepatic Vein Reconstruction, 3 were complicated by hepatic venous stenosis (median follow-up 43 months). By contrast, there were no hepatic Vein complications in the 20 patients who underwent the new technique (7 months). The current method appears to be technically feasible for outflow Reconstruction in left liver graft transplantation.

  • effects of middle hepatic Vein Reconstruction on right liver graft regeneration
    Transplantation, 2003
    Co-Authors: Nobuhisa Akamatsu, Norihiro Kokudo, Yasuhiko Sugawara, Hiroshi Imamura, Keiji Sano, Junichi Kaneko, Masatoshi Makuuchi
    Abstract:

    Background. A right liver graft without the middle hepatic Vein (MHV) trunk is now commonly used in living-donor liver transplantation for adult patients. The significance of MHV Reconstruction on regeneration or functional recovery of right liver grafts after living-donor liver transplantation, however, remains unclear. Methods. From 2000 to 2002 at the University of Tokyo Hospital in Tokyo, Japan, 56 adult patients received a right liver graft. The patients were divided into three groups by graft type: right liver graft without MHV trunk or MHV Reconstruction (n=17); right liver graft without MHV trunk, but with MHV Reconstruction (n=27); and extended right liver graft (n=12). Regeneration rate and postoperative liver function were compared among groups. Predictive factors associated with the graft regeneration were identified among clinical variables, including the graft type. Results. The regeneration rate of the right paramedian sector and the whole graft was lowest in the right liver grafts without the MHV trunk or MHV Reconstruction. The regeneration rate of the lateral sector was highest in this type of graft, but the difference was not statistically significant. The factors that significantly correlated with the regeneration rate were preoperative graft volume and graft type. There was no significant difference among groups in any of the liver function parameters. Conclusions. In the present series, satisfactory outcome was independent of the type of graft used, which indicates that MHV Reconstruction should not be omitted routinely but should be performed in selected patients.

  • living donor liver transplantation using the left liver with special reference to Vein Reconstruction
    Transplantation, 2003
    Co-Authors: Masatoshi Makuuchi, Yasuhiko Sugawara
    Abstract:

    The authors describe their techniques for hepatic Vein Reconstruction, devised for safe living-donor liver transplantation using a left liver graft. End-to-end anastomosis of the hepatic Veins is performed to prevent an outflow occlusion. To ensure adequate hepatic venous flow, it is necessary to obtain a wide ostium and sufficient length of the hepatic Vein for anastomosis, which should be secured by venoplasty of the hepatic Veins of the graft and the recipient. A left liver with a caudate lobe graft is useful for overcoming the problem of a small graft. Reconstruction of the short hepatic Vein of the caudate lobe may allow this portion to regenerate at the same rate as the left liver. In a left liver graft without the trunk of the middle hepatic Vein, Reconstruction of a tributary of this Vein might be necessary to prevent graft congestion in segment IV. Color Doppler ultrasonography or a hepatic arterial clamping test should be performed in donor hepatectomy to evaluate the need for middle hepatic Vein Reconstruction.

Shin Hwang - One of the best experts on this subject based on the ideXlab platform.

  • hemashield vascular graft is a preferable prosthetic graft for middle hepatic Vein Reconstruction in living donor liver transplantation
    Annals of Transplantation, 2019
    Co-Authors: Gilchun Park, Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Youngin Yoon, Huidong Cho, Jae Hyun Kwon
    Abstract:

    BACKGROUND Because of the supply shortage for homologous Vein allografts, we previously used ringed Gore-Tex vascular grafts for middle hepatic Vein (MHV) Reconstruction in living donor liver transplantation. However, owing to the subsequent unavailability of ringed Gore-Tex grafts, we replaced them with Hemashield vascular grafts. This study aimed to compare the patency of Hemashield grafts with that of ringed Gore-Tex grafts. MATERIAL AND METHODS This was a retrospective double-arm study between the study group that used Hemashield grafts (n=63) and the historical control group that used ringed Gore-Tex grafts (n=126). RESULTS In the Gore-Tex and Hemashield groups, mean age was 53.1±6.2 and 54.3±10.4 years; model for end-stage liver disease score was 16.5±8.3 and 17.5±9.9; and graft-recipient weight ratio was 1.11±0.23 and 1.12±0.25, respectively. In the Gore-Tex graft group, V5 Reconstruction was done in single (n=107, 84.9%), double (n=17, 13.5%), and none (n=2, 1.6%). V8 Reconstruction was done in single (n=95, 75.4%), double (n=1, 0.8%), and none (n=30, 23.8%). In the Hemashield group, V5 Reconstruction was done in single (n=43, 68.3%), double (n=19, 30.2%), and triple (n=1, 1.6%). V8 Reconstruction was done in single (n=45, 71.4%), double (n=9, 14.3%), and none (n=9, 14.3%). One-year conduit patency rates in the Gore-Tex and Hemashield groups were 54.8% and 71.6%, respectively (p=0.048). CONCLUSIONS MHV Reconstruction using Hemashield vascular grafts demonstrated higher short-term patency rates than those associated with ringed Gore-Tex vascular grafts. We suggest that the Hemashield vascular graft is one of the best prosthetic materials for MHV Reconstruction.

  • usability of cryopreserved aortic allografts for middle hepatic Vein Reconstruction during living donor liver transplantation
    Journal of Gastrointestinal Surgery, 2016
    Co-Authors: Seokhwan Kim, Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Gilchun Park, Sunggyu Lee
    Abstract:

    Iliac Vein allografts are suitable for middle hepatic Vein (MHV) Reconstruction during living-donor liver transplantation (LDLT), but their supply is often limited. Polytetrafluoroethylene (PTFE) grafts are easily available but have drawbacks of accidental gastric penetration and non-degradable foreign body. To replace the use of PTFE grafts, we started using cryopreserved aorta allografts (CAAs). This study presents the technical details and patency outcomes of using CAAs in MHV Reconstruction. We reviewed the surgical techniques of CAA interposition and analyzed the patency rates in 74 patients who underwent LDLT during the 6-year study period. The two control groups received either cryopreserved iliac Veins (n = 122) or PTFE grafts (n = 84). The surgical techniques for MHV Reconstruction used to implant the CAA and PTFE grafts are very similar because the techniques developed for PTFE grafts were also applied to CAAs. We inserted an arterial patch at the liver cut surface because the CAA wall is too thick to perform direct anastomosis. Two patients (2.7 %) underwent MHV stenting during the first month. The 1-year patency rate was 69.7 % in the CAA group vs. 39.2 % in iliac Vein group vs. 57.2 % in PTFE group (p = 0.000). The overall graft and patient survival rates did not differ depending on the MHV interposition vessel materials (p > 0.1). CAAs combined with small-artery patches demonstrated high patency rates that surpass other vessel grafts, and thus, we suggest that CAA can be reliably used for MHV Reconstruction when CAA is available.

  • complications analysis of polytetrafluoroethylene grafts used for middle hepatic Vein Reconstruction in living donor liver transplantation
    Transplantation proceedings, 2014
    Co-Authors: Shin Hwang, Chulsoo Ahn, Deokbog Moon, Giwon Song, D H Jung, K H Kim, G C Park, Hyungwoo Park, Yohan Park, B H Jung
    Abstract:

    Abstract Background We previously showed that ringed polytetrafluoroethylene (PTFE) grafts combined with small allograft patches showed high patency rates similar to those of iliac Vein grafts and therefore that they can be used for middle hepatic Vein (MHV) Reconstruction. Although such use of PTFE graft showed high patency rates, its long-term safety regarding infection and other types of complications were not presented. In this study, we investigated the actual risk of complications directly associated with PTFE graft interposition for MHV Reconstruction. Methods During the study period of 30 months, we performed 215 cases of adult living-donor liver transplantation with modified right lobe graft and PTFE grafts. We classified the potential complications directly associated with PTFE graft interposition as infectious and surgical complications. The medical records of study patients were retrospectively reviewed. Results MHV graft patency rate was 76.3% at 6 months and 36.7% at 12 months. Their 1-year graft and patient survival rates were 92.6% and 93.5%, respectively. The 1-year actual incidences of infectious complication and surgical complication were near zero and 1 case (0.5%), respectively. In 1 recipient, the PTFE graft penetrated into the stomach wall 6 months after transplantation, but the patient did not complain of any specific symptoms. The PTFE graft was removed with the use of laparotomy, and the patient recovered uneventfully. Conclusions Although the incidence of PTFE graft–associated complication rate is very low, we suggest that it is necessary to closely monitor the PTFE graft, because unexpected complications can happen during long-term follow-up.

  • usability of ringed polytetrafluoroethylene grafts for middle hepatic Vein Reconstruction during living donor liver transplantation
    Liver Transplantation, 2012
    Co-Authors: Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Gilchun Park, Sungwon Jung, Samyoul Yoon, Jungman Namgoong
    Abstract:

    Large Vein allografts are suitable for middle hepatic Vein (MHV) Reconstruction, but their supply is often limited. Although polytetrafluoroethylene (PTFE) grafts are unlimitedly available, their long-term patency is relatively poor. We intended to enhance the clinical usability of PTFE grafts for MHV Reconstruction during living donor liver transplantation (LDLT). Two sequential studies were performed. First, PTFE grafts were implanted as inferior vena cava replacements into dogs. Second, in a 1-year prospective clinical trial of 262 adults undergoing LDLT with a modified right lobe, MHV Reconstruction with PTFE grafts was compared with other types of Reconstruction, and the outcomes were evaluated. In the animal study, PTFE grafts induced strong inflammatory reactions and luminal thrombus formation, but the endothelial lining was well developed. In the clinical study, the Reconstruction techniques were revised to make a composite PTFE graft with an artery patch on the basis of the results of the animal study. MHVs were reconstructed with cryopreserved iliac Veins (n = 122), iliac arteries (n = 43), aortas (n = 13), and PTFE (n = 84), and these Reconstructions yielded 6-month patency rates of 75.3%, 35.2%, 92.3%, and 76.6%, respectively. The overall 6-month patency rates for the iliac Vein and PTFE grafts were similar (P = 0.92), but the 6-month patency rates with Vein segment 5 were 51.0% and 34.7%, respectively (P = 0.001). The overall graft and patient survival rates did not differ among these 4 groups. In conclusion, ringed PTFE grafts combined with small vessel patches showed high patency rates comparable to those of iliac Vein grafts; thus, they can be used for MHV Reconstruction when other sizable vessel allografts are not available. Liver Transpl, 2012. © 2012 AASLD.

  • usability of ringed polytetrafluoroethylene grafts for middle hepatic Vein Reconstruction during living donor liver transplantation
    Liver Transplantation, 2012
    Co-Authors: Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Gilchun Park, Sungwon Jung, Samyoul Yoon, Jungman Namgoong
    Abstract:

    Large Vein allografts are suitable for middle hepatic Vein (MHV) Reconstruction, but their supply is often limited. Although polytetrafluoroethylene (PTFE) grafts are unlimitedly available, their long-term patency is relatively poor. We intended to enhance the clinical usability of PTFE grafts for MHV Reconstruction during living donor liver transplantation (LDLT). Two sequential studies were performed. First, PTFE grafts were implanted as inferior vena cava replacements into dogs. Second, in a 1-year prospective clinical trial of 262 adults undergoing LDLT with a modified right lobe, MHV Reconstruction with PTFE grafts was compared with other types of Reconstruction, and the outcomes were evaluated. In the animal study, PTFE grafts induced strong inflammatory reactions and luminal thrombus formation, but the endothelial lining was well developed. In the clinical study, the Reconstruction techniques were revised to make a composite PTFE graft with an artery patch on the basis of the results of the animal study. MHVs were reconstructed with cryopreserved iliac Veins (n = 122), iliac arteries (n = 43), aortas (n = 13), and PTFE (n = 84), and these Reconstructions yielded 6-month patency rates of 75.3%, 35.2%, 92.3%, and 76.6%, respectively. The overall 6-month patency rates for the iliac Vein and PTFE grafts were similar (P = 0.92), but the 6-month patency rates with Vein segment 5 were 51.0% and 34.7%, respectively (P = 0.001). The overall graft and patient survival rates did not differ among these 4 groups. In conclusion, ringed PTFE grafts combined with small vessel patches showed high patency rates comparable to those of iliac Vein grafts; thus, they can be used for MHV Reconstruction when other sizable vessel allografts are not available.

Deokbog Moon - One of the best experts on this subject based on the ideXlab platform.

  • hemashield vascular graft is a preferable prosthetic graft for middle hepatic Vein Reconstruction in living donor liver transplantation
    Annals of Transplantation, 2019
    Co-Authors: Gilchun Park, Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Youngin Yoon, Huidong Cho, Jae Hyun Kwon
    Abstract:

    BACKGROUND Because of the supply shortage for homologous Vein allografts, we previously used ringed Gore-Tex vascular grafts for middle hepatic Vein (MHV) Reconstruction in living donor liver transplantation. However, owing to the subsequent unavailability of ringed Gore-Tex grafts, we replaced them with Hemashield vascular grafts. This study aimed to compare the patency of Hemashield grafts with that of ringed Gore-Tex grafts. MATERIAL AND METHODS This was a retrospective double-arm study between the study group that used Hemashield grafts (n=63) and the historical control group that used ringed Gore-Tex grafts (n=126). RESULTS In the Gore-Tex and Hemashield groups, mean age was 53.1±6.2 and 54.3±10.4 years; model for end-stage liver disease score was 16.5±8.3 and 17.5±9.9; and graft-recipient weight ratio was 1.11±0.23 and 1.12±0.25, respectively. In the Gore-Tex graft group, V5 Reconstruction was done in single (n=107, 84.9%), double (n=17, 13.5%), and none (n=2, 1.6%). V8 Reconstruction was done in single (n=95, 75.4%), double (n=1, 0.8%), and none (n=30, 23.8%). In the Hemashield group, V5 Reconstruction was done in single (n=43, 68.3%), double (n=19, 30.2%), and triple (n=1, 1.6%). V8 Reconstruction was done in single (n=45, 71.4%), double (n=9, 14.3%), and none (n=9, 14.3%). One-year conduit patency rates in the Gore-Tex and Hemashield groups were 54.8% and 71.6%, respectively (p=0.048). CONCLUSIONS MHV Reconstruction using Hemashield vascular grafts demonstrated higher short-term patency rates than those associated with ringed Gore-Tex vascular grafts. We suggest that the Hemashield vascular graft is one of the best prosthetic materials for MHV Reconstruction.

  • usability of cryopreserved aortic allografts for middle hepatic Vein Reconstruction during living donor liver transplantation
    Journal of Gastrointestinal Surgery, 2016
    Co-Authors: Seokhwan Kim, Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Gilchun Park, Sunggyu Lee
    Abstract:

    Iliac Vein allografts are suitable for middle hepatic Vein (MHV) Reconstruction during living-donor liver transplantation (LDLT), but their supply is often limited. Polytetrafluoroethylene (PTFE) grafts are easily available but have drawbacks of accidental gastric penetration and non-degradable foreign body. To replace the use of PTFE grafts, we started using cryopreserved aorta allografts (CAAs). This study presents the technical details and patency outcomes of using CAAs in MHV Reconstruction. We reviewed the surgical techniques of CAA interposition and analyzed the patency rates in 74 patients who underwent LDLT during the 6-year study period. The two control groups received either cryopreserved iliac Veins (n = 122) or PTFE grafts (n = 84). The surgical techniques for MHV Reconstruction used to implant the CAA and PTFE grafts are very similar because the techniques developed for PTFE grafts were also applied to CAAs. We inserted an arterial patch at the liver cut surface because the CAA wall is too thick to perform direct anastomosis. Two patients (2.7 %) underwent MHV stenting during the first month. The 1-year patency rate was 69.7 % in the CAA group vs. 39.2 % in iliac Vein group vs. 57.2 % in PTFE group (p = 0.000). The overall graft and patient survival rates did not differ depending on the MHV interposition vessel materials (p > 0.1). CAAs combined with small-artery patches demonstrated high patency rates that surpass other vessel grafts, and thus, we suggest that CAA can be reliably used for MHV Reconstruction when CAA is available.

  • complications analysis of polytetrafluoroethylene grafts used for middle hepatic Vein Reconstruction in living donor liver transplantation
    Transplantation proceedings, 2014
    Co-Authors: Shin Hwang, Chulsoo Ahn, Deokbog Moon, Giwon Song, D H Jung, K H Kim, G C Park, Hyungwoo Park, Yohan Park, B H Jung
    Abstract:

    Abstract Background We previously showed that ringed polytetrafluoroethylene (PTFE) grafts combined with small allograft patches showed high patency rates similar to those of iliac Vein grafts and therefore that they can be used for middle hepatic Vein (MHV) Reconstruction. Although such use of PTFE graft showed high patency rates, its long-term safety regarding infection and other types of complications were not presented. In this study, we investigated the actual risk of complications directly associated with PTFE graft interposition for MHV Reconstruction. Methods During the study period of 30 months, we performed 215 cases of adult living-donor liver transplantation with modified right lobe graft and PTFE grafts. We classified the potential complications directly associated with PTFE graft interposition as infectious and surgical complications. The medical records of study patients were retrospectively reviewed. Results MHV graft patency rate was 76.3% at 6 months and 36.7% at 12 months. Their 1-year graft and patient survival rates were 92.6% and 93.5%, respectively. The 1-year actual incidences of infectious complication and surgical complication were near zero and 1 case (0.5%), respectively. In 1 recipient, the PTFE graft penetrated into the stomach wall 6 months after transplantation, but the patient did not complain of any specific symptoms. The PTFE graft was removed with the use of laparotomy, and the patient recovered uneventfully. Conclusions Although the incidence of PTFE graft–associated complication rate is very low, we suggest that it is necessary to closely monitor the PTFE graft, because unexpected complications can happen during long-term follow-up.

  • usability of ringed polytetrafluoroethylene grafts for middle hepatic Vein Reconstruction during living donor liver transplantation
    Liver Transplantation, 2012
    Co-Authors: Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Gilchun Park, Sungwon Jung, Samyoul Yoon, Jungman Namgoong
    Abstract:

    Large Vein allografts are suitable for middle hepatic Vein (MHV) Reconstruction, but their supply is often limited. Although polytetrafluoroethylene (PTFE) grafts are unlimitedly available, their long-term patency is relatively poor. We intended to enhance the clinical usability of PTFE grafts for MHV Reconstruction during living donor liver transplantation (LDLT). Two sequential studies were performed. First, PTFE grafts were implanted as inferior vena cava replacements into dogs. Second, in a 1-year prospective clinical trial of 262 adults undergoing LDLT with a modified right lobe, MHV Reconstruction with PTFE grafts was compared with other types of Reconstruction, and the outcomes were evaluated. In the animal study, PTFE grafts induced strong inflammatory reactions and luminal thrombus formation, but the endothelial lining was well developed. In the clinical study, the Reconstruction techniques were revised to make a composite PTFE graft with an artery patch on the basis of the results of the animal study. MHVs were reconstructed with cryopreserved iliac Veins (n = 122), iliac arteries (n = 43), aortas (n = 13), and PTFE (n = 84), and these Reconstructions yielded 6-month patency rates of 75.3%, 35.2%, 92.3%, and 76.6%, respectively. The overall 6-month patency rates for the iliac Vein and PTFE grafts were similar (P = 0.92), but the 6-month patency rates with Vein segment 5 were 51.0% and 34.7%, respectively (P = 0.001). The overall graft and patient survival rates did not differ among these 4 groups. In conclusion, ringed PTFE grafts combined with small vessel patches showed high patency rates comparable to those of iliac Vein grafts; thus, they can be used for MHV Reconstruction when other sizable vessel allografts are not available. Liver Transpl, 2012. © 2012 AASLD.

  • usability of ringed polytetrafluoroethylene grafts for middle hepatic Vein Reconstruction during living donor liver transplantation
    Liver Transplantation, 2012
    Co-Authors: Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Gilchun Park, Sungwon Jung, Samyoul Yoon, Jungman Namgoong
    Abstract:

    Large Vein allografts are suitable for middle hepatic Vein (MHV) Reconstruction, but their supply is often limited. Although polytetrafluoroethylene (PTFE) grafts are unlimitedly available, their long-term patency is relatively poor. We intended to enhance the clinical usability of PTFE grafts for MHV Reconstruction during living donor liver transplantation (LDLT). Two sequential studies were performed. First, PTFE grafts were implanted as inferior vena cava replacements into dogs. Second, in a 1-year prospective clinical trial of 262 adults undergoing LDLT with a modified right lobe, MHV Reconstruction with PTFE grafts was compared with other types of Reconstruction, and the outcomes were evaluated. In the animal study, PTFE grafts induced strong inflammatory reactions and luminal thrombus formation, but the endothelial lining was well developed. In the clinical study, the Reconstruction techniques were revised to make a composite PTFE graft with an artery patch on the basis of the results of the animal study. MHVs were reconstructed with cryopreserved iliac Veins (n = 122), iliac arteries (n = 43), aortas (n = 13), and PTFE (n = 84), and these Reconstructions yielded 6-month patency rates of 75.3%, 35.2%, 92.3%, and 76.6%, respectively. The overall 6-month patency rates for the iliac Vein and PTFE grafts were similar (P = 0.92), but the 6-month patency rates with Vein segment 5 were 51.0% and 34.7%, respectively (P = 0.001). The overall graft and patient survival rates did not differ among these 4 groups. In conclusion, ringed PTFE grafts combined with small vessel patches showed high patency rates comparable to those of iliac Vein grafts; thus, they can be used for MHV Reconstruction when other sizable vessel allografts are not available.

Sunggyu Lee - One of the best experts on this subject based on the ideXlab platform.

  • usability of cryopreserved aortic allografts for middle hepatic Vein Reconstruction during living donor liver transplantation
    Journal of Gastrointestinal Surgery, 2016
    Co-Authors: Seokhwan Kim, Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Gilchun Park, Sunggyu Lee
    Abstract:

    Iliac Vein allografts are suitable for middle hepatic Vein (MHV) Reconstruction during living-donor liver transplantation (LDLT), but their supply is often limited. Polytetrafluoroethylene (PTFE) grafts are easily available but have drawbacks of accidental gastric penetration and non-degradable foreign body. To replace the use of PTFE grafts, we started using cryopreserved aorta allografts (CAAs). This study presents the technical details and patency outcomes of using CAAs in MHV Reconstruction. We reviewed the surgical techniques of CAA interposition and analyzed the patency rates in 74 patients who underwent LDLT during the 6-year study period. The two control groups received either cryopreserved iliac Veins (n = 122) or PTFE grafts (n = 84). The surgical techniques for MHV Reconstruction used to implant the CAA and PTFE grafts are very similar because the techniques developed for PTFE grafts were also applied to CAAs. We inserted an arterial patch at the liver cut surface because the CAA wall is too thick to perform direct anastomosis. Two patients (2.7 %) underwent MHV stenting during the first month. The 1-year patency rate was 69.7 % in the CAA group vs. 39.2 % in iliac Vein group vs. 57.2 % in PTFE group (p = 0.000). The overall graft and patient survival rates did not differ depending on the MHV interposition vessel materials (p > 0.1). CAAs combined with small-artery patches demonstrated high patency rates that surpass other vessel grafts, and thus, we suggest that CAA can be reliably used for MHV Reconstruction when CAA is available.

  • morphometric and simulation analyses of right hepatic Vein Reconstruction in adult living donor liver transplantation using right lobe grafts
    Liver Transplantation, 2010
    Co-Authors: Shin Hwang, Donghwan Jung, Chulsoo Ahn, Deokbog Moon, Kihun Kim, Giwon Song, Sunggyu Lee, Kyu Bo Sung, Dong Il Gwon, Kyoung Won Kim
    Abstract:

    The incidence of clinically significant right hepatic Vein (RHV) stenosis after adult living donor liver transplantation has been higher than expected. In this study, an assessment of the risk factors for the development of RHV stenosis in this context was undertaken. Hepatic anatomy, surgical techniques, and the incidence of RHV stenosis 1 year after transplantation were evaluated retrospectively in 225 recipients of right lobe grafts. These patients underwent independent RHV Reconstruction, which was facilitated by the application of computed tomography morphometry and computational simulation analyses. Three types of preparation of the orifice of the graft RHV and 7 types of preparation for venoplasty of the recipient RHV were used. The frequency of high, middle, and low sites of RHV insertion into the inferior vena cava (IVC) was 56.0%, 36.4%, and 7.6%, respectively, for donors, and 26.7%, 58.7%, and 14.7%, respectively, for recipients. Nine patients (4%) developed RHV stenosis of early onset that required stent insertion during the first 2 postoperative weeks; in 12 patients (5.3%), RHV stenosis of delayed onset occurred. Inappropriate matching of RHV sites of insertion correlated with the incidence of stenosis of early onset (P = 0.039). Technical refinements to avoid adverse consequences of inappropriate ventrodorsal matching of RHV sites of insertion include making the recipient RHV orifice wide and enlarging the recipient IVC by a customized incision and patch venoplasty after anatomical assessment of the RHV and IVC of the graft and recipient. Liver Transpl 16:639-648, 2010. © 2010 AASLD.

  • doppler sonographic abnormalities suggestive of venous congestion in the right lobe graft of living donor liver transplant recipients
    American Journal of Roentgenology, 2007
    Co-Authors: Kyoung Won Kim, Tae Kyoung Kim, So Yeon Kim, Minjeong Kim, Misuk Park, Moongyu Lee, Sunggyu Lee
    Abstract:

    OBJECTIVE. Establishing optimal hepatic venous outflow is the key for a successful outcome of living donor liver transplantation using a right lobe graft. The purpose of this article is to illustrate the surgical techniques of middle hepatic Vein Reconstruction with an interposition Vein graft in living donor liver transplant recipients using a modified right lobe graft, normal postoperative Doppler sonographic findings, and various Doppler sonographic abnormalities suggestive of hepatic venous congestion.CONCLUSION. Hepatic venous congestion after living donor liver transplantation using a right lobe graft may produce various abnormalities on Doppler sonography. In addition to allowing the patency of the middle hepatic Vein tributaries and interposition Vein graft to be assessed during the early postoperative period, Doppler sonography can depict the flow direction in the portal Vein and in the middle hepatic Vein tributaries; therefore, Doppler sonography can reveal reversal of portal flow direction in ...

  • cryopreserved iliac artery is indispensable interposition graft material for middle hepatic Vein Reconstruction of right liver grafts
    Liver Transplantation, 2005
    Co-Authors: Shin Hwang, Chulsoo Ahn, Kihun Kim, Sunggyu Lee, Kwangmin Park, Deokbog Moon
    Abstract:

    Cryopreserved iliac Vein grafts (IVGs) have often been used for Reconstruction of middle hepatic Vein (MHV) branches in right liver grafts, but their storage pool has often been exhausted in our institution due to the low incidence of deceased donor organ procurement. To overcome this shortage of IVG, we started to use cryopreserved iliac artery graft (IAG). During September and October 2004, we carried out 41 cases of adult living donor liver transplantation, including 29 right lobe grafts with MHV Reconstruction. Interposition vessel grafts were autologous Vein (n = 6), IVG (n = 13), and IAG (n = 10). IAG was used in 3 (21%) of 13 cases during the first month. For the next month, it was more frequently used (7 [44%] of 16) because handling of cryopreserved IAG was not difficult and its outcome was favorable. On follow-up with computed tomography for 3 months, outflow disturbance occurred in 1 (17%) of 6 autologous Vein cases, in 2 (15%) of 13 IVG cases, and in 1 (10%) of 10 IAG cases. Two-month patency rate of IAG was not lower than that of IVG. In conclusion, we feel that cryopreserved IAG can be used as an interposition vessel graft for MHV Reconstruction of right liver graft when cryopreserved IVG is not available.

  • cryopreserved iliac artery is indispensable interposition graft material for middle hepatic Vein Reconstruction of right liver grafts
    Liver Transplantation, 2005
    Co-Authors: Shin Hwang, Chulsoo Ahn, Kihun Kim, Sunggyu Lee, Kwangmin Park, Deokbog Moon
    Abstract:

    Cryopreserved iliac Vein grafts (IVGs) have often been used for Reconstruction of middle hepatic Vein (MHV) branches in right liver grafts, but their storage pool has often been exhausted in our institution due to the low incidence of deceased donor organ procurement. To overcome this shortage of IVG, we started to use cryopreserved iliac artery graft (IAG). During September and October 2004, we carried out 41 cases of adult living donor liver transplantation, including 29 right lobe grafts with MHV Reconstruction. Interposition vessel grafts were autologous Vein (n = 6), IVG (n = 13), and IAG (n = 10). IAG was used in 3 (21%) of 13 cases during the first month. For the next month, it was more frequently used (7 [44%] of 16) because handling of cryopreserved IAG was not difficult and its outcome was favorable. On follow-up with computed tomography for 3 months, outflow disturbance occurred in 1 (17%) of 6 autologous Vein cases, in 2 (15%) of 13 IVG cases, and in 1 (10%) of 10 IAG cases. Two-month patency rate of IAG was not lower than that of IVG. In conclusion, we feel that cryopreserved IAG can be used as an interposition vessel graft for MHV Reconstruction of right liver graft when cryopreserved IVG is not available. (Liver Transpl 2005;11:644–649.)