title: Technical challenges of hepatic venous outflow reconstruction in right lobe adult living donor liver transplantation.
abstract: A right lobe graft that is drained by the right hepatic vein (RHV) is obtained by transecting the liver on the right side of the middle hepatic vein (MHV). On occasion, a small RHV that only drains a portion of the right lobe, with the predominant outflow achieved by the MHV, is encountered. If such variation is not recognized while performing right lobe liver transplantation and the RHV only is used for reconstruction, venous outflow obstruction with subsequent graft congestion and eventual graft failure will occur. Additionally, preservation of the main MHV and its branch drainage of the left lobe is crucial to avoid outflow blockage to the remaining segment 4 in the donor. We report 4 cases showing a variant type of small RHV and large MHV branch that drain not only segments 5 and 8, but also segments 6 and 7. These variations were simultaneously associated with a large-caliber inferior RHV that also required reconstruction. The methods used to diagnose such anatomic variations and the techniques for reconstruction in the donor and recipient are described.
authors.affiliation: Department of Surgery, Division of Liver and Pancreas Transplantation, The Dumont-UCLA Transplant Center, Los Angeles, CA 90095-7054, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Ghobrial
authors.forename: C B
authors.initials: CB
authors.lastname: Hsieh
authors.forename: S
authors.initials: S
authors.lastname: Lerner
authors.forename: S
authors.initials: S
authors.lastname: Winters
authors.forename: N
authors.initials: N
authors.lastname: Nissen
authors.forename: S
authors.initials: S
authors.lastname: Dawson
authors.forename: F
authors.initials: F
authors.lastname: Amersi
authors.forename: P
authors.initials: P
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Farmer
authors.forename: H
authors.initials: H
authors.lastname: Yersiz
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000033:anatomy & histology / Q000502:physiology* / Q000601:surgery*; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000000981:diagnostic imaging / Q000379:methods* / Q000502:physiology; D019520:Living Donors; D008875:Middle Aged; D014463:Ultrasonography