Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein.
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.
Wu
Hong
H
Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China.
Yan
Lu-Nan
LN
Li
Bo
B
Zeng
Yong
Y
Wen
Tian-Fu
TF
Zhao
Ji-Chun
JC
Wang
Wen-Tao
WT
Yang
Jia-Yin
JY
Xu
Ming-Qing
MQ
Chen
Zhe-Yu
ZY
Lu
Qiang
Q
Luo
Hong-Zhi
HZ
Li
Jin
J