title: Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation.
abstract: BACKGROUND
  The availability of a venous graft is limited in the setting of living donor liver transplantation (LDLT), and the management of the middle hepatic vein middle hepatic vein tributaries in right lobe LDLT still remains controversial.
  
  
  METHODS
  Twenty-three right lobe LDLT grafts, with the reconstruction of middle hepatic vein tributaries using the explanted portal veins from the explanted livers, were evaluated for the patency, postLDLT liver function tests, and graft survival.
  
  
  RESULTS
  The methods of outflow reconstruction were classified into three types: the interposition of the graft to the middle/left hepatic vein (n=12), to the vena cava (n=9), and to the vena cava as a co-orifice with the graft right hepatic vein (n=2). The 1- and 3-year patency rates were 76.7% and 76.7% respectively, with the graft occlusion in five cases. The occluded cases (n=5) had significantly higher aspartate aminotransferase and alanine transaminase levels as compared with those of patent cases (n=18) at 4 weeks after transplantation (P<0.01). However, there was no significant difference in the total bilirubin and prothrombin time in either group during the observation periods. The 1- and 3-year graft survival rates were 91.1% and 91.1%, respectively. In addition, there was no graft loss due to occlusion.
  
  
  CONCLUSIONS
  The use of the recipient's explanted full-length hilar portal vein for the reconstruction of the middle hepatic vein tributaries is thus considered to be a feasible and valuable strategy in the setting of a right lobe LDLT, where appropriate vascular grafts are not always available.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.tikesurg@yahoo.co.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy; D006503:Hepatic Veins / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000276:immunology; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011517:Prothrombin Time
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin