title: Impact of right lobe with middle hepatic vein graft in living-donor liver transplantation.
abstract: Technical improvements in adult-to-adult living-donor liver transplantation (LDLT) have led to the use of right-lobe grafts to overcome the problems encountered with 'small-for-size grafts'. The major controversy remains that the venous drainage from anterior segment substantially depends on tributaries of the middle hepatic vein (MHV), and deprivation of such tributaries may critically influence the postoperative graft function. Right-lobe grafts with MHV could resolve the potential problem of congestion in anterior segment. From December 2000 to January 2004, we performed 217 right-lobe LDLTs for adult patients. Of these, 40 patients received a right lobe with MHV graft (18.4%). The overall cumulative 3-year graft survival rate of a right lobe with (n = 40) and without MHV (n = 177) was 86.2% and 74.8% (p = NS). The proximal side of the MHV and the drainage vein of segment IV to the MHV (the left medial superior vein) were preserved in 24 patients. All of them needed venous interposition graft for anastomosis. All patients had a patent right hepatic vein (RHV) and MHV anastomosis during the follow-up period. We adopted the right lobe with MHV graft in 40 LDLT cases. Vein graft is essential for safe MHV anastomosis in cases which preserve proximal side of the MHV.
authors.affiliation: Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Japan. mureo@kuhp.kyoto-u.ac.jp
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Uryuhara
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Yonekawa
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000601:surgery / Q000637:transplantation*; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D014682:Vena Cava, Inferior / Q000601:surgery