Beridze D, Mikeladze L, Tomadze G, Kordzaia D, Kashibadze K. Peculiarities of implantation of the right graft veins into the inferior vena cava during living donor liver transplantation. World J Transplant 2025; 15(3): 102378 [DOI: 10.5500/wjt.v15.i3.102378]
Corresponding Author of This Article
Davit Beridze, MD, Department of Surgery, New Vision University, N1 Evgeni Mikeladze Street, Tbilisi 0159, Georgia. davitberidzemd@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2025; 15(3): 102378 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.102378
Peculiarities of implantation of the right graft veins into the inferior vena cava during living donor liver transplantation
Davit Beridze, Lasha Mikeladze, Gia Tomadze, Dimitri Kordzaia, Kakhaber Kashibadze
Davit Beridze, Department of Surgery, New Vision University, Tbilisi 0159, Georgia
Lasha Mikeladze, Gia Tomadze, Department of Surgery, Tbilisi State Medical University, Tbilisi 0160, Georgia
Dimitri Kordzaia, Institute of Morphology, Tbilisi State University, Tbilisi 0159, Georgia
Kakhaber Kashibadze, Department of General Surgery and Transplantology, High Technology Medical Center, Batumi Referral Hospital, Batumi 6010, Ajaria, Georgia
Kakhaber Kashibadze, Department of Surgery, Shota Rustaveli Batumi State University, Batumi 6010, Adjara, Georgia
Co-corresponding authors: Davit Beridze and Dimitri Kordzaia.
Author contributions: Beridze D, Mikeladze L and Kashibadze K participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data; Tomadze G, Kordzaia D, and Kashibadze K wrote the manuscript; all authors critically reviewed and provided final approval of the manuscript, were responsible for the decision to submit the manuscript for publication.
Institutional review board statement: This study has been approved by the Institutional Review Board.
Informed consent statement: The patients were precisely informed.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: Any requitement for shared data can contact the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Noncommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Davit Beridze, MD, Department of Surgery, New Vision University, N1 Evgeni Mikeladze Street, Tbilisi 0159, Georgia. davitberidzemd@gmail.com
Received: October 21, 2024 Revised: March 12, 2025 Accepted: March 21, 2025 Published online: September 18, 2025 Processing time: 180 Days and 0.8 Hours
Abstract
BACKGROUND
Living donor liver transplantation (LDLT) is a crucial alternative to deceased donor transplantation, especially in regions with limited access to cadaveric organs. Right lobe graft implantation into the inferior vena cava (IVC) requires advanced surgical techniques to optimize outcomes and reduce complications.
AIM
To compare two venous anastomosis techniques—direct polytetrafluoroethylene (PTFE) grafting of V5-V8 veins to the IVC vs triangulation to the right hepatic vein (RHV)—in terms of graft viability and postoperative outcomes.
METHODS
A retrospective analysis was conducted on 96 patients who underwent LDLT with right lobe grafts between 2014 and 2023. Patients were divided into three groups: (1) No venous outflow reconstruction; (2) PTFE graft direct anastomosis to the IVC; and (3) PTFE graft anastomosis using triangulation to the RHV. Perioperative and postoperative outcomes, including bile duct complications, alanine aminotransferase/aspartate aminotransferase levels, and graft perfusion, were compared across groups.
RESULTS
Group 3 (triangulation to RHV) showed significantly improved venous outflow, fewer complications, and faster normalization of liver function tests. Bile duct complications were highest in group 1 (12.8%) and lowest in group 3 (7%). Doppler ultrasonography revealed better graft perfusion in group 3 compared to groups 1 and 2.
CONCLUSION
Triangulation to the RHV improves graft viability, reduces biliary complications, and enhances early postoperative outcomes compared to direct PTFE grafting to the IVC.
Core Tip: This study compares two venous anastomosis techniques—direct polytetrafluoroethylene grafting of V5-V8 veins to the inferior vena cava vs triangulation to the right hepatic vein (RHV). It is shown that triangulation to the RHV improves graft viability, reduces biliary complications, and enhances early postoperative outcomes.
