title: Reconstruction of the middle hepatic vein tributary in a right lateral sector graft.
abstract: A right lateral sector graft (RLSG) was devised to overcome graft-size disparity in living donor liver transplantation (LDLT). When the RLSG has a middle hepatic vein (MHV) tributary, which drains a significant part of segment VI, the MHV tributary (V6) should be reconstructed to avoid congestion of the RLSG. In the donor operation, congestive area of segment VI was identified by 5 minutes of simultaneous clamping of V6 and the hepatic artery to the right lateral sector. An RLSG was harvested, preserving the V6 orifice. After plastic surgery of outflow veins including V6 using venous grafts, the RLSG was implanted into the recipient. In 19 patients who received RLSG in our institution, 2 RLSGs required V6 reconstruction. The postoperative courses of these two recipients and donors were uneventful. In conclusion, the present technique might be useful to avoid complications due to congestion and poor function of the relevant graft area and might help to expand the indications for RLSG.
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kishi
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002648:Child; D006503:Hepatic Veins / Q000601:surgery* / Q000637:transplantation*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D012189:Retrospective Studies