title: Effect of middle hepatic vein reconstruction in living donor liver transplantation using right lobe.
abstract: BACKGROUND
  This study reviewed the impact of middle hepatic vein (MHV) reconstruction on right lobe graft with regard to functional recovery and graft regeneration at 1 week after transplantation.
  
  
  METHODS
  From January 1999 to September 2005. 211 adult living donor liver transplantations were performed using the right lobe. The reconstruction of hepatic venous tributaries from segment 5 or segment 8 or both was performed in every cases of sufficient size. The patency of graft vessels was evaluated with computed tomography (CT) angiography on postoperative day 7. We analyzed liver enzymes (aspartate transferase [AST], alanine transferase [ALT] and bilirubin) at 1 week postoperatively and evaluated regeneration activity by CT volumetry at 1 week postoperatively.
  
  
  RESULTS
  Among 211 cases, 182 (86.3%) were reconstructed with interpositional MHV grafts. Among them, 51 cases (51.9%) were patent at 1 week postoperatively. The levels of AST and ALT in patent cases of all patients and small-for-size grafts were lower than among the occlusion cases, albeit not significantly. The mean graft regeneration at 1 week postoperatively among patent cases was 1.75 +/- 0.39 versus 1.64 +/- 0.24 in the occluded cases (P = .111), but among small-for-size grafts, there was a significant difference in graft regeneration between patent versus occluded cases (2.05 +/- 0.50 vs 1.66 +/- 0.17, P = .037).
  
  
  CONCLUSIONS
  Functional recovery and graft regeneration in small-for-size grafts showed a beneficial effect in patent cases, compared with occluded cases. Our selection criteria for MHV reconstruction must include cases of small-for-size grafts not all cases.
authors.affiliation: Department of Surgery, Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul 137-040, Korea. kimdg@catholic.ac.kr
authors.forename: D G
authors.initials: DG
authors.lastname: Kim
authors.forename: I S
authors.initials: IS
authors.lastname: Moon
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: Y J
authors.initials: YJ
authors.lastname: Lee
authors.forename: M D
authors.initials: MD
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D007839:Functional Laterality; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology; D008111:Liver Function Tests; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome