Efficacy of right anterior sector drainage reconstruction in right-lobe live-donor transplantation.
BACKGROUND
Without including the middle hepatic vein (MHV) into right-lobe grafts, venous drainage of the anterior segment (AS) has always been a concern. The efficacy and the necessity of additional venous reconstruction in the AS for graft viability and function are still controversial.


METHODS
Since February 2002, 57 right-lobe grafts were implanted into adult recipients. The mean graft to ideal recipient weight ratio (GRWR) was 1.3% (minimum: 0.8%, maximum 2.1%). All minor venous tributaries to the MHV less than 5 mm in diameter were ligated. The management of MHV tributaries was categorized into three groups: (A) no major tributaries (n = 33); (B) major tributaries ligated (n = 11); and (C) major tributaries reconstructed (n = 13). Reconstructions were established using vascular grafts (PTF, n = 8; cadaveric, n = 2) or joining with right hepatic vein orifice (n = 6). The groups were homogenous in age, gender, MELD (17 +/- 6, 16 +/- 4, 18 +/- 7), graft weight (817 +/- 181, 838 +/- 152, and 855 +/- 159 g), and graft/ideal liver weight ratio (0.54 +/- 0.12, 0.57 +/- 0.13, and 0.57 +/- 0.1, respectively). We investigated the volume of ascites, serum bilirubin, albumin, and liver enzyme levels and INR on postoperative day 4 (POD4) and POD21.


RESULTS
Two patients died of MRSA sepsis on POD18 and POD23 (MELD: 24 and 28) after initial graft function. Their graft weights were 800 g and 980 g, and their volumes were 47% (group B) and 62% (group A) of the ideal liver mass of the recipients, respectively. One PTF and another cadaveric vascular graft were found occluded 4 and 7 days after implantation without any negative consequence. At 6-month follow-up, the remaining 55 patients were alive with primary liver grafts. Vascular reconstructions were patent except for 2 early occlusions. Among the 3 groups, no significant difference was found on POD4. Three weeks after transplantation, the mean AST level in the major ligation group (46.7 +/- 8.14) was significantly higher than in the minor ligatation group (29.6 +/- 8.6) but not in the major reconstruction group (33.7 +/- 3.7; P = .03 and P = .29). The mean albumin level was highest after minor ligation (3.2 +/- 0.18), which was significantly better than the major reconstruction (2.7 +/- 0.1) but not the major ligation (3.1 +/- 0.14) cohorts (P = .02 and P = .13).


CONCLUSIONS
In this study of a limited number of cases, right-lobe liver grafts with GRWR of > or =1.1% displayed optimal graft function without additional venous reconstruction to the AS.
Karademir
S
S
HPB and Liver Transplantation Study Group, Dokuz Eylul University Hospital, Inciralti, Izmir, Turkey.
Astarcioglu
H
H
Ozbilgin
M
M
Ozkardesler
S
S
Yilmaz
T
T
Akarsu
M
M
Akan
M
M
Ozzeybek
D
D
Obuz
F
F
Astarcioglu
I
I
D000328:Adult; D001835:Body Weight; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008099:Liver / Q000033:anatomy & histology; D008102:Liver Circulation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome