4^th Global Surgery and Transplantation Congress (715th Conference)

Biography

Biography: Ashok Thorat

Abstract

In Asia, living donor liver transplantation (LDLT) was adapted and later became the most effective source of liver allografts as the deceased organ donation remains scarce. However, LDLT procedure often challenged by complex right liver allograft anatomy, smaller caliber of hepatic artery and need of backtable venoplasty that has led the transplant surgeons to adapt new or modified surgical techniques to make donor hepatectomy safe and graft implantation feasible. We have introduced modified donor hepatectomy technique termed as “Rooftop and Skeletonization Technique” that entails meticulous dissection on and around the middle hepatic vein (MHV) to include or exclude later in the donor allograft. The most important aspect of the LDLT is the venous outflow reconstruction. Due to partial nature of the liver allograft in LDLT, backtable venoplasty procedure is required to facilitate the outflow reconstruction in recipients. However, due to scarcity of cryopreserved vascular grafts, the synthetic vascular grafts such as expanded polytetrafluoroethylene (ePTFE) grafts have been used and proven to be an effective alternative for vascular conduits. In our center, we have innovated outflow reconstruction using ePTFE vascular grafts in presence of donor hepatic venous anomalies and/or limited recipient retrohepatic space. We have achieved lowest hepatic artery thrombosis rate (< 1 %) so far that can be attributed to our center’s unique hepatic arterial reconstruction technique. In this presentation, we intend to summarize our center’s LDLT surgery techniques and postoperative management of complications in transplant recipients.