Modified right liver graft from a living donor to prevent congestion.
BACKGROUND
Right liver grafts without middle hepatic vein (MHV) drainage reconstruction resulted in severe congestion of the anterior segment (AS) in our early experience of adult-to-adult living donor liver transplantation (LDLT). However, a detailed strategy for preventing such congestion or the necessity of MHV reconstruction has not been discussed in LDLT using a right lobe graft.


METHODS
From July 1997 to February 1998, two of five right lobe grafts without MHV drainage reconstruction were complicated with severe congestion of the AS. Thereafter, 42 adult recipients who received right liver grafts with sizable MHV tributaries underwent the reconstruction of MHV drainage. All sizable (>5 mm in diameter) MHV tributaries were preserved during donor hepatectomy and were reconstructed with the recipient's autogenous interposition vein grafts at the bench surgery. The reconstructed vein grafts of this modified right lobe graft were anastomosed to the stump of the MHV and/or left hepatic vein of the recipient after graft revascularization.


RESULTS
Serial Doppler ultrasonography, which was regularly checked until 30 days posttransplant, revealed the patent interposition vein graft in 38 of 42 recipients (patency rate 90.5%). In these 38 recipients, no evidence of congestion in the AS was recognized on enhanced computed tomography, while providing enough functioning liver mass comparable to an extended right lobe graft. Also, congestion-related graft injury, such as an infarct of the AS, was not observed in these recipients.


CONCLUSIONS
Our early experience indicated the necessity of MHV drainage reconstruction in right lobe grafts, which do not have MHV trunk in certain instances. However, preoperatively, it is difficult to predict the degree of AS congestion of the right liver graft without MHV drainage reconstruction. We suggest aggressive reconstruction of MHV drainage tributaries of the AS, under the circumstances that sizable MHV tributaries are encountered, to prevent possible congestion-related complications.
Gyu Lee
Sung
S
Department of General Surgery, Asan Medical Center, Ulsan University, Seoul, Korea. sglee2@www.amc.seoul.kr
Min Park
Kwang
K
Hwang
Shin
S
Hun Kim
Ki
K
Nak Choi
Dong
D
Hyung Joo
Sun
S
Soo Anh
Chul
C
Won Nah
Yang
Y
Yeong Jeon
Jang
J
Hoon Park
Sang
S
Suck Koh
Kyung
K
Hoon Han
Sang
S
Taek Choi
Kyu
K
Sam Hwang
Kyu
K
Sugawara
Yasuhiko
Y
Makuuchi
Masatoshi
M
Chul Min
Pyung
P
D000293:Adolescent; D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D014463:Ultrasonography; D014654:Vascular Patency