الفهرس 
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Abstract
Living donor liver transplantation has become an excellent treatment method for patients with end-stage liver disease. The optimal outcome of this maneuver lies as much on the venous outflow as on the
inflow so optimal venous outflow is critical for its success.
Hepatic venous outflow block is occasionally diagnosed
intraoperatively on the basis of swelling and congestion of the graft.
Intraoperative ultrasonography detects a flat waveform in the hepatic
vein. Hepatic venous outflow block detected intraoperatively can usually
be relieved by keeping the graft in its original position. Postoperatively,
the clinical presentation of HVOB can include ascites, elevated liver
function test results, splenomegaly, variceal bleeding, lower-extremity
edema, and kidney dysfunction. HOVB can be treated successfully by
interventional balloon angioplasty and stent placement.
This study evaluates the different techniques of hepatic out flow
reconstruction, and their impact on outcome in ٩٠ patients underwent
living donor liver transplantation in the National Liver Institute, in the
period starting from April ٢٠٠٣ till June ٢٠١٠. They were ٦٩ (٧٦.٦%)
males & ٢١ (٢٣.٤%) females, ٢٣ (٢٥.٥%) of them were Children (≤١٨
years of age) & ٦٧ (٧٤.٥%) were adults (>١٨ years).
In pediatric recipients: we used left lateral segment (segment II &
III) in ١٦ cases (٦٩.٥%), Left lateral segment with partial part of segment
IV in ٣ cases (١٣%), left lobe including MHV in ٣ cases (١٣%) and right
lobe in one case (٤.٣%). In adult recipients: we used right lobe without
MHV in ٦٠ cases (٨٩.٦%) [in ٨ cases significant tributaries for MHV
was present in the liver graft so it was reconstructed] & right lobe with
MHV in ٧ cases (١٠.٤%).
Summary-------------------------------------------------------------------------------------------
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The venous drainage was as following in grafts for pediatric
recipients: LHV only was present in ١٢ grafts (٥٢.٣%). LHV & MHV
was included (separately) in ٢ grafts (٨.٦%). RHV in one graft (٤.٣%) (Rt
lobe graft was implanted in case No. ٨٩). Separate opening for segment II
& segment III Veins in ٧ grafts (٣٠.٥%). Common trunk for LHV &
MHV in one graft (٤.٣%).
In grafts for adult recipients: RHV only was present in ٣١ grafts
(٤٦.٢%). RHV+IRHV in ١٦ grafts (٢٣.٩%). RHV+V٥ in ٤ grafts (٦%).
RHV+V٨ in ٢ grafts (٣%). RHV+V٥+V٨ in ٢ grafts (٣%).
RHV+V٥+IRHV in one graft (١.٥%). RHV+V٨+IRHV in ٢ grafts (٣%).
RHV+IRHV+PRHV in ٢ grafts (٣%). RHV+MHV+IRHV in ٧ grafts
(١٠.٤%).
The venous grafts was used only in the adult group in ١٦
hepatocaval anastomosis (٢٣.٩%) which was in the form of interposition
venous graft in ١٤ anastomosis (٢٠.٩%) & anterior venous patch graft to
elongate the anterior wall of the liver graft HVs in ٦ anastomosis (٨.٩%).
The source of the venous grafts was the recipient’s PV in ١٤ venous
grafts (٢٠.٩%), the recipient’s recanalised umbilical vein in ٢ venous
grafts (٣%) & in one case (١.٥%) we used the recipient’s left external iliac
vein (as interposition venous graft) & the donor’s inferior mesenteric vein
(as anterior venous patch graft).
Hepatic venoplasty in the form of widening of the hepatic vein
opening, suturing of two HVs opening to be a single opening or anterior
venous patch graft (only used in adult receoients) was used in ١٠
pediatric recipients and ١٢ adult cases.