title: Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein.
abstract: BACKGROUND
  We explored the pattern of hepatic venous outflow reconstruction in adult right lobe (segments V5-8) living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). The difficulty and challenge of LDLT without MHV is the outflow reconstruction of hepatic vein. We have modified the surgical procedure and here report the results.
  
  
  METHODS
  Retrospective analysis was made of the clinical data of 50 recipients who underwent LDLT using right lobe without MHV.
  
  
  RESULTS
  Forty-five recipients (90.0%, 45/50) are alive at median follow up of 10 months. The graft-to-recipient bodyweight ratio (GRWR) was 1.21% +/- 0.49% (range, 0.72% to 1.98%). The recipients of GRWR <0.8% (extra-small graft), 0.8% < GRWR < 1.2% (small graft) and GRWR > 1.2% (ideal graft) were 14, 27 and 9, respectively. Total ratio venous outflowreconstruction of V5, V8 and inferior right hepatic vein was 66.0% (33/50). The overall incidence of small-for-size syndrome was 10.0% (n = 5), the overall graft survival rate was 92.0% (46/50).
  
  
  CONCLUSIONS
  Graft function and survival rates are not only influenced by graft size, but also by hepatic venous outflow reconstruction; the 'multiple-opening vertical anastomosis' for reconstruction of hepatic vein outflow was used when the GRWR was smaller than 1.2%. This technique alleviates surgical risk in living donors, ensures excellent venous drainage, and reduces the incidence of small-for-size syndrome.
authors.affiliation: Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Zeng
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
authors.forename: Ji-Chun
authors.initials: JC
authors.lastname: Zhao
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Wang
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Xu
authors.forename: Zhe-Yu
authors.initials: ZY
authors.lastname: Chen
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lu
authors.forename: Hong-Zhi
authors.initials: HZ
authors.lastname: Luo
authors.forename: Jin
authors.initials: J
authors.lastname: Li