Effect of Complex Venous Outflow Drainage Reconstruction on Postoperative Graft Function in Right-Lobe Living Donor Liver Transplantation

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dc.contributor.authorKilercik, Hakan
dc.contributor.authorAkbulut, Sami
dc.contributor.authorElsarawy, Ahmed
dc.contributor.authorAktas, Sema
dc.contributor.authorAlkara, Utku
dc.contributor.authorSevmis, Sinasi
dc.date.accessioned2026-04-04T13:31:04Z
dc.date.available2026-04-04T13:31:04Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground: Living donor liver transplantation (LDLT) is the predominant transplantation technique in regions with low rates of deceased donation. Right-lobe grafting is adopted in most clinical and radiological donor/recipient scenarios. Due to the considerable variations in right-lobe hepatic venous anatomy, many techniques have been used over the years for the purpose of appropriate venous outflow reconstruction during the recipient procedure. In this paper, we present the technical details and consequences of a complex venous outflow reconstruction model (CORM) based on experience, and the long-term patency results obtained using the model. Methods: Data of patients with end-stage liver disease who underwent LDLT between 21 December 2017 and 29 November 2022 were prospectively collected and retrospectively reviewed. The nomenclature of CORM was assigned when three or more hepatic vein anastomoses were performed. Patients with CORM (CORM group; n = 69) were compared with non-CORM patients (non-CORM group; n = 130) in terms of demographic, pre- and postoperative clinical, and follow-up features. Results: Sixty-nine recipients had three or more separate outflow reconstructions (RHV, RIHV, and one or more anterior sectoral veins); these constituted the CORM group. The estimated graft volume of the CORM group was significantly lower than that of the non-CORM group (833 vs. 898; p = 0.022), and the mean GRWR was also significantly lower (1.1 vs. 1.2; p = 0.004). CORM cases showed longer anhepatic phases, as well as longer times for cold and warm ischemia, than non-CORM cases (63 vs. 51 min, 46 vs. 38 min, and 48 vs. 33 min, p < 0.001), though no difference was found with respect to total operative duration. There were no statistical differences between the two groups with respect to rates of in-hospital re-exploration, length of ICU stay, or length of total hospital stay. Graft survival rates at 1 year, 3 years, and 5 years were 88.1%, 83.3%, and 83.3%, respectively, in the CORM group, and 82.9%, 80.2%, and 70.6%, respectively, in the non-CORM group (p = 0.167). Conclusions: Performing three or more CORMs in right-lobe LDLT is not associated with inferior outcomes, either with regard to perioperative variables or to patient and graft outcomes. Right-lobe graft with complex venous anatomy from a living donor should not be a determinant factor for donor exclusion.
dc.identifier.doi10.3390/jcm14062005
dc.identifier.issn2077-0383
dc.identifier.issue6
dc.identifier.orcid0000-0002-6864-7711
dc.identifier.orcid0000-0002-0299-5473
dc.identifier.orcid0000-0001-8728-5472
dc.identifier.pmid40142813
dc.identifier.scopus2-s2.0-105001239854
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org/10.3390/jcm14062005
dc.identifier.urihttps://hdl.handle.net/11616/108562
dc.identifier.volume14
dc.identifier.wosWOS:001454074200001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherMdpi
dc.relation.ispartofJournal of Clinical Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectliver transplantation
dc.subjectliving donor liver transplantation
dc.subjectcomplex venous outflow reconstruction
dc.subjectartificial vascular graft
dc.subjectliver graft survival
dc.titleEffect of Complex Venous Outflow Drainage Reconstruction on Postoperative Graft Function in Right-Lobe Living Donor Liver Transplantation
dc.typeArticle

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