Efficacy of middle hepatic vein reconstruction in adult right-lobe living donor liver transplantation.
BACKGROUND
Congestion of the right anterior segment may lead to graft dysfunction in right-lobe living donor liver transplantation (LDLT) without a middle hepatic vein (MHV) trunk. Selective reconstruction of MHV tributaries with the interposition of vascular grafts has been introduced to overcome this problem. However, there is still no consensus on the definite criteria of MHV reconstruction.


METHODS
LDLT patients were reviewed to evaluate the effects of MHV reconstruction. From March 2005 to September 2008 in our transplantation center, 120 consecutive LDLTs were performed using a right-lobe graft without a MHV. Excluding 11 patients, among the remainder, 73 (67%) had reconstructed MHV tributaries, and the others 36 (33%) did not. The values of liver functional index and liver graft regeneration ratio were compared between the two groups.


RESULTS
There was a prolonged period of liver functional recovery in patients with small-for-size grafts and a graft-recipient weight ratio (GRWR) <1.0%, and without MHV reconstruction. The ratio of liver regeneration 1 month post-operatively in reconstruction cases was 81%, versus 78% in patients without reconstruction (P=0.352), but among small-for-size grafts, there was a significant difference between the two groups (95% vs. 80%).


CONCLUSIONS
Our study shows that reconstruction of MHV tributaries is not necessary in all patients, but is beneficial for patients with GRWR <1.0%.
Peng
Ci-Jun
CJ
Department of Liver and Vascular Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Wang
Xiao-Fei
XF
Li
Bo
B
Wei
Yong-Gang
YG
Yan
Lu-Nan
LN
Wen
Tian-Fu
TF
Yang
Jia-Yin
JY
Wang
Wen-Tao
WT
Zhao
Ji-Chun
JC
D000328:Adult; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged