title: Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation.
abstract: OBJECTIVE
  To evaluate the safety of donors who have donated the middle hepatic vein in right lobe live donor liver transplantation (LDLT) and to determine whether such inclusion is necessary for optimum graft function.
  
  
  BACKGROUND
  The necessity to include the middle hepatic vein in a right lobe graft in adult-to-adult LDLT is controversial. Inclusion of the middle hepatic vein in the graft provides uniform hepatic venous drainage but may lead to congestion of segment IV in the donor.
  
  
  METHODS
  From 1996 to 2002, 93 right-lobe LDLTs were performed. All right-lobe grafts except 1 contained the middle hepatic vein. In the donor operation, attention was paid to preserve the segment IV hepatic artery and to avoid prolonged rotation of the right lobe. The middle hepatic vein was transected proximal to a major segment IVb hepatic vein whereas possible to preserve the venous drainage in the liver remnant.
  
  
  RESULTS
  There was no donor death. Two donors had intraoperative complications (accidental left hepatic vein occlusion and portal vein thrombosis) and were well after immediate rectification. Twenty-four donors (26%) had postoperative complications, mostly minor wound infection. The postoperative international normalized ratio on day 1 was better in the donors with preservation of segment IVb hepatic vein than those without the preservation, but, in all donors, the liver function was largely normal by postoperative day 7. The first recipient had severe graft congestion as the middle hepatic vein was not reconstructed before reperfusion. In 7 other recipients, the middle hepatic vein was found occluded intraoperatively owing to technical errors. The postoperative hepatic and renal function of the recipients with an occluded or absent middle hepatic vein was worse than those with a patent middle hepatic vein. The hospital mortality rate was also higher in those with an occluded middle hepatic vein (3/9 vs. 5/84, P = 0.028).
  
  
  CONCLUSIONS
  Inclusion of the middle hepatic vein in right-lobe LDLT is safe and is essential for optimum graft function and patient survival.
authors.affiliation: Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. hrmsfst@hkucc.hku.hk
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chung-Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Chi-Leung
authors.initials: CL
authors.lastname: Liu
authors.forename: Wen-Xi
authors.initials: WX
authors.lastname: Wang
authors.forename: John
authors.initials: J
authors.lastname: Wong
mesh_terms: D000328:Adult; D006503:Hepatic Veins / Q000637:transplantation*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D019737:Transplants / Q000592:standards*; D016896:Treatment Outcome